Local government alcohol policy development: case studies in three New Zealand communities

Alcohol-attributed disease burden and formal alcohol policies in the Nordic countries (1990-2019): an analysis using the Global Burden of Disease Study 2019

It is still unclear how changes in alcohol control policies may have contributed to changes in overall levels of alcohol-attributed harm between and within the Nordic countries. We modified and applied the Bridging the Gap (BtG)-scale to measure the restrictiveness of a set of alcohol control policies for each Nordic country and each year between 1990 and 2019. Alcohol-attributed harm was measured as total and sex-specific alcohol-attributed disease burden by age-standardized years of life losts (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) per 100 000 population from the Global Burden of Disease Study (GBD). Longitudinal cross-country comparisons with random effects regression analysis were employed to explore associations, within and across countries, differentiated by sex and the time to first effect. Overall, alcohol-attributed YLLs, YLDs, and DALYs decreased over the study period in all countries, except in Iceland. The burden was lower in those countries with restrictive national policies, apart from Finland, and higher in Denmark which had the least restrictive policies. Changes in restrictiveness were negatively associated with DALYs for causes with a longer time to effect, although this effect was stronger for males and varied between countries. The low alcohol attributed disease burden in Sweden, Norway, and Iceland, compared to Denmark, points towards the success of upholding lower levels of harm with strict alcohol policies. However, sex, location and cause-specific associations indicate that the role of formal alcohol policies is highly context dependent and that other factors might influence harm as well.

Generating political priority for alcohol policy reform: A framework to guide advocacy and research

INTRODUCTION

While effective policies exist to reduce alcohol-related harm, political will to enact them is low in many jurisdictions. We aimed to identify key barriers and strategies for strengthening political priority for alcohol policy reform.

METHODS

A framework synthesis was conducted, incorporating relevant theory, key informant interviews (n = 37) and a scoping review. Thematic analysis informed the development of a framework for understanding and influencing political priority for alcohol policy.

RESULTS

Twelve barriers and 14 strategies were identified at multiple levels (global, national and local). Major barriers included neoliberal or free trade ideology, the globalised alcohol industry, limited advocate capacity and the normalisation of alcohol harms. Strategies fell into two categories: sector-specific and system change initiatives. Sector-specific strategies primarily focus on influencing policymakers and mobilising civil society. Examples include developing a clear, unified solution, coalition building and effective framing. System change initiatives target structural change to reduce the power imbalance between industry and civil society, such as restricting industry involvement in policymaking and securing sustainable funding for advocacy. A key example is establishing an international treaty, similar to the Framework Convention on Tobacco Control, to support domestic policymaking.

DISCUSSION AND CONCLUSIONS

Our findings provide a framework for understanding and advancing political priority for alcohol policy. The framework highlights that progress can be achieved at various levels and through diverse groups of actors. The importance of upstream drivers of policymaking was a key finding, presenting challenges for time-poor advocates, but offering potential facilitation through effective global leadership.

Understanding local government responses to alcohol-related harm

INTRODUCTION

Local governments (LG) have a key role in reducing alcohol-related harm, yet, Australian research investigating this is limited. This study aimed to explore Australian LGs' role in alcohol policy by investigating how LGs respond to alcohol-related harm and what influences their responses.

METHODS

A collective case study approach guided two-stage purposive sampling. Victorian metropolitan and regional LGs were invited to participate based on alcohol-related harm profiles. Officers within LGs with alcohol policy knowledge participated in semi-structured interviews. Transcripts were analysed deductively using a pre-existing alcohol policy framework and inductively using thematic analysis.

RESULTS

Nine officers from eight LGs participated. LG responses to alcohol-related harm predominately included bans on alcohol in public spaces, licensed premises planning and alcohol-free youth events. Half implemented liquor forums/accords and most implemented education programs in sporting clubs, schools or workplaces. In some LGs, the reduction of alcohol-related harm was not considered a priority. Key influences on alcohol initiatives were legislation, the composition of licensed venues, extent of alcohol-related harms, resources and priorities, and stakeholder feedback.

DISCUSSION AND CONCLUSIONS

While particular policies were widespread, participating LGs varied greatly in activity in, and responses to, reducing alcohol-related harm. LGs reported varied influences on their responses. LGs recognised the long-term health harms of alcohol in their health planning documents, however, most prioritised interventions targeting short-term amenity and safety harms. Changes to Victorian planning and liquor licensing legislation to give additional powers to LGs and providing pre-developed alcohol programs with dedicated funding should be considered.

