By Simon Kuper:
In the early years after the second world war, health researchers in Britain noticed a curious epidemic: people had begun dying of heart attacks in unprecedented numbers. Nobody knew why, and so a scientist in London named Jerry Morris set up a vast study to examine the heart-attack rates in people of different occupations – schoolteachers, postmen, transport workers and more.
Morris is today a neat, bird-like man who uses a cane to get around. He turns 100 next May but still regularly makes his way to his poky little office at the London School of Hygiene and Tropical Medicine. It is here that he describes the day he saw the data that changed medicine. “The very first results we got were from the London busmen,” says Morris, in Glaswegian tones undimmed by seven-odd decades in London. “And there was a striking difference in the heart-attack rate. The drivers of these double-decker buses had substantially more, age for age, than the conductors.”
The data were so telling because drivers and conductors were men of much the same social class. There was only one obvious difference between them. “The drivers were prototypically sedentary,” explains Morris, “and the conductors were unavoidably active. We spent many hours sitting on the buses watching the number of stairs they climbed.” The conductors ascended and descended 500 to 750 steps per working day. And they were half as likely as the drivers to drop dead of a sudden heart attack.
Today, almost everyone understands that physical exercise can help prevent heart disease, as well as cancer, diabetes, depression and much else besides.But on that day in 1949 when Morris looked at the bus data, he was the first person to see the link. He had inadvertently – “mainly luck!” – stumbled on a great truth about health: exercise helps you live longer.
That’s a truth even more relevant in 2009 than it was in 1949, because so few of us now perform vigorous physical tasks as part of daily life. If present generations are going to live longer, we must exercise. But if that depends on us getting on rowing machines in our spare time, it won’t happen.
Morris is not simply a man with a mission – he is a man with several missions. But since reading those numbers about busmen, he has wanted to help everyone exercise more. Then we might live lives something like his.
Morris grew up in the lost world of the Southside of Glasgow “in a two-bedroom-and-kitchen house, father, mother and three boys”, he recalls. “We were next door to a slum street. I still remember the screaming women on Friday night and Saturday night, when they were beaten by their drunk husbands. As you can imagine, I have a contact with social inequalities and with poverty that most of my colleagues know from the literature.”
He began exercising in early childhood. “My father used to take me on a four-mile walk from Glasgow once a week, when I was a schoolboy. We used to aim to do the four miles in an hour. If we did that OK, I got an ice-cream. If we did it in even a minute less, I got a choc-ice.
“Many years later, when I became interested in these things, I challenged him, and he had no idea where he got this four miles an hour from. I was eager for a quote, you see. And he couldn’t produce it. Except, ‘It’s always been a habit.’”
Morris warbles a line from a song: “‘What comes naturally…’ This is from one of my favourite musicals. ‘Na-tu-rally.’ It’s probably from Guys and Dolls.”
In Morris’s own words, he always was a “do-gooder”. He once went to his local Labour MP to volunteer for campaign work, but was rejected on the grounds of being 12 years old. He joined Labour aged 16 in 1926, and remains a due-paying member, despite breaking with the party over the Iraq war. “I remember writing to Blair: ‘How many of your cabinet have even seen the Blitz?’ None, is the answer. I was in London during the Blitz. Since 2003, I have voted Green.”
But he remains obsessed with the old Labour issue of inequality in health. From the neat paper trays that cover his office, he ferrets out one of his recent reports: “Minimum income for healthy living: Older people.” Morris’s office features none of the awards or pictures of handshakes that you see in many old men’s playrooms. Other than some obituaries of dear colleagues on his noticeboard, this is a working person’s office. He has even organised our lunch himself: a cheese-and-tomato sandwich, a slice of cake and an orange juice await me.
When Morris went into medicine, he took a novel approach: he wanted to know why different kinds of people got different diseases. Epidemiology, as this science is now called, barely existed then. In the 1930s, he became obsessed with juvenile rheumatism. His boss, a fashionable Harley Street doctor who also worked at Eton College, remarked that he never saw a case at Eton. Morris dryly calls this “a good clinical observation”. Only the poor got juvenile rheumatism.
