Gaming platforms play important roles as tools of entertainment and socialization for 3 billion users globally. Yet gaming also enables harm including addiction, harassment, disinformation, extremism, and predators. Platform safety and health are connected to approaches to monetization, anonymity, dark patterns, diversity, standards, oversight, and transparency. Smaller platforms lack the capacity to assess and address risks, which contributes to socially unsustainable gaming and information ecosystems. These risks grow as gaming platforms merge with other media forms to become increasingly important vectors of information distribution.