Nick Walton | Newcastle University (original) (raw)
Papers by Nick Walton
BMJ Open, 2018
Objectives: Our central research question was, in England, are geographical inequalities in opioi... more Objectives: Our central research question was, in England, are geographical inequalities in opioid use driven by health need (pain)? To answer this question, our study examined: (1) if there are regional inequalities in rates of chronic pain prevalence, pain intensity and opioid utilisation in England; (2) if opioid use and chronic pain are associated after adjusting for individual-level and area-level confounders. Design Cross-sectional study design using data from the Health Survey for England 2011.
Setting: England.
Primary and secondary outcome measures: Chronic pain prevalence, pain intensity and opioid utilisation.
Participants: Participant data relating to chronic pain prevalence, pain intensity and opioid usage data were obtained at local authority level from the Health Survey for England 2011; in total, 5711 respondents were included in our analysis.
Methods: Regional and local authority data were mapped, and a generalised linear model was then used to explore the relationships between the data. The model was adjusted to account for area-level and individual-level variables.
Results: There were geographical variations in chronic pain prevalence, pain intensity and opioid utilisation across the English regions—with evidence of a ‘pain divide’ between the North and the South, whereby people in the North of England more likely to have ‘severely limiting’ or ‘moderately limiting’ chronic pain. The intensity of chronic pain was significantly and positively associated with the use of opioid analgesics.
Conclusions: There are geographical differences in chronic pain prevalence, pain intensity and opioid utilisation across England—with evidence of a ‘pain divide’. Given the public health concerns associated with the long-term use of opioid analgesics—and their questionable activity in the management of chronic pain—more guidance is needed to support prescribers in the management of chronic pain, so the initiation of opioids can be avoided.
European Journal of Public Health, 2017
Background Community pharmacies have been identified globally as an easily accessible and cost-e... more Background
Community pharmacies have been identified globally as an easily accessible and cost-effective platform for delivering services aimed at promoting health and preventing disease. In the light of a rapid increase in community pharmacy delivered public health services and an accompanying increase in the evidence-base, this umbrella review aimed to synthesise systematic reviews of community pharmacy public health interventions and assess their effects on population health and health inequalities.
Methods
Systematic review methodology was used to used to locate, appraise and synthesise published systematic review level evidence on the effects of community pharmacy delivered interventions on health and inequalities in health. Twenty databases were searched from the start date until January 2017. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR). Primary outcomes were conceptualised according to he Hardeman framework, and included determinants of behaviour, behavioural outcomes, physiology and biochemical outcomes, and health outcomes.
Results
Twelve systematic reviews met the inclusion criteria, and were included within the Umbrella review. The reviews summarised evidence from a variety of different community pharmacy delivered interventions including those targeting smoking, obesity, alcohol misuse, cardiovascular disease, sexual health, and cancer. Results were mixed and reviews were generally of low quality; however, there is some evidence to suggest community pharmacy delivered interventions are more effective when compared to usual care (a non-active control), although there was minimal evidence related to how such interventions target different populations and, accordingly, how they impact on inequalities in health.
Conclusions
This umbrella review has identified several community pharmacy public health interventions that could be delivered to improve health.
The European Journal of Public Health, 2017
Background Many local authorities in England have recently developed integrated health and wellb... more Background
Many local authorities in England have recently developed integrated health and wellbeing services, which combine holistic behaviour change interventions with efforts to address the wider determinants of health. Service models draw on evidence demonstrating that unhealthy behaviours tend to cluster, as well as being more prevalent in socio-economically disadvantaged groups. There is growing evidence to suggest that multiple health-related behaviours can be addressed either simultaneously or sequentially. However, little is known about the impact of these holistic approaches on health inequalities and whether they represent value for money.
Methods
An academic evaluation of the Wellbeing for Life (WFL) service in County Durham was undertaken between September 2015 and February 2017. Routine monitoring data were anonymised, extracted and analysed to examine health and wellbeing outcomes for clients (n = 1201 at post-intervention). Service costs were provided by the WFL manager and entered, along with activity and outcome data, into an established ready reckoner to estimate overall value for money.
