Martineau F P, Graff H, Mitchell C, Lock K
SPHR@L, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
UK Health Forum, Victoria House, 7th Floor, Southampton Row, London WC1B 4AD, UK.
J Public Health (Oxf). 2014 Sep;36(3):435-42. doi: 10.1093/pubmed/fdt079. Epub 2013 Aug 9.
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.
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.
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.
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.
影响健康诸多社会决定因素的权力掌握在地方政府部门手中，而这些部门并不在公共卫生的传统职责范围内。我们分析了通过地方政府酒精控制政策实现健康改善所面临的挑战，在这些政策中，法律和专业实践框架似乎与公共卫生行动相冲突。
对英格兰和威尔士现行的地方酒精控制立法进行审查和分析，以找出实施有效的人群层面健康干预措施的障碍和机遇。描述了地方政府酒精控制实践的案例研究。
缺乏特定的法定健康许可目标以及公共卫生与法律对健康证据与特定场所相关性评估的差异，限制了对与酒精相关健康危害的应对。然而，地方政府可以通过为与酒精相关的健康危害收集地方证据；在许可政策声明中应对累积影响，并通过其他非立法途径，如卫生与非卫生部门伙伴关系，来实施与健康相关的政策。创新性的地方举措——例如最低单位定价许可条件——可作为在全国范围内更广泛实施的试点案例。
通过整合参与酒精控制的众多地方政府部门所拥有的权力，可以通过现有的地方机制来应对与酒精相关的健康和社会危害。
