BackgroundPublic 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.MethodsTo 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.ResultsResults 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.ConclusionsThis 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.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6306-8) contains supplementary material, which is available to authorized users.

Against political and resource constraints at local and national government levels, pragmatic approaches for strengthening public health influence over alcohol licensing are required, including promoting relationships between stakeholders and offering opportunities for PHPs to share best practice about making effective contributions to licensing.

Background The relocation of public health into English local government in 2013 provided opportunities for closer integration of public health and alcohol licensing work in local authorities, with potential to shape local alcohol environments. How public health practitioners can best influence alcohol licensing to improve population health remains unclear. This study aimed to explore the contextual influences on, and perceived impact of, public health practice for alcohol licensing in local authorities in London. MethodsA mixed-methods study explored how, why, and with what effect public health practitioners act on alcohol licence applications. The sample included practitioners from across the 33 local authorities in London. Data collection included ethnographic observations of public health practice (eight local authorities), in-depth interviews with licensing practitioners (n=15), four focus group discussions with a range of stakeholders, an online survey of public health practitioners (18 local authorities), and analysis of 10 months' routine alcohol licensing data (five local authorities). Qualitative data were analysed thematically and descriptive statistics conducted on the survey and routine data.Findings Public health practitioners used a variety of strategies to act on alcohol licence applications. Routine data indicated that both formal representations and informal actions (eg, negotiating with applicants) were made by some practitioners. Factors that appeared supportive of practitioners' licensing work included close relationships with other licensing responsible authorities, access to locally specific and timely data, and a strong local Statement of Licensing Policy. However, some perceived public health to lack clear authority to make representations without support from other responsible authorities, or without a specific health licensing objective. Viewing their contributions as influential was more common among public health practitioners who meet regularly with other responsible authorities than those who do not, though all practitioners identified broader values of alcohol licensing work, including shaping alcohol policy and increasing understanding of public health values within local government.Interpretation Public health impact on alcohol licensing is shaped and potentially constrained by the contextual dynamics of local authorities. Public health practice may be supported through access to locally specific health data, mechanisms to strengthen relationships with other responsible authorities such as regular meetings, and promotion of public health priorities among broader local government strategies.