Results
Improvements in all variables observed at the post-intervention stage were maintained, to some extent, at six and 12 months. Furthermore, there was some evidence that inequalities between the most disadvantaged clients and all others had narrowed at six months, in terms of self-rated health (EQ-5D) and mental wellbeing (SWEMWBS). The reader reckoner results indicated that the service represented value for money, with a net cost of £3,900 per quality-adjusted life year and a social return on investment of £3.59 for every £1 spent on WFL.
Conclusions
These findings suggest that interventions aiming to improve wellbeing and tackle multiple behaviours can have a positive impact on health inequalities, as well as offering health gains at costs that compare favourably with the thresholds set by both NICE and Public Health England.
Journal of Epidemiology & Community Health, 2017
Background: The return of public health to local government in England in 2013 created an opport... more Background: The return of public health to local government in England in 2013 created an opportunity to integrate preventive services with agencies that act on the wider determinants of health. A number of local authorities subsequently developed integrated health and wellbeing approaches, in recognition that the previous ‘silo’ approach to the provision of single-issue lifestyle services had made little impact on inequalities. These integrated services often involve targeting the most disadvantaged geographical and non-geographical communities locally. One example is the Wellbeing for Life (WFL) service in County Durham.
Methods: The impact of WFL was evaluated using a mixed methods study design, involving: i) ethnographic observations plus interviews and focus groups with clients (n=58), staff (n=47), volunteers (n=15) and external stakeholders (n=10); ii) secondary analysis of intervention monitoring data at baseline (n=1461 clients), three (n=1201), six (n=380) and 12 months (n=133); and iii) a value for money assessment. Primary outcome measures were the EQ-5D and short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS). Secondary outcome measures were BMI, fruit and vegetable intake, physical activity, alcohol consumption, smoking and self-efficacy.
Results: Clients reported positive experiences of engaging with the service and described making lifestyle changes, such as reducing portion sizes or trying new activities. Many would have liked a longer intervention (usually 8–12 weeks) and staff agreed that the duration was often insufficient for those with more complex physical, mental and/or social needs. Pre/post analysis of the intervention data revealed significant improvements across all outcome measures, with the largest changes observed in clients with the least positive results at baseline. These changes were largely maintained at both follow-up periods. Furthermore, reductions in the differences in EQ-5D and SWEMWBS scores between clients from the 30% most deprived communities and all other clients at the six-month follow-up stage implied that inequalities had narrowed over time. The value for money assessment indicated an estimated cost per quality-adjusted life year (QALY) of £3900 and a social return on investment of around £3.59 for every £1 spent on WFL.
Discussion: An integrated health and wellbeing approach can be acceptable to members of the target communities, encourage them to make and maintain lifestyle changes, and potentially reduce health inequalities. The WFL service appeared to represent good value for money, although the reliance on self-report data and lack of a control group were limitations of the study design. Further research is needed to establish the effectiveness of this approach over other intervention models.
Systematic Reviews, 2017
Background Community pharmacies have great potential to deliver services aimed at promoting healt... more Background
Community pharmacies have great potential to deliver services aimed at promoting health and preventing disease, and are embedded within communities. In the light of a rapid increase in community pharmacy-delivered public health services and an accompanying increase in the evidence base, this systematic review of reviews will synthesise systematic reviews of public health community pharmacy interventions and assess their effects on public health and health inequalities.
Methods/design
Systematic review methodology will be used to identify all systematic reviews that describe the health and health equity effects of community pharmacy public health interventions. Twenty databases will be searched using a pre-determined search strategy to evaluate community pharmacy-delivered public health interventions. Findings from the included reviews will be pooled, and a narrative synthesis executed to identify overarching patterns and results.
Discussion
Findings will support future decision-making around how community pharmacy public health services can be used alongside other strategies to promote health, prevent disease and reduce health inequalities.
