New research exploring the experiences of public health professionals involved in local Scottish licensing details the complexities and challenges involved in efforts to see health considered in licensing decisions.
Uniquely, Scotland has a public health objective within its licensing legislation, which applies particularly to the concept of 'overprovision' of premises in a given area. However, experiences on the ground reveal challenges in both interpreting and applying the legislation, including the extent to which public health evidence is seen as relevant in the context of local decision-making.
To a large extent, the research suggests it is naïve to expect that simply presenting evidence on the health burden of alcohol will directly result in decisions to tackle overprovison. There were varying degrees of support for the use of the public health objective to tackle overprovision among licensing decision-makers. There was also significant variation in what stakeholders saw as constituting persuasive evidence, demonstrating a clear tension between what public health stakeholders viewed as compelling evidence and that which had relevance to local licensing teams. One public health interviewee quoted in the study commented:
“There’s a whole group of non-believers out there. I had someone from the Licensing Board say to me that he didn’t believe any statistics ever.”
Some public health stakeholders felt that licensing committees placed higher value on economic considerations, or perceived public opinion, in decision-making than they did on high-level health data. The researchers point out that to an extent, this simply reflects the fact that public policymaking inevitably involves many competing interests. However, they also highlight the reality that, in the context of local licensing decisions-making, high-level health data represents only one type of evidence. As such it may be regarded as particularly limited in value compared to the direct – and locally specific - evidence provided by, for instance, the police.
Given such challenges, some public health professionals expressed disappointment or questioned the value of seeking to address public health considerations within licensing decisions. Others though identified a process of “winning hearts and minds” which involved developing and maintaining relationships over time. Similar findings have been seen through local alcohol strategy efforts in England in which tensions between national and local priorities may also play out in different ways.
The findings echo some of those set out in the MESAS evaluation of Scotland's National Strategy, which suggest that although the 2005 Licensing Act had changed practice, the challenges of implementation and data collection meant assessing the impact on licensing decisions (especially those related to the public health objective) on availability is difficult.
Can England & Wales consider 'health' within licensing?
In England and Wales, health is not included within the licensing objectives, although relevant health bodies can engage in licensing decisions as 'responsible authorities'. Licensing decisions therefore cannot account for issues such as public health or overprovison, although 'Cumulative Impact' policies (CIPs) - often known as 'saturation' zones' - can be designated where high rates of harm have been linked to high outlet density. Last year research suggested CIPs influenced the type of premises, resulting in fewer premises associated with alcohol harms. However CIPs do not appear to halt new premises opening, although questions over the data have been raised.
More broadly, the appropriateness of licensing legislation in England and Wales was recently questioned by an extensive report from the Institute of Alcohol Studies (IAS). It suggested that the interests of the licensed trade have benefited over those of local communities, and local authorities felt they had a lack of leverage over the off-trade in particular, which now accounts for the majority of sales. At the same time, it suggested many of the powers were under-utilised, including potential for health and wellbeing issues to be addressed. The use of health data within the current legislative framework was however recognised as challenging, especially when local authorities may be cautious of costly legal implications. Other recent research suggests that there are many opportunities for the involvement of public health in licensing, albeit that expectations need to be realistic.
Officially, the addition of a public health related licensing objective remains under consideration and a number of local pilots have explored better ways to develop constructive roles for public health in the licensing process. The latest round of Local Alcohol Action Areas also include a number of areas exploring greater involvement of public health in licensing. Meanwhile in Scotland, public health continues to adapt and embed itself in licensing processes. Crucially though, a decision permitting minimum unit pricing following a long running battle expected later this year would undoubtedly shake up the off-trade retailing environment. Should it somehow fail, interest to tackle alcohol health harms via licensing processes could return to the forefront of alcohol health policy calls.
ExILEnS: Exploring the Impact of alcohol Licensing in England and Scotland
Licensing remains an area of interest for researchers, policy makers and various stakeholders in alcohol policy debates. A new NIHR-funded study will shortly be underway to further examine whether intensive public engagement in alcohol licensing reduces alcohol-related harms by comparing 40 local areas. It also aims to explore the costs and cost-savings, mechanisms of action, and impact on health inequalities of public health engagement in licensing. For further information contact Dr. Richard Purves (email@example.com).
With thanks to Dr Niamh Fitzgerald and Dr James Nicholls for comments.