‘I’d rather go with a heart attack than drag on’: lay images of heart disease and the problems they present for primary and secondary prevention

Current public health policy emphasizes the importance of primary and secondary prevention of coronary heart disease (CHD). However, evidence on the effectiveness of health advice to modify behavioural risk factors to date is discouraging. This lends urgency to understanding more about the public’s perceptions of the causes and consequences of heart disease, and particularly any barriers to adopting less coronary prone behaviours. Using data from a qualitative study of heart disease amongst 61 men and women living in the west of Scotland, we draw attention to a powerful image that recurred when people were weighing up their decisions about health-related behaviours and appeared to undermine people’s preparedness to change their lifestyle. This is the image of CHD as a ‘good way to go’, typically described in contrast to a painful and lingering death, usually from cancer. Two elements of this characterization of CHD as a ‘more desirable’ way to die were apparent: in some deaths (particularly those occurring prematurely) its ‘quickness’ was emphasized; and in deaths amongst older people a heart attack was often portrayed as an inevitable and ‘natural’ way of dying from ‘old age’.