Factors that influence the risk of alcohol harm from licensed premises
Some local communities experience more harm from alcohol outlets than others. That means that a bottle store (for example) may result in more harm in one community than another. Even if the different communities have the same number of licensed premises in them.
Two local factors that influence the level of risk of harm from licensed premises are 1) the level of deprivation in the area, and 2) the ethnic composition of the area.
1) Deprivation
In any community, there are often individuals that are experiencing socio-economic deprivation. This is important to know in licensing decisions.
This is because an individual experiencing deprivation may experience more harm per drink of alcohol than more socio-economically advantaged persons. Even if they drink the same amount of alcohol.
New Zealand research has demonstrated that some drinkers experience more harm per drink than other drinkers. Persons with any of the following individual characteristics were found to be associated with reporting higher levels of alcohol-related disorders (e.g. physical fights, serious arguments, or forced to leave a place) in the past 12 months, over and above their level of alcohol consumption or drinking:
• having no qualification;
• having below-average income;
• being unemployed;
• having low socio-economic status.
In the above study, being a student, unemployed or of low socio-economic status was also found to be independently associated with alcohol dependence, over and above the amount of alcohol they consumed or their pattern of drinking.
These differences by deprivation were not found in relation to experiencing more minor alcohol-related harms, such as feeling the effects of alcohol the next day, or being ashamed of actions, etc.
The body of international research also points towards deprived drinkers experiencing more harm per drink, when compared to those experiencing lower levels of deprivation, see here.
Deprivation can also be measured at the community level. We know that the local alcohol environment may play a stronger role in alcohol-related harm in deprived areas than in less-deprived areas.
Decisions regarding alcohol licences (of any type) in a neighbourhood that is already experiencing multiple stressors requires very careful consideration.
Impact of on-licence density in socio-economically deprived areas
Overall, the body of international evidence suggests that bars located in deprived areas are associated with higher levels of violent crime when compared to less deprived areas.
Research in Melbourne, Australia, demonstrated that high on-license availability had stronger (twice as strong) effects on assaults (over a nine-year period) in areas characterised by socio-economic deprivation. These effects were found to be most concentrated in disadvantaged suburban areas. For premises that can sell alcohol for consumption both on and off the premises (known as General licences in Victoria, Australia), the results were mixed.
This finding concurs with earlier research in California, whereby the effects of bar density on hospital discharges from violence were significantly greater within unstable poor areas (classified as high minority ethnic composition, low home ownership, high turnover of housing, high unemployment and concentrated poverty).
In a cross-sectional study from the United States (US), the relationship between bar density and assault was found to be stronger in areas characterised by socio-economic disadvantage, female-headed households and residential instability.
One US longitudinal study found three neighbourhood exposures predicted stronger relationships be- tween bar on-licences and violent assaults; low income populations, high population density, and ethnic composition (stronger relationships in neighbourhoods with high proportions of African American and high proportions of Whites).
One high-quality longitudinal study in Sweden showed that persons living in deprived neighbourhoods were more likely to develop an alcohol use disorder if they lived in a neighbourhood with higher levels of alcohol availability. However, all types of licensed premises were aggregated, limiting the understanding of the particular role of on-license bars.
In relation to less violent crimes associated with alcohol, two US studies in urban cities showed that neighbourhood deprivation did not modify the relationship between on-license density and non-violent crimes and robberies.
New Zealand research:
One New Zealand study found no difference between low and high deprivation neighbourhoods in the relationship between on-licence bar density and a range of alcohol-related harms.
Another study also found no influence of deprivation on the relationship between on-licences and alcohol harm.
Further investigation is required to understand why findings from New Zealand research differ to those found in international studies. Methodological differences across the above studies may help to explain inconsistencies in the findings.
Impact of off-licence density in socio-economically deprived areas
Overall, there are fewer studies examining the effects of off-licences in deprived areas when compared to the quantity of research pertaining to on-licences. The evidence that is available suggests that off-licences in deprived areas are associated with higher levels of violent crime when compared to less deprived areas.
Research in Melbourne, Australia, demonstrated that high off-license availability had stronger effects on assaults (over a nine-year period) in disadvantaged suburban areas.
In a cross-sectional study from the US, off-license density was found to be associated with assaults, with the relationship stronger in areas characterised by socio-economic disadvantage, female-headed households and residential instability. These variables were used to describe the concept of social organisation - finding that the impact of alcohol outlet density was significantly weaker in communities that are more socially organised.
This finding concurs with a high-quality longitudinal study in Sweden showing that persons living in deprived neighbourhoods were more likely to develop an alcohol use disorder if they lived in a neighbourhood with at least one licensed premises. However, all types of licensed premises were aggregated, limiting the understanding of the particular role of different types of licences.
In relation to less violent crimes associated with alcohol, two US studies in urban cities showed that neighbourhood deprivation did not modify the relationship between off-license density and non-violent crimes and robberies. As such, the effect of deprivation on the relationship between off-license density and harm may be dependent on the type of harm examined.
New Zealand research:
One New Zealand study found no difference in the effects of deprivation on the relationship between off-license density and violence.
Another study also found no influence of deprivation on the relationship between off-licences and alcohol harm.
Further investigation is required to understand why findings from New Zealand research differ to those found in international studies. Methodological differences across the above studies may help to explain inconsistencies in the findings.
2) Ethnic composition
The ethnic composition of an area unit (and surrounding areas) may play a role in the risk of harm from licensed premises
This is because New Zealand research has shown that, taking into account deprivation, young (15- 24 years) Māori and Pacific males are significantly more likely to drink hazardously when living in closer proximity to alcohol outlets.
Although the reasons for this have not been directly articulated, inequities in health outcomes are known to reflect underlying social causes of health. This includes past and present processes of colonisation, discrimination, dominance of Western worldviews, and other structural determinants that play a role in wealth, power or prestige. These factors have an impact on how resources (needed to enable healthy communities) are shared and distributed among society. Eliminating inequities in alcohol harm experienced by Māori is consistent with honoring our commitments to Te Tiriti o Waitangi.
Whilst the above research did not differentiate between outlet types (e.g. on-licence vs off-licence) in terms of risk hazardous drinking, the findings do suggest that ethnic composition may play a role in local variability in the relationship between outlet density and harm.