Longer opening hours, alcohol consumption and health

Increased alcohol availability in England has led to increased heavy drinking and, as a consequence, poorer physical and mental health outcomes for heavy drinkers. That is the central finding of research by LUMS economists, Professor Colin Green and Dr Maria Navarro Paniagua.

Since 2003, venues in England and Wales have been to apply for licences to stay open and serve alcohol until 5am. By April 2006, over 50,000 venues had been granted a licence; four years later, over half of all licences allowed this. The new law had been introduced because it was thought that the previous closing time (11pm) meant that people drank more and more until the very end, leading to more crime and traffic accidents as drunk people concentrated outside at the same time.

The new study finds that in fact late-night licences have actually led to more heavy drinking and a greater toll on the physical and mental health of drinkers. It combines results from the Health Survey of England with data from the Health and Social Care Information Centre on the number of licences granted per region each year.

The authors find that although an extra 1,000 extended hours licences in a region only means that people drink on average 0.1 extra units on a busy night, heavy drinkers are 36% more likely to drink 12 or more units on their heaviest nights. What’s more, this increase in the likelihood of binge-drinking means that heavy drinkers are 16 percentage points more likely to report a physical health problem, and also more likely to report mental health problems.

The regulation of alcohol consumption is a contentious area of policy. This is particularly true for legislation aimed at changing when alcohol is available to be purchased, such as licensing hours.

In England and Wales, the post-war experience has been one of continuing expansion of licensing hours. This culminated in the licensing act of 2003 that allowed venues to apply for opening to 5am from November 2005 onwards. By 1 April 2006, 50,114 venues had been granted these licences. Four years later this had increased to 78,879 venues out of approximately 130,000 total premises licensed to sell alcohol in England and Wales.

At the heart of the push for longer hours was a view that the previous standard closing hours, typically 11pm, were themselves a source of social problems. These early closing hours were thought to cause excessive, concentrated drinking as individuals drank to the clock. Unified closing times also have the potential to lead to problems outside of venues, such as crime and traffic fatalities.

This research examines how this marked increase in on-premise alcohol availability influenced both heavy drinking and the physical and mental health of drinkers. The researchers demonstrate that more availability, in terms of the number of extended hours’ licences in an area, is associated with markedly higher levels of heavy drinking.

This doesn’t necessarily need to ‘map in’ to greater alcohol-related harms if this drinking is spread out over a greater time. In subsequent analysis, however, the researchers find that this greater drinking leads to deterioration in physical and mental health.

The researchers adopt a variety of approaches that aim to get close to the causal effect of longer hours on drinking and health. Their main approach involves combining the Health Survey of England, a representative annual data set with administrative information from the Health and Social Care Information Centre on the number of extended hours licences granted per region each year.

The study focuses on one particular measure of alcohol consumption that is measured consistently over the period of analysis (2003 to 2009): how many units of alcohol you consumed on your heaviest day of drinking in the last seven days?

The results demonstrate that an increase in 1,000 extended hours licences in a region is associated with a very small increase in consumption on average for the population (0.1 units on the heaviest night of drinking).

This, however, masks larger impacts for heavy drinkers. For example, the increase in availability led to a 36% increase in the incidence of consuming 12 or more units of alcohol on the heaviest night of drinking. Given that higher levels of consumption are where alcohol harms may be concentrated; this suggests that the extension of availability led to negative health outcomes.

The researchers follow this line of reasoning to examine the link between heavy drinking, alcohol availability and health. They rely on the variation in extended hours licences to identify the effect of increased alcohol consumption on self-reported health outcomes.

Again, they find that one additional unit of consumption on the heaviest night is associated with a small (1/2 percentage point) increase in the likelihood of reporting a physical health problem on average for the population.

This again masks increasingly large impacts for heavy drinkers. For example, the increase in the likelihood of drinking more than 12 units in a single sitting associated with a 16 percentage point increase in the likelihood of reporting a physical health problem. There are effects of similar magnitude on the probability of reporting a mental health problem.

Together this provides a body of evidence demonstrating how increased alcohol availability in England led to increased heavy drinking and through this, to poorer physical and mental health outcomes for heavy drinkers.

Longer Opening Hours, Alcohol Consumption and Health