The impact of public health in the licensing process

Some regions have embraced the opportunity to have a say while others, presumably, are too stretched to allot parts of their organisation to the rigours of the licensing regime.

I was struck by a piece of research recently published about the consumption habits of a few in Glasgow and Edinburgh. In Scotland, public health is the fifth licensing objective and sits alongside the other four we have in England and Wales and with equal relevance to each other.

The government in Scotland commissioned a study on the consumption of alcohol and its misuse in 2009. This followed recognition that misuse leads to public health problems.
A quick look at the findings of the study are quite worrying.

You may remember initial justification for a minimum pricing strategy partly hinged on the debate regarding affordability and, with it, an imagined tipping point that is reached in response to pricing where consumption by those most vulnerable will fall.

A Canadian study showed consumption by the most vulnerable goes down when the price of a product reaches a certain level and issues relating to alcohol misuse and health then improve.

Not so with the Scottish study: Heavy drinking by vulnerable groups who had attended hospital, and their reliance on cheap booze, has been tempered somewhat by the introduction of minimum pricing (even though the legislation is yet to come into force, many operators in the multiples have increased pricing to reflect the minimum pricing requirements presumably in anticipation of the Scottish government winning the argument in the European Court).

An expected drop in consumption based upon the Canadian model has not occurred. The study confirms that drinkers in the vulnerable groups switched products because their usual drink became less affordable. Cheap vodka in many instances was replaced by white cider. The product became an important buffer because of its cheap unit price, approximately 17p per unit as against an average almost 40p per unit for the spirit that had been consumed previously.

Health risks associated with this type of alcohol ingestion among white cider drinkers (about 45 times the UK definition of harmful consumption) is apparently exacerbated by smoking, with approximately 70% of the cohort of the study smoking an average of 20 cigarettes per day.

The Local Government Association has provided guidance for public health teams to participate effectively as consultees not only in respect of their capacity as a responsible authority but also in assisting with the development and reviewing of licensing policies by licensing authorities.

Research has recently shown that overall consumption of alcohol has dropped since the commencement of the Licensing Act 2003 and articles previously on this page have confirmed the same.

The study, however, in Scotland shows a continued high risk for heavy drinkers who would benefit from alcohol reduction strategies that are being developed by public health teams.

Several public health groups nationwide are already engaged with applicants for premises licences to request conditions that are based upon data previously not available; risk factors including poverty, depravation and the number of people in alcohol treatment are now being considered, not only when reviewing an application but also when considering the introduction of a cumulative impact policy.

The work of the public health teams will enhance the decision-making process for those applying for licences to sell alcohol and already doing so. One of their functions is to protect those responsible operators by identifying health-related issues in an area and making their concerns known to the licensed community and those who regulate provision.

Many licensees have questioned the addition of the public health teams as an extra responsible authority and view their input as almost closing the door after the horse has bolted.

However, the increased availability of data that only the public health teams have access to can pinpoint issues while they are happening. As such, public health is likely to play an increasing role in the licensing regime to inform authorities about ongoing health issues and concerns.

There is a tendency to believe that all the data the health teams will provide will be negative, however, best practice schemes can also be highlighted, better enabling the other responsible authorities to make informed decisions about requests for changes to existing premises and the addition of new licences.

The Government has said there is no plan to create a fifth licensing objective, as with the Scottish system. However, comments and representations from public health teams are becoming a reality and licensees will need to consider issues relating to health in their area when submitting applications.