Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government

Abstract

BackgroundThe power to influence many social determinants of health lies within local government sectors that are outside public health's traditional remit. We analyse the challenges of achieving health gains through local government alcohol control policies, where legal and professional practice frameworks appear to conflict with public health action.MethodsCurrent legislation governing local alcohol control in England and Wales is reviewed and analysed for barriers and opportunities to implement effective population-level health interventions. Case studies of local government alcohol control practices are described.ResultsAddressing alcohol-related health harms is constrained by the absence of a specific legal health licensing objective and differences between public health and legal assessments of the relevance of health evidence to a specific place. Local governments can, however, implement health-relevant policies by developing local evidence for alcohol-related health harms; addressing cumulative impact in licensing policy statements and through other non-legislative approaches such as health and non-health sector partnerships. Innovative local initiatives—for example, minimum unit pricing licensing conditions—can serve as test cases for wider national implementation.ConclusionsBy combining the powers available to the many local government sectors involved in alcohol control, alcohol-related health and social harms can be tackled through existing local mechanisms.

Local policies to tackle a national problem: Comparative qualitative case studies of an English local authority alcohol availability intervention

“…However, licensing authorities can choose to use health justifications to support their case for creating CIPs, and so CIPs have been considered a means by which English Public Health authorities can become involved in alcohol licensing policy, even without a specific public health licensing objective 7 (Martineau et al, 2013a.…”

“…Currently, the licensing of alcohol outlets represents arguably the most important lever for modifying the spatial and temporal availability of alcohol in the UK: a process that is administered by local licensing authorities (Martineau et al, 2013a;Nicholls, 2015). In England, the focus of this study, licensing authorities are situated in 326 principal local government authorities (LGAs) and have considerable leeway to develop tailored alcohol strategies, drawing on a mixture of compulsory and discretionary powers.…”

What is the problem?: Evidence, politics and alcohol policy in England and Wales, 2010–2014

“…The evidence base relevant to Treasury officials is not identical to that relevant to officials in the Department of Health. The same is true locally: evidence relevant to a licensing authority concerned with public order will not be identical to that relevant to a local health board concerned with reducing incidences of liver disease (Martineau, Graff, Mitchell, & Lock, 2013;Phillips & Green, in press;Toner et al, 2014). Policy frames, then, are not overlaid onto evidence; they are integral to its identification, development and application, and lack of congruence between frames and evidence can undermine the coherence of policy arguments.…”

Investigating local policy drivers for alcohol harm prevention: a comparative case study of two local authorities in England

“…The response of LAs to their new statutory responsibilities around alcohol policy has been highly variable and strongly informed by their differential prioritisation of the immediate socially disruptive effects of alcohol and its longer term chronic health impacts [7]. Research to date suggests a tendency for decisions to be informed by local experiential evidence rather than formal evidence sources such as peer reviewed studies or external expertise [8].…”

“…Research to date suggests a tendency for decisions to be informed by local experiential evidence rather than formal evidence sources such as peer reviewed studies or external expertise [8]. Although the variability of LAs' new approaches to alcohol policy has been noted, the processes which drive this variability are less well explored [6,7]. This includes how particular policies and combinations (or suites) of policies are chosen and how decisionmaking is variously informed by the identified or perceived needs of their local populations, the prioritisation of alcohol-related harm as well as resource constraints and competing priorities.…”