He spent most of the war as a military doctor in India. “We ran a first-class hospital in the swamps of Assam in the middle of the summer, where you got boiled alive the moment you woke up.” Demobbed afterwards in London, he landed in a golden age of British medical research. During the war, researchers in Oxford had helped develop penicillin. After it, Morris’s political hero, Nye Bevan, created the National Health Service, the world’s first completely free healthcare system. And what epidemiology there was in the world was led by Britain. In 1950, another London health researcher, Richard Doll, published a study showing that smoking – and not Tarmac or car fumes, as many had suspected – was causing the new epidemic of lung cancer.
Only occasionally in conversation do you get a hint that Morris is a man from a bygone age. Usually it’s when he uses extinct language, such as “refectory” for restaurant, or “pumping ship” for going to the toilet. Otherwise, he keeps up so well that he could probably win current-affairs quizzes. Yet he says: “I feel like a displaced person, in many ways. On the one hand, I’m a 2009 person. On the other hand I’m a 1940s person.”
. . .
“The 1940s was the generation that said ‘Yes we can.’ You need a national health service? You go out and do it. Eating fruit and vegetables – in the 1940s, they would have got the best brains in nutrition, in retail, in agriculture, and said: ‘Go away to the Hebrides and don’t come back until you’ve got us a national programme that’s easy for everybody every day.’”
Morris’s own mission of the late 1940s was heart disease. He spent “interminable hours” reading the wonderful postmortem folios of the London Hospital in the East End for 1907 to 1949. But he still couldn’t understand why heart attacks were increasing.
“We were in the fortunate situation,” he says, “that very little research had been done on it. It might be hard for you to imagine a time when heart attack wasn’t a major preoccupation of everybody.” Today, heart disease is the most common cause of death in western countries.
“The only hunch I had was that this might be related to occupation. It was commoner in men than women, it was commoner as middle age advanced, and there were some hints in the national statistics of mortality that it might be connected in some way to occupation.” The busmen’s data were fascinating, and the sample size was thousands of men. But Morris didn’t treat it as proof of anything. In what he has called “one of the tensest moments of my professional life”, he had to wait for data to arrive for other occupations. Finally, he got the figures for postal workers. “It was strikingly similar!” he says. The postmen who delivered the mail by bike or on foot had fewer heart attacks than sedentary men who served behind counters or as telephonists and clerks. It was true: exercise prevented heart disease.
And yet Morris sat on his data for years. If there were flaws in his theory, he was determined to find them before anyone else could. “We set about destroying this observation,” he says. “We brought in outside people with no blood in their veins, no interest, to destroy it.” But they couldn’t. His paper (“Coronary heart-disease and physical activity of work”) finally appeared in The Lancet in 1953. His hypothesis, as he still called it, was greeted with general disbelief. What could exercise possibly have to do with heart attacks? True, there had always been a vague belief that exercise was good for the soul. Mens sana in corpore sano (“a healthy mind in a healthy body”), the Roman poet Juvenal had written nearly two millennia before Morris, possibly with satirical intent, and the Victorians fetishised team spirit and muddy playing fields. But before Morris, nobody knew that exercise stopped people dying.
Even he had no idea how exactly the mechanism worked. Only after his paper appeared did the physiologist Henry Taylor sit him down for a solid day in a Washington hotel room and, in Morris’s words, “schoolboy-taught me the physiology of exercise”. Morris thinks the essential story is simple: “Exercise normalises the workings of the body.” Humans were meant to keep active.
With hindsight, his London bus drivers inhabited one of the first societies on earth where exercise was ceasing to be part of daily life. Technology was letting people grow slothful. Even in the 1950s, Morris foresaw that when poor countries developed, they would have the same problems. He remembers warning then: “Their time will come to develop these diseases, and not to make the mistakes that we made, eg a lack of exercise, eg smoking, eg our lousy diets. Of course, nobody paid any attention.” Today, India has the world’s worst diabetes epidemic, and in parts of rural Kenya, the prevalence of angina has reached levels found in inner-city Glasgow.
. . .
Clearly, if modern humans were going to exercise, it would have to be in their spare time. But would they? After his initial studies of occupations and heart attacks, Morris embarked on a large-scale study of British civil servants, to find out whether they did.
This was in the days before computers. Morris remembers: “I think of a room in this school, with the floor consisting of piles of documents. Men of this age, men of that age, men doing this kind of exercise or that. Going through all of these documents to extract the cyclists, then going through all the cyclists to extract those who cycle to work. Three very respectable ladies would spend days and days, and another lady would check they were not cutting corners. Changing a hypothesis now, in the computer age, is a matter of a twiddle on the knobs. Changing a hypothesis when we were doing important work was a major enterprise.”