In this paper I will be reviewing the topic of natural disaster vulnerability. Firstly I will exp... more In this paper I will be reviewing the topic of natural disaster vulnerability. Firstly I will explain why I feel that disaster research is important and also why economics is important to disaster research. I will then go onto outline the literature on the hazard vulnerability. To illustrate how hazard vulnerability is a key determinant of disaster outcomes I have used the case studies of the Bam and San Simeon earthquakes. Both Earthquakes occurred in December 2003, one in the city of Bam, south-east Iran, and the other in the counties of San Luis Obispo and Santa Barbara, California. Even though the earthquakes had similar seismic parameters the outcomes were very different, the main reason for this was the difference in the vulnerability of the two regions. The vulnerability parameters I will be analysing are: urbanisation and uncontrolled population growth, building standards, and mitigation. I will also outline how a region’s development will play a key role in determining its vulnerability. From this I will suggest possible policy implications for Iran so that in the future it may be able to reduce its exposure to hazards. One of the main aims of this paper is to illustrate that natural disasters are not so natural.
Seismic hazards pose a high risk to the Kathmandu Valley. This paper aims to assess the urban vul... more Seismic hazards pose a high risk to the Kathmandu Valley. This paper aims to assess the urban vulnerabilities of the valley, highlighting specific factors that increase risk. It also aims to evaluate the valley’s capacity to cope in the event of a powerful earthquake. To do this, this paper will firstly highlight how ‘natural disasters’ are not in fact natural and the threat to development they present. Hazards pose a risk to all nations, but this risk is especially high for developing countries. A literature review of the elements that determine risk will be presented, focusing on vulnerability, capacity, risk behaviour and school safety. The risks posed to the valley as well as the mitigation work of the National Society for Earthquake Technology (NSET) and Nepal Red Cross Society (NRCS) to reduce these risks will be analysed. The School Earthquake Safety Programme (SESP) is one of NSET’s main divisions. The work of SESP and DPSS (Disaster Preparedness for Safer Schools) I & II to reduce risk in 23 schools will be evaluated with cost-benefit analysis. This will determine the long term benefits of these programmes and assess their cost-effectiveness. Finally, this paper will bring all these factors together to provide policy implications for disaster risk management organisations.
BMJ Open, 2018
Objectives: Our central research question was, in England, are geographical inequalities in opioi... more Objectives: Our central research question was, in England, are geographical inequalities in opioid use driven by health need (pain)? To answer this question, our study examined: (1) if there are regional inequalities in rates of chronic pain prevalence, pain intensity and opioid utilisation in England; (2) if opioid use and chronic pain are associated after adjusting for individual-level and area-level confounders. Design Cross-sectional study design using data from the Health Survey for England 2011.
Setting: England.
Primary and secondary outcome measures: Chronic pain prevalence, pain intensity and opioid utilisation.
Participants: Participant data relating to chronic pain prevalence, pain intensity and opioid usage data were obtained at local authority level from the Health Survey for England 2011; in total, 5711 respondents were included in our analysis.
Methods: Regional and local authority data were mapped, and a generalised linear model was then used to explore the relationships between the data. The model was adjusted to account for area-level and individual-level variables.
Results: There were geographical variations in chronic pain prevalence, pain intensity and opioid utilisation across the English regions—with evidence of a ‘pain divide’ between the North and the South, whereby people in the North of England more likely to have ‘severely limiting’ or ‘moderately limiting’ chronic pain. The intensity of chronic pain was significantly and positively associated with the use of opioid analgesics.
Conclusions: There are geographical differences in chronic pain prevalence, pain intensity and opioid utilisation across England—with evidence of a ‘pain divide’. Given the public health concerns associated with the long-term use of opioid analgesics—and their questionable activity in the management of chronic pain—more guidance is needed to support prescribers in the management of chronic pain, so the initiation of opioids can be avoided.
European Journal of Public Health, 2017
Background Community pharmacies have been identified globally as an easily accessible and cost-e... more Background
Community pharmacies have been identified globally as an easily accessible and cost-effective platform for delivering services aimed at promoting health and preventing disease. In the light of a rapid increase in community pharmacy delivered public health services and an accompanying increase in the evidence-base, this umbrella review aimed to synthesise systematic reviews of community pharmacy public health interventions and assess their effects on population health and health inequalities.
