Addressing alcohol health harms through non-health sector policies in English local government: a systematic overview, legal analysis, and case study

Abstract

BackgroundMany key determinants of alcohol health harms lie outside the health sector and are affected by non-health sector policies. Public health practitioners tackling alcohol health harms need to work effectively with non-health sectors. Understanding how health can be addressed through non-health policies will improve the public health response to alcohol harms in England. We aimed to identify the barriers to and opportunities for implementation of population-level health interventions in English local government that effectively address alcohol health harms. MethodsWe used a three-stage research design. First, an overview of systematic reviews identified effective population-level interventions addressing alcohol-related health harms. 6775 articles were retrieved from Medline, Embase, Cochrane, Social Policy and Practice, DARE, Campbell, and NICE database searches, supplemented by screening of references of included reviews and contacting key experts to identify missed and unpublished reviews. 10% of articles were independently dual screened with the remainder screened individually after reconciling all classification disagreements. Systematic reviews were included if they were published since 2002, assessed the effectiveness of population-level interventions, and reported quantitative outcomes on alcohol use or related harm. Two reviewers independently assessed the included reviews' quality using the AMSTAR criteria. Second, a legal and policy analysis established the legislative framework governing English local authority alcohol control policies, identifying opportunities to enact effective policies to address alcohol health harms. Third, case studies were done in two local authorities to understand how local factors affected the choice and implementation of alcohol control policies. Data were obtained through non-audio recorded qualitative interviews with local government staff, work shadowing, documentary analysis of reports and external-facing communications, and quantitative analysis of administrative data. Findings52 systematic reviews were identified. The evidence base showed a pattern of support for regulatory or statutory enforcement interventions over local non-regulatory approaches. Interventions with proven effectiveness that are especially relevant to English local authority intervention include limiting alcohol outlet density and opening hours and increasing alcohol prices. By contrast, the legal and policy analysis showed that licensing decisions in England that might control local alcohol availability and affordability should be framed around non-health arguments. Licensing committees need data that relate to a specific premises or local geography, limiting how much aggregate population health indices can be used to justify policy choices. Nevertheless, alcohol health harms can be addressed by developing sufficiently detailed local health evidence; designing special policy areas to address cumulative effect; aligning local planning policy with licensing; and cross-sector collaborations—in particular with licensing, planning, the police, and community safety—such as joint needs assessments and strategies to tackle alcohol harms. The legal framework and local government operating practices do, however, make interventions that address the immediate harms associated with alcohol intoxication more feasible to implement in non-health sectors than those that tackle chronic overconsumption. Case study findings suggest that local government practitioners perceive that policy decisions relate to the priorities of a range of constituencies that might not align with health concerns. InterpretationOpportunities exist to address local health consequences of alcohol consumption through English local government policies. Public health practitioners wishing to engage with non-health sectors will benefit from understanding how other sectors define evidence in terms of relevance and validity, how legislation constrains and enables their practice and policy, and whose priorities shape policy choices. FundingNational Institute for Health Research (NIHR)'s School for Public Health Research (SPHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.