Did New Zealand's new alcohol legislation achieve its object of facilitating public input? Qualitative study of Māori communities

BACKGROUND AND AIMS

The Treaty of Waitangi stipulates equality between Māori and non-Māori, yet Māori continue to have substantially poorer health, a driver of which is alcohol-related morbidity. In 2012, the New Zealand government introduced legislation claiming it would facilitate community input on decisions about alcohol. We investigated the experience of Māori communities with the new law.

DESIGN AND METHODS

We obtained submissions made to local governments and invited a diverse range of submitters from iwi (tribes), hapū (sub-tribes/clan groups) and Māori service providers, to participate in semi-structured interviews with Māori researchers. We used template analysis to develop hypotheses, and searched for disconfirmatory evidence within interview transcripts and recordings.

RESULTS

Participants had committed substantial human resources to write submissions informed by technical knowledge of liquor licensing and relevant research. They reported that local governments did not seem to engage meaningfully with the content of their submissions, and failed in many instances to update participants on how the consultation was progressing. Some observed that the alcohol industry had easier access to local politicians, and therefore expected outcomes to reflect industry interests.

DISCUSSION AND CONCLUSIONS

In their response to Māori constituents on proposed alcohol policies, local governments were felt to lack the inclination or capacity to consult meaningfully. By devolving responsibility for alcohol availability while failing to compel and resource local government to give regard to treaty obligations, the new legislation risks widening existing health inequalities between Māori and non-Māori.

Getting shops to voluntarily stop selling cheap, strong beers and ciders: a time-series analysis evaluating impacts on alcohol availability and purchasing

BACKGROUND

'Reducing the Strength' (RtS) is a public health initiative encouraging retailers to voluntarily stop selling cheap, strong beers/ciders (≥6.5% alcohol by volume). This study evaluates the impact of RtS initiatives on alcohol availability and purchasing in three English counties with a combined population of 3.62 million people.

METHODS

We used a multiple baseline time-series design to examine retail data over 29 months from a supermarket chain that experienced a two-wave, area-based role out of RtS: initially 54 stores (W1), then another 77 stores (W2). We measured impacts on units of alcohol sold (primary outcome: beers/ciders; secondary outcome: all alcoholic products), economic impacts on alcohol sales and substitution effects.

RESULTS

We observed a non-significant W1 increase (+3.7%, 95% CI: -11.2, 21.0) and W2 decrease (-6.8%, 95% CI: -20.5, 9.4) in the primary outcome. We observed a significant W2 decrease in units sold across all alcohol products (-10.5%, 95% CI: -19.2, -0.9). The direction of effect between waves was inconsistent for all outcomes, including alcohol sales, with no evidence of substitution effects.

CONCLUSIONS

In the UK, voluntary RtS initiatives appear to have little or no impact on reducing alcohol availability and purchase from the broader population of supermarket customers.

Processes, practices and influence: a mixed methods study of public health contributions to alcohol licensing in local government

BACKGROUND

Public health in England has opportunities to reduce alcohol-related harms via shaping the availability and accessibility of alcohol through the licensing function in local government. While the constraints of licensing legislation have been recognised, what is currently little understood are the day-to-day realities of how public health practitioners enact the licensing role, and how they can influence the local alcohol environment.

METHODS

To address this, a mixed-methods study was conducted across 24 local authorities in Greater London between 2016 and 17. Data collection involved ethnographic observation of public health practitioners' alcohol licensing work (in eight local authorities); a survey of public health practitioners (n = 18); interviews with licensing stakeholders (n = 10); and analysis of public health licensing data from five local authorities. Fieldnotes and interview transcripts were analysed thematically, and quantitative data were analysed using descriptive statistics.

RESULTS

Results indicated that some public health teams struggle to justify the resources required to engage with licensing processes when they perceive little capacity to influence licensing decisions. Other public health teams consider the licensing role as important for shaping the local alcohol environment, and also as a strategic approach for positioning public health within the council. Practitioners use different processes to assess the potential risks of licence applications but also the potential strengths of their objections, to determine when and how actions should be taken. Identifying the direct influence of public health on individual licences is challenging, but the study revealed how practitioners did achieve some level of impact, for example through negotiation with applicants.

CONCLUSIONS

This study shows public health impact following alcohol licensing work is difficult to measure in terms of reducing alcohol-related harms, which poses challenges for justifying this work amid resource constraints. However, there is potential added value of the licensing role in strategic positioning of public health in local government to influence broader determinants of health.

