Influences on public health contributions to alcohol licensing processes in local government in England: a mixed-methods study

Abstract

BackgroundThe relocation of public health into English local government in 2013 provided opportunities for closer integration of public health and alcohol licensing work in local authorities, with potential to shape local alcohol environments. How public health practitioners can best influence alcohol licensing to improve population health remains unclear. This study aimed to explore the contextual influences on, and perceived impact of, public health practice for alcohol licensing in local authorities in London. MethodsA mixed-methods study explored how, why, and with what effect public health practitioners act on alcohol licence applications. The sample included practitioners from across the 33 local authorities in London. Data collection included ethnographic observations of public health practice (eight local authorities), in-depth interviews with licensing practitioners (n=15), four focus group discussions with a range of stakeholders, an online survey of public health practitioners (18 local authorities), and analysis of 10 months' routine alcohol licensing data (five local authorities). Qualitative data were analysed thematically and descriptive statistics conducted on the survey and routine data. FindingsPublic health practitioners used a variety of strategies to act on alcohol licence applications. Routine data indicated that both formal representations and informal actions (eg, negotiating with applicants) were made by some practitioners. Factors that appeared supportive of practitioners' licensing work included close relationships with other licensing responsible authorities, access to locally specific and timely data, and a strong local Statement of Licensing Policy. However, some perceived public health to lack clear authority to make representations without support from other responsible authorities, or without a specific health licensing objective. Viewing their contributions as influential was more common among public health practitioners who meet regularly with other responsible authorities than those who do not, though all practitioners identified broader values of alcohol licensing work, including shaping alcohol policy and increasing understanding of public health values within local government. InterpretationPublic health impact on alcohol licensing is shaped and potentially constrained by the contextual dynamics of local authorities. Public health practice may be supported through access to locally specific health data, mechanisms to strengthen relationships with other responsible authorities such as regular meetings, and promotion of public health priorities among broader local government strategies. FundingThe research was funded by the National Institute for Health Research (NIHR) School for Public Health Research Public Health Practice Evaluation Scheme, which operates in collaboration with Public Health England. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or Department of Health.