Bradford has one of the worst heart disease records in the country, and tackling it is a major problem. On Monday, the Government announced the National Service Framework on Coronary Heart Disease, a new programme to tackle Britain's biggest killer. But death rates from the condition are currently ten per cent higher in Bradford than the national average. Suzy Poole talks to the district's health chiefs to find out what is being done to tackle the issue.

IN THE early 1990s, health officials in Bradford realised they had a problem.

More people were dying and suffering from coronary heart disease (CHD) in the district than in most other parts of the country.

In 1988, 145 out of 100,000 people in Bradford were diagnosed with the condition compared to an average 111 in England and Wales and 133 in the Northern and Yorkshire region as a whole.

Nine years later, CHD was still the main cause of early death in the district with nearly 550 people under 74 dying each year from the disease - 30 per cent more than the national average.

The launch of the Government's new health strategy on Monday may have brought heart disease back into the news, but Bradford Health Authority's Director of Public Health, Dr Dee Kyle, says they have been fighting the district's biggest killer for more than ten years.

"It's an enormous problem and the biggest cause of death in the elderly and of early death (before 65-years-old)," she said.

"We were aware in 1993 that heart disease was a major problem. But just because Bradford has a very high death rate from CHD, it doesn't mean that we're not doing anything about it.

"It's undeniably true that it's not only a problem overall but that it's a bigger problem for more disadvantaged communities and that's part of the reason we are above the national average."

Heart disease is caused by fatty deposits blocking the arteries which feed the heart, damaging the heart muscle. The condition can lead to angina, sharp pains in the left chest, left arm and sometimes in the neck.

The root of the problems in Bradford lies in the fact that it is a complex illness to beat.

Surprisingly, only 40 per cent of heart disease is caused by the well-known risks of an unhealthy diet, lack of exercise and smoking. Others are caused by a combination of factors which make it more difficult to prevent such as poverty and genetics.

CHD deaths are about 50 per cent higher in areas of Bradford with low income, unemployment and poor housing. Deaths amongst Bradford's South Asian communities are also about one third higher than for the district's population as a whole. And associated diseases such as diabetes, also prevalent in Bradford, contribute to the high risk in the area.

"We need to narrow the gap," said Dr Kyle. "The more articulate, better educated and wealthier people find it easier to live a healthier lifestyle, to take exercise, have the right diet and give up smoking. And they access treatment and services.

"Those people who live in areas of disadvantage have many other things that have an impact on them. They're struggling with basics such as food and shelter and can't even stop to think about taking exercise. We have more emergency admissions from the South Asian community because they haven't accessed treatment before."

To tackle inequalities, the health authority launched Heartsmart in 1992, a unique collaboration with Bradford council. Special projects have included Gardening for Health, an allotment project on Queens Road where women have reclaimed derelict land and grown common garden vegetables as well as herbs found in Bangladesh.

And in 1995, the health project launched Bradford's Exercise on Prescription Scheme (BEEP)where physical exercise is available 'on prescription' to those at risk from strokes or heart disease who could not normally afford to access sports facilities.

Heartsmart manager Jane Thompson said such projects aimed to cover a wide range of issues, not just health.

She said: "Gardening for Health is a specific project which looks at exercise, but it also addresses isolation, healthy eating and access to fresh food. It's particularly aimed at Bangladeshi women. We are trying to get services more accessible."

As an Health Action Zone, Bradford has also received advanced funding for a smoking cessation scheme delivering basic and intensive counselling to those who are desperate to quit.

To an extent, Bradford Health Authority have pre-emptied the Government's fight against heart disease by producing its own strategy to prevent deaths.

But Bradford Royal Infirmary's consultant cardiologist, Dr Chris Morley claims that the biggest improvement in death rates has been advances in technology and welcomed the Government's announcement of extra funding for 50 extra chest clinics across the country.

He said: "Modern coronary care delivered from hospitals is having the biggest impact on saving lives than the preventative measures.

"A year ago we were awarded funding from the Health Authority for a chest clinic but it was withdrawn by the Department of Health at the last minute. With the national service framework, we hope to be one of the first in the country to have the clinic. We already have a business plan and an expert consultant in the area and we're champing at the bit.

"Bradford deserves it as we have one of the worst rates of heart diseases in the country, if not the world."

He added that the next step would be an improved angiogram service and eventually to establish Bradford as the next centre for heart surgery.

Latest figures show deaths in Bradford from heart disease have been reduced by 19 per cent since 1992, but it remains Bradford's biggest killer.

And despite advances in technology, planning and education, Dr Kyle knows she cannot afford to ignore it.

"I do welcome the national service framework and we can now fit our strategy into it. The good news is that we have been reducing deaths through some of the things we have done, but we are not complacent."

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