Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government.
BACKGROUND
The power to influence many social determinants of health lies within local government sectors that are outside public health's traditional remit. We analyse the challenges of achieving health gains through local government alcohol control policies, where legal and professional practice frameworks appear to conflict with public health action.


METHODS
Current legislation governing local alcohol control in England and Wales is reviewed and analysed for barriers and opportunities to implement effective population-level health interventions. Case studies of local government alcohol control practices are described.


RESULTS
Addressing alcohol-related health harms is constrained by the absence of a specific legal health licensing objective and differences between public health and legal assessments of the relevance of health evidence to a specific place. Local governments can, however, implement health-relevant policies by developing local evidence for alcohol-related health harms; addressing cumulative impact in licensing policy statements and through other non-legislative approaches such as health and non-health sector partnerships. Innovative local initiatives-for example, minimum unit pricing licensing conditions-can serve as test cases for wider national implementation.


CONCLUSIONS
By combining the powers available to the many local government sectors involved in alcohol control, alcohol-related health and social harms can be tackled through existing local mechanisms.
SPHR@L, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Martineau
UK Health Forum, Victoria House, 7th Floor, Southampton Row, London WC1B 4AD, UK.
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Graff
British Heart Foundation Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.
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Mitchell
SPHR@L, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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Lock
D000428:Alcohol Drinking / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D000434:Alcoholic Beverages / Q000009:adverse effects; D004739:England; D006801:Humans; D009111:Local Government; D011635:Public Health Administration / Q000331:legislation & jurisprudence / Q000379:methods; D011640:Public Policy / Q000331:legislation & jurisprudence; D014852:Wales
alcohol; government and law; public health