Public health and licensing workshop
Outlet density and cumulative impact
Dr James Nicholls
Alcohol Research UK
Three issues
Public health licensing objective for cumulative impact areas
Research on outlet density, consumption and harm
Scotland and ‘overprovision’ policies
Cumulative impact policies
A ‘rebuttable presumption that applications [which add to
cumulative impact] will normally be refused’ (Sections 13.19-38 of
Section 182 Guidance)
Consensus that outlet density exacerbates particular harms
158 CIAs across 93 licensing authorities in 2012 [134 / 83 in 2010]
Health evidence valid in preparing a policy (s. 13.23), but no health
objective for it to address.
‘We want to ensure that licensing authorities are
able to take alcohol-related health harms into
consideration when making decisions about
cumulative impact policies (CIPs) which can be
used to manage problems linked to the density
of premises in specific areas. We consider that a
new health-related objective for alcohol
licensing related specifically to cumulative
impact is the best way to achieve this.’
Objections to health objective
A&E admissions already covered by crime and
disorder objective
No link between density and health at local
level
A ‘bridge to far’ for health involvement in
licensing
Outlet density: evidence reviews
Popova, S. et al. (2009) ‘Hours and days of sale and density of alcohol
outlets: Impacts on alcohol consumption and damage: a systematic
review’, Alcohol and Alcoholism 44.5 (500-16)
Jackson et al. (2009) ‘Interventions on control of alcohol price,
promotion and availability for prevention of alcohol use disorders in
adults and young people’, NICE evidence review
Home Office (2012) ‘Impact assessment: consultation on including a
health objective in the Licensing Act 2003 related specifically to
cumulative impact’
Outlet density and consumption
Jackson et al. (2009): ‘A clear positive association between
outlet density and increases in alcohol consumption was
observed among both adults and young people. Further
limited evidence was also identified that found a positive
relationship between alcohol outlet density and alcoholrelated harms.’
Consistent evidence of impact on crime and disorder (though
variations by locality and type of outlet)
Outlet density and health
Theall, K. et al. (2009) ‘The neighborhood alcohol environment
and alcohol-related morbidity’, Alcohol and Alcoholism 44.5
(491-9)
Livingston, M. (2011) ‘Alcohol outlet density and harm:
comparing the impacts on violence and chronic harms’, Drug
and Alcohol Review 30 (515-23)
Also evidence from Nordic studies following state-level
changes in legislation.
Outlet density and health: the evidence
Theall et al., 2009: ‘Our findings support the notion that alcohol
outlets are likely to play a significant role in health outcomes at
neighborhood level, irrespective of individual consumption
patterns’
Livingston (2011): 10% increase in the number of off-licenses
would increase hospital admissions by 1.9% (on-licenses = 0.5%)
‘There was a strong positive association between [off-license]
density and rates of alcohol-caused chronic disease.’
‘Outlet density’ today
1884
2012
Key problems
Rebalancing towards the off-trade
Capacity v number of outlets
Impact of supermarkets on small off-licenses (cf. Forsyth, A. (2012)
‘Shop servers experience of alcohol-related issues and interventions
in socially contrasting neighbourhoods’ Alcohol Research UK)
Effective proximity measures (especially supermarkets and online)
Scale of CIA for health indicators
Scale of cumulative impact areas
Licensing authorities could introduce a new CIP or ‘extend the
geographic area of an existing CIP (potentially to cover the whole
licensing authority area) following consideration of health data’
(Health Objective Impact Assessment, p. 5)
Croydon’s proposed borough-wide policy is ‘disproportionate and
unhelpful … [It] may well be open to challenge and it certainly
falls foul of national policy’ (Association of Licensed Multiple
Retailers Press Release 25th Feb)
Is Government guidance clear enough on this?
Licensing (Scotland) Act 2005
Fifth licensing objective:
‘Protecting and improving public health’
Overprovision
Requirement for statement on ‘overprovision’ in Statement of
Licensing Policy
Support for data-gathering
Focus on Statements of Licensing Policy
Problem of causal relationships – bar is
lower for overprovision (risk, rather than
undermining objectives)
Strong trade resistance – legal challenges
Alcohol and Drug Partnerships
Community engagement through
Licensing Forums