Background

The UK–Ireland Alcohol Research Network (AcoRN) held the third in a series of webinars on 13 April 2022 examining alcohol availability. Previous webinars focused on alcohol marketing (November 2021) and alcohol and policymaking (February 2022). The event was chaired by Dr Sheila Gilheany of Alcohol Action Ireland and the three speakers gave an insight into alcohol availability both in Ireland and in the United Kingdom.

Alcohol policy and legislation in Ireland and Northern Ireland

Dr Joanna Purdy of the Institute of Public Health (IPH) in Ireland outlined the role the IPH has played in alcohol policy both in Ireland and Northern Ireland. The policy and legislation that govern alcohol were summarised and the similarities between the Northern Irish drug and alcohol strategy Preventing Harm, Empowering Recovery1 and Ireland’s Reducing Harm, Supporting Recovery2 were noted. It was argued that in Northern Ireland, the Licensing and Registration of Clubs (Amendment) Act 2021 has to a certain extent liberalised alcohol sales through extended opening hours, although other measures within the Act have restricted alcohol sales and availability.3

In order to facilitate policymakers’ and other concerned stakeholders’ understanding of the relationship between outlet density and alcohol-related harms, a mapping exercise of alcohol outlet density in Northern Ireland was conducted there by the Department for Communities. The report has implications for licensing policy and consideration of public health in the licensing process.4

Alcohol availability in Ireland was considered in the context of legislation, reports, and publications. Availability is a key part of the Public Health (Alcohol) Act 20185 as well as the Sale of Alcohol Bill, which aims to simplify and streamline alcohol licensing laws, but also to reduce alcohol-related harms, especially among young people.6 It is key too in the Report of the Night-Time Economy Taskforce,7 the aim of which is to create a vibrant night-time economy based on international models of best practice and stakeholder engagement. Although welcomed, especially as we emerge from the Covid-19 pandemic, concern was raised about the lack of a public health voice to contribute to the taskforce. A number of useful resources were referenced: the alcohol county profiles that detail alcohol-related harms by county8 and a report compiled by the National Community Action on Alcohol Network, which details how to object to or appeal a decision regarding alcohol licensing.9

The first session closed with a reminder that it is necessary to closely monitor the changes in both the temporal and spatial availability of alcohol and the impact on alcohol-related harm, and that there are currently no time series analysis or sophisticated mapping of outlet density and alcohol-related harms in Ireland or Northern Ireland.

Association between neighbourhood-level alcohol availability and related harm

Professor Niamh Shortt of the University of Edinburgh stated that to address the challenges of public health, we need to change our toxic environments, and that a variety of alcohol-related interventions (based on alcohol availability, promotion, and price) are required to achieve this objective. The environment we live in greatly influences our behaviours and the increased availability of alcohol results in more competitiveness among retailers, reduced prices, and thus increased consumption. The evidence indicates that alcohol availability tends to be higher in areas of social deprivation, and as deprivation increases so too does alcohol availability.10,11

Alcohol density appears to affect those in the lowest income groups more than those in higher income groups, suggesting a socially differentiated vulnerability to such environments. Evidence of the association between outlet density and inequalities, increased crime, domestic violence, road traffic collisions, mortality, and morbidity was outlined and how these need to be considered in licensing policy.

Having a sound knowledge base to better understand the influence of alcohol availability and its association with alcohol use and harm, children’s exposure to alcohol, and the social and spatial inequalities that exist informs researchers and policymakers. To date, there are inconsistent data available, and examples of mechanisms for collecting similar data were given. Ideally, a consistent, well-managed database with comprehensive information about licensing should be developed. 