Methods
Systematic review methodology was used to used to locate, appraise and synthesise published systematic review level evidence on the effects of community pharmacy delivered interventions on health and inequalities in health. Twenty databases were searched from the start date until January 2017. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR). Primary outcomes were conceptualised according to he Hardeman framework, and included determinants of behaviour, behavioural outcomes, physiology and biochemical outcomes, and health outcomes.
Results
Twelve systematic reviews met the inclusion criteria, and were included within the Umbrella review. The reviews summarised evidence from a variety of different community pharmacy delivered interventions including those targeting smoking, obesity, alcohol misuse, cardiovascular disease, sexual health, and cancer. Results were mixed and reviews were generally of low quality; however, there is some evidence to suggest community pharmacy delivered interventions are more effective when compared to usual care (a non-active control), although there was minimal evidence related to how such interventions target different populations and, accordingly, how they impact on inequalities in health.
Conclusions
This umbrella review has identified several community pharmacy public health interventions that could be delivered to improve health.
The European Journal of Public Health, 2017
Background Many local authorities in England have recently developed integrated health and wellb... more Background
Many local authorities in England have recently developed integrated health and wellbeing services, which combine holistic behaviour change interventions with efforts to address the wider determinants of health. Service models draw on evidence demonstrating that unhealthy behaviours tend to cluster, as well as being more prevalent in socio-economically disadvantaged groups. There is growing evidence to suggest that multiple health-related behaviours can be addressed either simultaneously or sequentially. However, little is known about the impact of these holistic approaches on health inequalities and whether they represent value for money.
Methods
An academic evaluation of the Wellbeing for Life (WFL) service in County Durham was undertaken between September 2015 and February 2017. Routine monitoring data were anonymised, extracted and analysed to examine health and wellbeing outcomes for clients (n = 1201 at post-intervention). Service costs were provided by the WFL manager and entered, along with activity and outcome data, into an established ready reckoner to estimate overall value for money.
Results
Improvements in all variables observed at the post-intervention stage were maintained, to some extent, at six and 12 months. Furthermore, there was some evidence that inequalities between the most disadvantaged clients and all others had narrowed at six months, in terms of self-rated health (EQ-5D) and mental wellbeing (SWEMWBS). The reader reckoner results indicated that the service represented value for money, with a net cost of £3,900 per quality-adjusted life year and a social return on investment of £3.59 for every £1 spent on WFL.
Conclusions
These findings suggest that interventions aiming to improve wellbeing and tackle multiple behaviours can have a positive impact on health inequalities, as well as offering health gains at costs that compare favourably with the thresholds set by both NICE and Public Health England.
Journal of Epidemiology & Community Health, 2017
Background: The return of public health to local government in England in 2013 created an opport... more Background: The return of public health to local government in England in 2013 created an opportunity to integrate preventive services with agencies that act on the wider determinants of health. A number of local authorities subsequently developed integrated health and wellbeing approaches, in recognition that the previous ‘silo’ approach to the provision of single-issue lifestyle services had made little impact on inequalities. These integrated services often involve targeting the most disadvantaged geographical and non-geographical communities locally. One example is the Wellbeing for Life (WFL) service in County Durham.
Methods: The impact of WFL was evaluated using a mixed methods study design, involving: i) ethnographic observations plus interviews and focus groups with clients (n=58), staff (n=47), volunteers (n=15) and external stakeholders (n=10); ii) secondary analysis of intervention monitoring data at baseline (n=1461 clients), three (n=1201), six (n=380) and 12 months (n=133); and iii) a value for money assessment. Primary outcome measures were the EQ-5D and short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS). Secondary outcome measures were BMI, fruit and vegetable intake, physical activity, alcohol consumption, smoking and self-efficacy.