Increasing powers to reject licences to sell alcohol: Impacts on availability, sales and behavioural outcomes from a novel natural experiment evaluation

Excessive alcohol consumption leads to negative health and social impacts at individual and population levels. Interventions that aim to limit the density of alcohol retail premises (including cumulative impact policies (CIPs)) have been associated with decreases in alcohol-related crime and alcohol-related hospital admissions. We evaluated the quantitative impact of introducing a new alcohol licensing policy that included a comprehensive Cumulative Impact Policy (CIP) enforced in seven Cumulative Impact Zones (CIZs) in one English Local Authority in 2013. We used time series analysis to assess immediate and longer term impacts on licensing decisions and intermediate outcomes, including spatial and temporal alcohol availability, crime, alcohol-related ambulance call-outs and on-licence alcohol retail sales across the Local Authority and in CIZs and non-CIZs during the period 2008 to 2016. We found no impact on licence application rates but post-intervention applications involved fewer trading hours. Application approvals declined initially but not over the longer term. Longer term, small reductions in units of alcohol sold in bars (-2060, 95% confidence interval (CI) = -3033, -1087) were observed in areas with more intensive licensing policies ('Cumulative Impact Zones' (CIZs)). Significant initial declines in overall crime rates (CIZs = -12.2%, 95% CI = -18.0%, -6.1%; non-CIZs = -8.0%, 95% CI = -14.0%, -1.6%) were only partially reversed by small, longer term increases. Ambulance callout rates did not change significantly. The intervention was partially successful but a more intensive and sustained implementation may be necessary for longer term benefits.

Investigating local policy drivers for alcohol harm prevention: a comparative case study of two local authorities in England

Background

The considerable challenges associated with implementing national level alcohol policies have encouraged a renewed focus on the prospects for local-level policies in the UK and elsewhere. We adopted a case study approach to identify the major characteristics and drivers of differences in the patterns of local alcohol policies and services in two contrasting local authority (LA) areas in England.

Methods

Data were collected via thirteen semi-structured interviews with key informants (including public health, licensing and trading standards) and documentary analysis, including harm reduction strategies and statements of licensing policy. A two-stage thematic analysis was used to categorize all relevant statements into seven over-arching themes, by which document sources were then also analysed.

Results

Three of the seven over-arching themes (drink environment, treatment services and barriers and facilitators), provided for the most explanatory detail informing the contrasting policy responses of the two LAs: LA1 pursued a risk-informed strategy via a specialist police team working proactively with problem premises and screening systematically to identify riskier drinking. LA2 adopted a more upstream regulatory approach around restrictions on availability with less emphasis on co-ordinated screening and treatment measures.

Conclusion

New powers over alcohol policy for LAs in England can produce markedly different policies for reducing alcohol-related harm. These difference are rooted in economic, opportunistic, organisational and personnel factors particular to the LAs themselves and may lead to closely tailored solutions in some policy areas and poorer co-ordination and attention in others.

New Zealand's new alcohol laws: protocol for a mixed-methods evaluation

Background

Alcohol consumption is a major cause of mortality and morbidity globally. In response to strong calls from the public for alcohol law reform, the New Zealand Government recently reduced the blood alcohol limit for driving and introduced the Sale and Supply of Alcohol Act which aim to (1) improve community input into local decision-making on alcohol; (2) reduce the availability of alcohol; and (3) reduce hazardous drinking and alcohol-related harm. In this project we seek to evaluate the new laws in terms of these objectives.

Design and methods

A policy evaluation framework is proposed to investigate the implementation and outcomes of the reforms. We will use quantitative and qualitative methods, employing a pre-post design. Participants include members of the public, local government staff, iwi (Māori tribal groups that function collectively to support their members) and community group representatives. Data will be collected via postal surveys, interviews and analysis of local government documents. Liquor licensing, police and hospital injury data will also be used. Community input into local government decision-making will be operationalised as: the number of objections per license application and the number of local governments adopting a local alcohol policy (LAP). Outcome measures will be the ‘restrictiveness’ of LAPs compared to previous policies, the number (per 1000 residents) and density (per square kilometre) of alcohol outlets throughout NZ, and the number of weekend late-night (i.e., post 10 pm) trading hours. For consumption and harm, outcomes will be the prevalence of hazardous drinking, harm from own and others’ drinking, community amenity effects, rates of assault, and rates of alcohol-involved traffic crashes. Multiple regression will be used to model how the outcomes vary by local government area from before to after the law changes take effect. These measures will be complemented by qualitative analysis of LAP development and public participation in local decision-making on alcohol.

Discussion

The project will evaluate how well the reforms meet their explicit public health objectives.

Use of research in local alcohol policy-making

Purpose

– On-premise trading hours are generally decided at the local level. The purpose of this paper is to identify relevant advocacy coalitions and to assess to what extent and how these coalitions used research in the alcohol policy-making process concerning changes in on-premise trading hours in Norway.

