Health Secretary Frank Dobson has handed Bradford and Keighley a chance to make significant inroads into the serious ill health of thousands by making the district a Health Action Zone. Health Reporter Mike Waites looks at the problems and how health chiefs plan to tackle them.

Ministers considering Bradford's bid to become a Health Action Zone could not fail to have been shocked by the scale of ill health facing local people - and the huge inequalities between different areas.

The district overall is the fourth most deprived outside London and the most deprived in Yorkshire and the North East, but this masks parts of inner city Bradford and Keighley where levels of illness are far worse.

In some parts diabetes is four times more common than the national average, while deaths from heart disease are more than double.

Already 190,000 people - two in five - are classified as deprived, and unless action is taken problems are likely to be exacerbated in years to come with further pressures on services through an increase in the population likely to rise by 25,000 to 511,000 within 15 years.

Poverty, poor housing and environmental conditions and social isolation have all been identified as key causes of the poor health in particular heart disease, respiratory illness, mental health, teenage pregnancies and drug misuse.

Now health chiefs believe the Health Action Zone with its £3-4 million pot of cash offers the chance to make a real difference to inequalities between the inner city and the rest of the district, with action aimed not just at improving the health service but involving a range of related organisations including business, the voluntary sector and regeneration agencies.

The problems of health in inner city Bradford are familiar to Girlington GP, Dr Martin Taylor.

Poor health in his patients was often passed on from generation to generation and action within the health service was not enough to tackle deep-rooted problems.

A lot of money could be spent on educating people about health without changing outcomes, and messages had to be constructive to engage people, he said.

"Bradford's inner city is no different to any other - there are a lot of people who don't have any personal resources, either financial or otherwise," he added.

"Many of the problems are fairly intractable and move from generation to generation so that parents with poor health, no job, poor housing and bad experiences in their lives visit those same experiences on children who very early have children themselves.

"Many improvements in health have historically always been in the area of improving people's standards of living. The trouble is some people are left behind and it is those people we tend to be dealing with.

"It's wonderful that Bradford has secured extra resources. I'm sure there is action that can be taken but it is a difficult task - most of the benefits lie in changes outside the control of doctors."

Inner-city GPs will be among those specifically targeted under HAZ plans with improvements to facilities and services covering more than 30 practices within a year.

New targets will be set for prescribing, vaccination, immunisation, smear test screening and management of common and serious diseases - asthma, epilepsy, heart disease and diabetes.

Diabetes will in itself be a major target for the HAZ, and the work already carried out in Bradford on the horrendous scale of the problem has been singled out for praise by health secretary Frank Dobson.

There are about 12,000 diabetics diagnosed across the district with the condition which is a major cause of heart disease, blindness and disability, and is particularly common among the Asian community.

Health chiefs estimate there are probably as many as 3,500 people undiagnosed who could put a massive strain on health resources in years to come unless the condition is detected.

Plans drawn up by health chiefs include targeting of health promotion to specific schools, a campaign of early detection and the creation of 15 local diabetic centres.

Diabetic Yunis Chowdery, 66, of Allerton, Bradford, has long been involved in efforts in Bradford to make people more aware of the condition.

He was diagnosed with diabetes more than 20 years ago, inheriting it from his mother who died of complications from the illness, and knows there are hundreds of people in the Bradford area who risk similar serious consequences unless it is treated.

"It is a very alarming situation," he said. "If you have diabetes, you want to look after yourself otherwise it's fatal.

"There are so many side-effects but you can control it if you know what you are doing with things like medication, eating habits and exercise.

"With the National Health Service people have got so much going for them - the problem is getting the message across to them. Some don't know diabetes is a killer disease."

Another immediate focus lies in improving recuperation and rehabilitation to tackle problems offering support to sick and injured people when they leave hospital.

Some people are currently needlessly placed in residential and nursing homes because of a lack of attention to their rehabilitation and recuperation needs.

This inefficient use of resources puts pressure on budgets and leads to poor quality care in some cases, and now budgets will be pooled breaking down barriers and red tape between various care organisations to try to organise services better.

A number of teams of community rehabilitation staff will be created and medical input into residential homes and day centres will be extended.

Bradford Council Director of Social Services Liam Hughes said the HAZ gave Bradford an unprecedented opportunity to look to the future.

"We have been used to solving problems after they have occurred," he said. "What we want to do is get in early to look to the longer term, make improvements for many years ahead."

Health chiefs - and perhaps more importantly Government ministers - expect to see reduced, or at least levelled out, rates of illness and significant and demonstrable improvements to services by the end of the seven-year process.

Health Action Zone status is a significant coup for Bradford - now all eyes will be on how much can be achieved.

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