Results: Clients reported positive experiences of engaging with the service and described making lifestyle changes, such as reducing portion sizes or trying new activities. Many would have liked a longer intervention (usually 8–12 weeks) and staff agreed that the duration was often insufficient for those with more complex physical, mental and/or social needs. Pre/post analysis of the intervention data revealed significant improvements across all outcome measures, with the largest changes observed in clients with the least positive results at baseline. These changes were largely maintained at both follow-up periods. Furthermore, reductions in the differences in EQ-5D and SWEMWBS scores between clients from the 30% most deprived communities and all other clients at the six-month follow-up stage implied that inequalities had narrowed over time. The value for money assessment indicated an estimated cost per quality-adjusted life year (QALY) of £3900 and a social return on investment of around £3.59 for every £1 spent on WFL.
Discussion: An integrated health and wellbeing approach can be acceptable to members of the target communities, encourage them to make and maintain lifestyle changes, and potentially reduce health inequalities. The WFL service appeared to represent good value for money, although the reliance on self-report data and lack of a control group were limitations of the study design. Further research is needed to establish the effectiveness of this approach over other intervention models.
Systematic Reviews, 2017
Background Community pharmacies have great potential to deliver services aimed at promoting healt... more Background
Community pharmacies have great potential to deliver services aimed at promoting health and preventing disease, and are embedded within communities. In the light of a rapid increase in community pharmacy-delivered public health services and an accompanying increase in the evidence base, this systematic review of reviews will synthesise systematic reviews of public health community pharmacy interventions and assess their effects on public health and health inequalities.
Methods/design
Systematic review methodology will be used to identify all systematic reviews that describe the health and health equity effects of community pharmacy public health interventions. Twenty databases will be searched using a pre-determined search strategy to evaluate community pharmacy-delivered public health interventions. Findings from the included reviews will be pooled, and a narrative synthesis executed to identify overarching patterns and results.
Discussion
Findings will support future decision-making around how community pharmacy public health services can be used alongside other strategies to promote health, prevent disease and reduce health inequalities.
In this paper I will be reviewing the topic of natural disaster vulnerability. Firstly I will exp... more In this paper I will be reviewing the topic of natural disaster vulnerability. Firstly I will explain why I feel that disaster research is important and also why economics is important to disaster research. I will then go onto outline the literature on the hazard vulnerability. To illustrate how hazard vulnerability is a key determinant of disaster outcomes I have used the case studies of the Bam and San Simeon earthquakes. Both Earthquakes occurred in December 2003, one in the city of Bam, south-east Iran, and the other in the counties of San Luis Obispo and Santa Barbara, California. Even though the earthquakes had similar seismic parameters the outcomes were very different, the main reason for this was the difference in the vulnerability of the two regions. The vulnerability parameters I will be analysing are: urbanisation and uncontrolled population growth, building standards, and mitigation. I will also outline how a region’s development will play a key role in determining its vulnerability. From this I will suggest possible policy implications for Iran so that in the future it may be able to reduce its exposure to hazards. One of the main aims of this paper is to illustrate that natural disasters are not so natural.
Seismic hazards pose a high risk to the Kathmandu Valley. This paper aims to assess the urban vul... more Seismic hazards pose a high risk to the Kathmandu Valley. This paper aims to assess the urban vulnerabilities of the valley, highlighting specific factors that increase risk. It also aims to evaluate the valley’s capacity to cope in the event of a powerful earthquake. To do this, this paper will firstly highlight how ‘natural disasters’ are not in fact natural and the threat to development they present. Hazards pose a risk to all nations, but this risk is especially high for developing countries. A literature review of the elements that determine risk will be presented, focusing on vulnerability, capacity, risk behaviour and school safety. The risks posed to the valley as well as the mitigation work of the National Society for Earthquake Technology (NSET) and Nepal Red Cross Society (NRCS) to reduce these risks will be analysed. The School Earthquake Safety Programme (SESP) is one of NSET’s main divisions. The work of SESP and DPSS (Disaster Preparedness for Safer Schools) I & II to reduce risk in 23 schools will be evaluated with cost-benefit analysis. This will determine the long term benefits of these programmes and assess their cost-effectiveness. Finally, this paper will bring all these factors together to provide policy implications for disaster risk management organisations.