A paper, The Tory Health Lottery - Getting to the Heart of the Matter, claims that 40 per cent of district health authorities in England will not meet the Government's Health of the Nation targets and some are getting worse rather than improving.
Excluding some London district health authorities, there is a clear North- South divide in the distribution of mortality rates for coronary heart disease. The worst DHAs identified in 1994 also figure prominently in the worst DHAs over the period covering 1984 to 1994.
Coronary heart disease is a principal cause of premature death. In 1994 nearly 18,000 men and women under 65 died from the disease in England - a higher rate than in most industrialised countries.
The five worst districts were Manchester, Rotherham, Liverpool, Sandwell and South Durham, whose mortality rates range from 82 to 71 deaths per 100,000 - nearly 60 per cent above the national average of 45 per 100,000, the report says.
Compared with that the least affected areas were West Surrey (29), Cambridge (30), Oxfordshire (30), East Sussex (31) and Northamptonshire (33). With the exception of east London and the City the 20 worst affected areas are in the North and the 20 least affected are in the South. Even within some regions there is a wide disparity - the death rate in the worst district double that in the best.
In the North-west, Manchester (82) had double the rate of Morecambe Bay (41) and in North Thames area, east London (66) had double the rate of Barnet (33), in north London.
Of the 105 DHAs in England, 42 will not meet the target of reducing mortality rates between 1990 and 2000. And of the 49 DHAs with above average mortality rates in 1994, three- quarters will fail to meet their targets, meaning that the worst DHAs for heart disease are also showing the least improvement. Rotherham, Sandwell, Exeter and North Devon, Huntingdon and Herefordshire DHAs have actually seen an increase in mortality rates.
Projecting the annual average rate of change to 2000, many DHAs will remain significantly above the target of 35 deaths per 100,000 population.
Labour's analysis shows the extent and persistence of high death rates concentrated in relatively small numbers of DHAs,Henry McLeish, the party's health spokesman, said. "The dramatic variations in mortality rates between DHAs in England and DHAs within, and between, regions reinforce the findings of the Audit Commission report which said access to treatment, such as coronary artery bypass operations, depends on where you live, and more lives could be saved through well-focused preventative treatment and care."
The Audit Commission recently reported that better measures to prevent and treat the disease could save up to 8,000 more lives a year by 2000.