Regulations can work, alcohol edition

From the BMJ Journal of Epidemiology and Community Health, “Measurable effects of local alcohol licensing policies on population health in England“:

Background: English alcohol policy is implemented at local government level, leading to variations in how it is put into practice. We evaluated whether differences in the presence or absence of cumulative impact zones and the ‘intensity’ of licensing enforcement—both aimed at regulating the availability of alcohol and modifying the drinking environment—were associated with harm as measured by alcohol-related hospital admissions.

Methods: Premises licensing data were obtained at lower tier local authority (LTLA) level from the Home Office Alcohol and Late Night Refreshment Licensing data for 2007–2012, and LTLAs were coded as ‘passive’, low, medium or highly active based on whether they made use of cumulative impact areas and/ or whether any licences for new premises were declined. These data were linked to 2009–2015 alcohol-related hospital admission and alcohol-related crime rates obtained from the Local Alcohol Profiles for England. Population size and deprivation data were obtained from the Office of National Statistics. Changes in directly age standardised rates of people admitted to hospital with alcohol-related conditions were analysed using hierarchical growth modelling.

Often, when we talk about many public-health-related issues, people say there’s nothing we can do. That’s not always the case. We know of the dangers of alcohol. In the UK, about a third of women and more men drink more than is considered ok. Some laws there allow for the limiting of the number of new alcohol outlets in areas where they might affect crime or public safety, cause problems, or possible impact kids.

Researchers developed a measure of how much these zones and regulations were used. Then they looked at whether regulation was related to changes in alcohol-related hospital admissions and crime rates.

They found that in areas with more intense alcohol licensing policies there were bigger reductions in alcohol-related admission rates. They also found a “dose response”. Specific areas with the most intensive licensing policies had 5% greater reduction (p=0.006) in 2015 compared to those with no policies.

There are limitations, of course. It’s possible that changes in admissions are caused by changes in disease and not in incidence. It’s possible visits went from inpatient to outpatient. It’s possible something unmeasured is at play. But this is still interesting, or at least worth looking into further.


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