Ill health and preventable death rates are higher in the East End than anywhere else in Britain, according to the the East London and City Health Authority.

Its annual report, published yesterday, says it is 'totally unrealistic' to try to meet the Government's national health targets because of the high levels of poverty and deprivation in boroughs such as Hackney and Tower Hamlets. Suicides, breast cancer, TB and accident rates will actually increase, it predicts.

Recent research shows one- third of east Londoners have to live on a household income of less than pounds 4,500 a year.

Dr Bobbie Jacobson, the authority's director of public health, said: 'One of the main factors that determines health in our population is poverty. I would defy anyone living on this kind of money to make ends meet and not be under

any stress.'

Deprivation levels - including the proportion of unemployed people, lone parents, people living alone and overcrowding - in Tower Hamlets have increased by 16 per cent in the past 10 years. In Newham, they have fallen by 25 per cent. In east London, an estimated 20,000 people are homeless, while unemployment levels in the 1991 census were 21 per cent. According to the census, just over a third of people in the East End were from ethnic minorities, in particular Bengalis, black Caribbeans, black Africans and other Asian groups. There is also a small Chinese population. Additionally, the number of refugees from Somalia and Eritrea is growing.

Dr Jacobson argues that the health prevention targets for east London must take account of local factors. 'We are starting from a higher level of ill health.'

The Government has identified heart disease and strokes, cancer of the lung, cervix and skin, mental health, accident prevention, Aids and sexual health among its national targets for 2000.

On all these, other than skin and breast cancer, east London has higher death rates than the national average. Death from coronary heart disease is one-third higher among the Asian than the white population.

Death rates from lung cancer are 41 per cent higher among men than the national average and deaths from cervical cancer are 27 per cent higher than nationally. In 1993, only 62 per cent of eligible women had a smear test, compared with the national average of 80 per cent.

Tuberculosis, which is not among the Government's identified targets, has also been on the increase in east London. The number of cases notified to health officials rose from 42 in 1986 to 60 in 1993 although, according to Dr Jacobson, the health authority is probably notified of only half. Although coronary heart disease and lung cancer should decrease, according to the trends, it will still be well above the national average in 2000.

TB, in particular, is asso-ciated with overcrowded and unhealthy conditions.

'We have the highest levels of overcrowding in the London area,' said Dr Jacobson. 'It harks back to the 19th century when overcrowding and poor housing caused high levels of TB. Until the Government can do more to reduce the wealth divide, we will be able to make only a small difference in reducing ill health,' she said.

(Photograph omitted)