Design/methodology/approach

– Theory-driven content analyses were conducted, applying data from city council documents (24 Norwegian cities) and Norwegian newspaper articles and broadcast interviews (n=138) in 2011-2012.

Findings

– Two advocacy coalitions with conflicting views and values were identified. Both coalitions used research quite extensively – in the public debate and in the formal decision-making process – but in different ways. The restrictive coalition, favouring restricted trading hours and emphasising public health/safety, included the police and temperance movements and embraced research demonstrating the beneficial health/safety effects of restricting trading hours. The liberal coalition of conservative politicians and hospitality industry emphasised individual freedom and industry interests and promoted research demonstrating negative effects on hospitality industry turnover. This coalition also actively discredited the research demonstrating the beneficial health/safety effects of restricting trading hours.

Originality/value

– Little is known about how local alcohol policy-making processes are informed by research-based knowledge. This study is the first to analyse how advocacy coalitions use research to influence local alcohol policy-making.

UK substance use policy research should think local

Purpose

– The purpose of this paper is to consider how policy researchers should respond to recent developments in substance use and the governance of drug and alcohol policy in the UK.

Design/methodology/approach

– The paper takes two elements from the 2010 UK Drug Strategy – supply and treatment – and considers a case study in each to briefly examine the potential role of local policymakers in shaping how substance use is experienced.

Findings

– It is argued that the Coalition Government’s health reforms have given local commissioners greater autonomy over treatment policy than they had under the preceding Labour Government. Similarly, the regulation of new psychoactive substances in the UK has left local areas to determine their own approach to controlling supply through retail outlets.

Research limitations/implications

– Drawing on the broader academic literature on policymaking, this paper calls for ethnographic research into local policymaking related to substance use, which will help to illuminate how perceived policy problems are shaped by particular local systems and understandings of evidence.

Originality/value

– While this paper is not unique in identifying the importance of locally based research, it identifies the particular relevance of this research agenda in the UK today. It seeks to inform and encourage research that can shape the development of local policymaking.

The development of alcohol policy in contemporary China

Over recent years, an increase in alcohol-related problems has been noted in China. Taking effective measures against the problem requires clear reviewing and understanding of the evolution of the Chinese alcohol policy. This study is aimed to evaluate the alcohol policy with special focus on reviewing the alcohol production and consumption situation in China and assessing the changes in Chinese alcohol policy along with other related fields. This article finishes with a set of recommended policy changes that could help solve the recent alcohol-related problems and analyze the major impediments.

Public, official, and industry submissions on a Bill to increase the alcohol minimum purchasing age: A critical analysis

BACKGROUND

In 2005 a Bill was introduced to the New Zealand parliament to increase the alcohol minimum purchasing age (MPA) from 18 to 20 years and submissions were invited from interested parties. We sought to characterise and critique the arguments tendered for and against the proposal.

METHODS

We used template analysis to study written submissions on the Bill from 178 people and organisations in New Zealand. Independent raters coded submissions according to the source, whether for or opposed, and the arguments employed.

RESULTS

The most common sources of submissions were members of the public (28%), the alcohol industry (20%), and NGOs (20%). Overall, 40% opposed increasing the MPA, 40% were in favour, 4% supported a split MPA (18 years for on-premise, 20 years for off-premise), 7% were equivocal, and 8% offered no comment. The most common proponents of increasing the MPA were NGOs (36%) and members of the public (30%) and their arguments concerned the expected positive effects on public health (36%) and public disorder/property damage (16%), while 24% argued that other strategies should be used as well. The most common sources of opposition to increasing the MPA were the alcohol industry (50%) and the public (20%). It was commonly claimed that the proposed law change would be ineffective in reducing harm (22%), that other strategies should be used instead (16%), that it would infringe adult rights (15%), and that licensed premises are safe environments for young people (14%). There were noteworthy examples of NGOs and government agencies opposing the law change. The alcohol industry maximised its impact via multiple submissions appealing to individual rights while neglecting to report or accurately characterise the scientific evidence. Several health and welfare agencies presented confused logic and/or were selective in their use of scientific evidence.

CONCLUSION

In contrast to the fragmented and inconsistent response from government and NGOs, the alcohol industry was organised and united, with multiple submissions from the sector with most at stake, namely the hospitality industry, and supporting submissions from the manufacturing, import, and wholesale sectors. Systematic reviews of research evidence should be routinely undertaken to guide the legislature and submissions should be categorised on the basis of pecuniary interest.

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.