BackgroundAlcohol policy in England is determined at local government level, and as a result differences between local authorities in priorities around how best to reduce the effects of alcohol consumption have led to variability in local composition of alcohol control policies and interventions. An important policy area is that of regulating the physical availability of alcohol and modifying the commercial drinking environment. We evaluated whether the intensity with which local licensing policies, including specifically cumulative impact zones, were implemented and enforced has resulted in measurable differences in local population health. MethodsAlcohol and late night refreshment licensing data (2007–12) from the Home Office were linked to alcohol-related hospital admissions from the Local Alcohol Profiles for England, and to population size and area deprivation at local area level. Cumulative policy and enforcement intensity was coded as passive, medium, or high on the basis of presence of cumulative impact zones, whether any new licence applications were successfully challenged, or both. Changes in directly age-standardised rates of people admitted to hospital with alcohol-related conditions in 2009 to quarter one of 2015 were analysed with mixed-effects log-rate models adjusted for seasonality, population size, deprivation, and alcohol-related crime rate. FindingsData were obtained for all 326 lower tier local authority areas in England, of which 319 provided licensing activity data. Spatial autocorrelation in licensing policy intensity was negligible (Moran's I=0·02). An exposure-response association was observed, with an additional average decrease in alcohol-related hospital admission rates in the areas with the highest intensity policies compared with passive areas of 2% annually (95% CI −3 to −2, p=0·006). Accounting for other population changes, this equated to a modest additional 5% reduction, or about eight unique admissions per 100 000 people, in 2015 compared with what would have been expected had these areas not had active policies in place. InterpretationAlthough these analyses do not directly prove causality, they add to the available evidence about the efficacy of alcohol licensing policies specifically for England. Despite the fairly modest average effect, the intensity of alcohol licensing policies implementation and enforcement is related to measurable health gain. FundingThis work was funded by the National Institute for Health Research School for Public Health Research (NIHR SPHR).