Exploring study design to evaluate policy changes in licensing and availability

Professor Niamh Fitzgerald from the University of Stirling provided an overview of the diversity of evaluation study designs, methods, and study sizes that can be used to advance our understanding of the impact of availability policy from a public health perspective. The licensing system in Scotland was described and how public health stakeholders have a statutory role in the system and can object to the granting of a licence on the grounds that it would breach the objectives or the local statement of licensing policy. Several studies that have looked at alcohol licensing and how this engagement of public health practitioners has helped or hindered were examined. One such study, Exploring the Impact of Alcohol Premises Licensing in England and Scotland (ExILEnS), examines the impact of public health stakeholders’ engagement in alcohol premises licensing.12

A mixed-methods study, Evaluating Later or Expanded Premises Hours for Alcohol in the Night-time Economy (ELEPHANT), was described and how it aims to understand and evaluate the contribution of changes in trading hours for bars and clubs in Glasgow and Aberdeen to harms, services, and economic costs in the local night-time economy.13 This study aims to build on international research, suggesting several risks of later opening hours (increased intoxication, assaults, injuries, or use of services).

However, not all studies found such robust evidence of harms and/or were methodologically weak, and/or out-of-date, and the importance of robust and up-to-date evidence was emphasised.

As well as a variety of methods and potential research questions that can be used to build on our understanding of alcohol availability and its impact on health, crime, and economics, a number of methods was proposed. These include observations in late-night premises, ambulance call-outs, time series analysis, and qualitative interviews with diverse stakeholders. 

Conclusion

The webinar closed by concluding that to understand the impact of alcohol availability and policies that affect availability, it is crucial that we have consistent longitudinal data on alcohol-related outcomes and access to data on exposure to availability.
 

1    Department of Health (Northern Ireland) (2021) Preventing harm, empowering recovery: a strategic framework to tackle the harm from substance use (2021–31). Belfast: Department of Health. https://www.drugsandalcohol.ie/34827/

2    Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health.
https://www.drugsandalcohol.ie/27603/

3    Licensing and Registration of Clubs (Amendment) Act (Northern Ireland) 2021. Available online at:
https://www.legislation.gov.uk/nia/2021/7/contents/enacted

4    Institute of Public Health in Ireland (2015) Using alcohol licensing data in public health research and policy: proceedings of a knowledge exchange forum hosted by the North South Alcohol Policy Advisory Group. Dublin/Belfast: Institute of Public Health in Ireland. https://www.drugsandalcohol.ie/27683/

5    Office of the Attorney General (2018) Public Health (Alcohol) Act 2018. https://www.drugsandalcohol.ie/33698/

6    Department of Justice (2021) Sale of Alcohol Bill. Available online at: https://www.justice.ie/en/JELR/Pages/SaleAlcohol%20Bill

7    Night-Time Economy Taskforce (2021) Report of the Night-Time Economy Taskforce. Dublin: Department of Tourism, Culture, Arts, Gaeltacht, Sport and Media. https://www.drugsandalcohol.ie/34846/

8    For access to the 26 alcohol county profiles for 2019 published by the Health Service Executive in collaboration with the Alcohol Forum, visit: https://alcohol.iph.ie/?p=407

9    Tracey S and National Community Action on Alcohol Network (2017) A community guide to alcohol licensing in Ireland. Donegal: Alcohol Forum. https://www.drugsandalcohol.ie/28432/

10  Shortt NK, Rind E, Pearce J, et al. (2018) Alcohol risk environments, vulnerability and social inequalities in alcohol consumption. Ann Am Assoc Geogr, 108(5): 1210–1227.

11  Trangenstein PJ, Curriero FC, Jennings JM, et al. (2019) Methods for evaluating the association between alcohol outlet density and violent crime. Alcohol Clin Exp Res, 43(8): 1714–1726.

12  Fitzgerald N, Egan M, de Vocht F, et al. (2018) Exploring the impact of public health teams on alcohol premises licensing in England and Scotland (ExILEnS): protocol for a mixed methods natural experiment evaluation. BMC Med Res Methodol, 18: 123. Available online at: https://exilens.stir.ac.uk/

13  For further information on the ELEPHANT study, visit:
https://www.stir.ac.uk/research/hub/contract/1399293