Harms and Health Inequalities in the Night-Time Economy: A Qualitative Exploration of Professional Stakeholders' Experiences and Explanations.

Goods and services consumed in the night-time economy (NTE) are associated with adverse health outcomes. These outcomes are more prevalent in areas with greater deprivation and among minoritized population subgroups. This study was aimed at exploring the views of local authority stakeholders on the harms and health inequalities in the NTE. We focused on inequalities from alcohol and gambling, their relationship with the NTE and how different forms of power might underpin the inequalities generated. We interviewed 17 local authority and third sector stakeholders from two case study areas (Swindon and Derby) who had a professional remit for the night-time economy. Data were analyzed using framework analysis using McCartney's Sources of Power as a guiding framework for the analytical narrative. Participants highlighted the cumulative impact of years of economic decline in the NTE and resultant tension between local authorities' public health and economic priorities. For instance, the economic benefits of alcohol licenses were felt to be prioritized over potential adverse health outcomes. Collaboration and the adoption of a whole-system approach were suggested as ways of reducing harms in the town centers and improving users' perceived safety. However, frustration was expressed at the lack of flexibility in how funds could be spent and the need to give local authorities more power to allocate funds according to the area's unique challenges. Stakeholders identified that different population sub-groups had varying experiences in using the NTE in their local authorities and consequently had different requirements for what the NTE should ideally offer. Participants highlighted a need for future NTE spaces to accommodate all members of the different communities it serves. This is one of the few qualitative studies that explores the wider contextual factors that underpin persistent inequalities in harms associated with unhealthy commodities. Our findings can be used to help policymakers inform their decision-making process to address these harms and inequalities.