Stereotypes that contradict health advice are rare

When it comes to promoting healthier lifestyles, getting past the stereotypes is often a major challenge. Every time you say “Don’t smoke” someone will point to ‘Uncle Norman’, a familiar male figure who ignores medical advice and lives to tell the tale. Suggesting regular exercise provokes a debate on ‘the Last Person’ (you’d expect), who dies at a young age from a heart attack despite taking medical advice and living an exemplary lifestyle.

Researchers from the Medical Research Council Social and Public Health Sciences Unit at the University of Glasgow have now shown that these two stereotypes do exist, but are few and far between.

In a survey of 6000 Scottish men who were first studied in the 1970s and followed up for more than 25 years, they identified a group of 193 overweight, heavy smokers normally considered at high risk from a heart attack. Only half of these survived to the age of 70; around a quarter still died of a heart attack before that age.

Among the ‘low risk’ group of 337 men who had never smoked and who were the correct weight, the mortality rate was very low. Only 12 people, or one in 25, died of heart disease before the age of 70.

The majority of these ‘Last Person’ deaths were associated with other less obvious risks for heart disease, such as poor lung function, diabetes, previous heart disease and poorer social circumstances. Similarly, three quarters of the surviving ‘Uncle Normans’ had protective factors such as being taller and having lower cholesterol levels.

“Our assessment shows that the ‘Last Person’ is indeed a rare occurrence but looms large in public consciousness because such deaths are dramatic, unexpected and premature,” notes Dr Kate Hunt, one of the study’s senior researchers. “In addition to the trauma to immediate families and friends, such deaths often make a large impact locally and nationally through media coverage.”

Dr Carol Emslie, another investigator, adds, “‘Uncle Norman’ is not as common as people think, but it is true that there is a very small group of men who appear relatively immune to coronary disease risks. It is important for health promotion to acknowledge the existence of ‘Uncle Norman’ while emphasising that general healthy living advice is relevant to the vast majority of us.”

‘The Last Person’ and ‘Uncle Norman’ are both real people, but they are both rare. What is more important is the huge difference in coronary mortality between men at high and low risk. Using ‘Uncle Norman’ or ‘the Last Person’ to defend a poor lifestyle is dangerous – they are both outsiders. You should not bet against the established risk factors for heart disease.