As in most other countries, England has no explicit alcohol licensing objective around health, so objections to applications tend to focus on the traditional concerns of crime and public disorder. We examined the practicalities of using health-related information in local licensing decisions and the prospects for a dedicated health-associated licensing objective. Seven local authority pilot areas were purposively selected and provided with a compendium of health information (Public Health England Toolkit), including data-access agreements and mapping software. A series of ‘mock licensing hearings’ explored practical challenges in using health data. Key informants were interviewed at baseline and 10–12 weeks after receiving the Toolkit. Access to localised health information was problematic, and there was a mismatch between a ‘data-orientated approach’ and the need for contextualised evidence. Perceived difficulty in proving that a new licence would damage health discouraged challenges on health grounds. Constraints in using health information in alcohol licensing are not restricted to the absence of a dedicated health-associated licensing objective. While the latter may enhance the legitimacy of public health participation, improved access to localised health information, stronger collaborative working and training in how to contextualise evidence, will all be critical to better alcohol harm reduction through licensing decisions.