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The role of the public health practitioner is multifaceted. In the instance of Suffolk, and the proposed interventions, this involves overcoming a complex problem which requires partnership working across a range of stakeholders (The Open University, 2019d). Public health professionals can play a vital role in championing the needs of the local resident population (Bunton et al., 2003). This is particularly true for vulnerable populations such as children, as included in this proposal, who are not always able to have their own voice in policy decisions (Freire, 2018). Importantly, reducing health inequalities is a central role of public health practitioners (The Open University, 2019e). This means the avoidable differences between groups which could be the richest and poorest, oldest and youngest, or different races, religious groups, or those with a protected characteristic such as mental or physical disabilities. Compared to other stakeholder groups such as trading standards, public health stakeholders have a more clearly defined role relating to health inequalities (Naidoo et al., 2000).
Central to public health is the monitoring and surveillance of health data, and this should include continual monitoring following any policy intervention (Bunton et al., 2003). This enables an evaluation of the possible impact of any interventions or policies. So, following the initiatives relating to challenge 25 and parental provision of information in Suffolk, continual monitoring of the under 18s alcohol-related hospital admissions should be undertaken. It is likely that we would see decreases in the number/rate with time, however if there is no change, the role of the public health actor should be to understand why no change is occurring. It may be that the proposed interventions are not effective or are not being implemented as intended. It is their role to identify why this might be occurring (e.g. facilitators and barriers) and find ways to overcome this, involving all relevant stakeholder groups (Bunton et al., 2003). It may be worth ascertaining patient or public experience (PPE), since public opinion on policy plays an important role in ensuring policy is acceptable and feasible and is grounded in the realities of local-level human behaviour (Freire, 2018). What may be effective in one local area may not be in a second, and public health professionals need to use local data to guide and understand their own populations.
The ‘challenge 25’ intervention requires multiple stakeholders and actors to be effective which can become quite complex (The Open University, 2019f). The police, trading standards, retailers, responsible licensing authorities (including public health, child protection, crime and public order) will all need to liaise and work together (Dean et al., 2014). Though the primary responsibility falls on retailers, if the retailer violates the law and sells to someone under the legal age, then the responsible authorities (public health, health protection, crime and public disorder) will need to work together to present a legitimate legal case for the premise to have their licence revoked or the conditions of sale altered (Jones and Douglas, 2012). This can be challenging where resources or priorities across these different stakeholder groups may not always align (Bert et al., 2015). To overcome these issues, it may be useful to focus on the principle of health in all policies (HIAP) (The Open University, 2019g). HIAP is well established in public health and is increasingly recognised as important to stakeholders outside of public health such as police and crime commissioners (Bert et al., 2015). Ultimately, there is a strong financial disincentive for retailers to serve underage customers (a fine), and this has also been shown to be a powerful behaviour change stimulus.
The provision of information to parents may also come up against some barriers since parents may prefer to permit their children to drink alcohol at home and be supervised by them as opposed to a possible alternative where the children drink unsupervised and away from the home. This, while understandable, could be overcome by educating parents of the harm of alcohol to the developing brain and the finding that age of first use is strongly related to heavy drinking and alcohol problems in later life (Burton et al., 2017). More immediately, underage drinking is known to increase the risk of school truancy, drug use, antisocial behaviour, and acute poisoning (Burton et al., 2017). Again, ensuring the information campaign is effective at conveying these important findings is key to overcome any possible barriers (Jones and Douglas, 2012). The intervention could be delivered in schools and higher education settings, for example, by providing materials in school newsletters or parent-teacher conferences and sending these information campaigns out in the post or online mailing lists. The school would ultimately incur the cost of this, which may be a barrier, so public health professionals could aim to identify if money from the public health grant is available to support this health prevention activity.
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