Because the civil servants in his study were middle-class British males, 91 per cent were gardeners. “It’s what keeps us sane,” they repeatedly told Morris’s team. Morris had thought gardening would protect them from heart disease. It turned out not to. Only vigorous exercise, such as swimming or playing football, was enough.
These findings were made in an era when many British adults got no exercise beyond lighting cigarettes. Morris, however, applied all the new epidemiological findings to himself. Long a “stress smoker”, he read Doll’s studies and quit cigarettes even before Iain Macleod, the health minister, held the famous press conference in which he confirmed Doll’s findings while chain-smoking throughout. Morris also began to jog. “I was the first person to run on Hampstead Heath, in the 1960s. Every Sunday morning, if the weather was at all possible, I took off my coat, and my little boy carried my coat, I took off my jacket and my little girl carried my jacket, and I ran for 20 minutes. People thought I was bananas.”
Morris has been a habitual exerciser for many decades. “It’s the only way in which I feel entitled, as an old buffer, to give advice to people. I’m constantly being asked: ‘Your long life, what would you advise?’ and so forth. To start telling other people what to do – I’m very reluctant. Except on exercise, where to a large extent I feel it’s what I’ve done myself that’s contributed to longevity. For decades I had a pulse-rate of 52.” Even today, Morris is often to be found shuffling up and down stairs at the London School.
Since he discovered exercise, medical researchers have established that it is good not just for the heart but for almost everything. “Exercise is a universal for health,” Morris likes to say. By now, most people have got the message. Some of them even exercise. Did Morris improve the world by encouraging the habit? “That’s a very generous qualification.”
Surely he got people to exercise more?
“I suppose so. And failed in many respects with my own friends.”
Morris is not a man who likes to waste time celebrating himself. When friends planned a great academic party for his 90th, he was very anxious that it should be a proper scientific conference, and not just a bunch of people in smart clothes standing up and saying what a good chap he was. But when he discusses the limited take-up of exercise he is being frank, not humble. It frustrates him hugely. The key issue is not individual will, he insists. “It’s got to be a joint effort between the government and yourself.”
He uses his own example: until his mid-90s, he was a habitual swimmer (he stopped in part because he was embarrassed by people rushing over to help him out of the pool). And, “well, swimming means there must be pools”. Governments need to build pools and bike paths, and pedestrianise city centres. In 1994, Morris wrote a paper arguing that “physical activity could be today’s ‘best buy’ in public health for the west.” Hardly anybody listened. Now western countries spend growing fortunes curing their obese and inactive citizens. Already 10 per cent of the NHS’s budget goes towards diabetes.
“For the first time in history,” says Morris, “the mass of the population has deliberately got to take exercise. It’s a new phenomenon, which is not appreciated.” For decades he has tried to persuade governments to make exercise easier. He was involved in the pioneering English National Fitness Survey of 1990, which found that half of women aged 55 to 64 could not comfortably walk a mile. These people were in effect disabled. The government ignored the report. Since then, British exercise levels haven’t changed much. His voice becomes high-pitched with outrage: “Just imagine, what historians in the future are going to say about the way we’ve allowed this epidemic of childhood obesity. ‘Disgrace’ is a sort of mild word.”
He’s not about to stop pushing governments now. “Unfortunately,” he tries to look sorrowful, “I’m a work addict. It’s an obsession, a compulsion. I don’t think it’s a disease. Now, that’s a happy way of getting into old age. It’s better than an alcohol addict or – are there womanising addicts in old age? They must have a tough time.”
He has two big ambitions for government: “On the one hand, for the first time, to have a serious programme on health inequalities. Not a large programme, or a complicated programme or an ambitious programme, I mean the word ‘serious’.” Second, he wants government to help the new, giant cohort of old people to exercise.
To Morris, none of this is utopian. All you need to achieve it is the spirit of the 1940s. He’s not sure any politician has it now, though – perhaps not even his new hero, Barack Obama. “This phrase, ‘Yes we can’, comes up much less nowadays, doesn’t it?” he grumbles.
He ushers me out. A car – his family won’t allow him to use public transport any more – is arriving to take him home. There is work to be done, experts to call, e-mails to send, an exercise bike to ride, books to order, pupils to mentor (he micromanaged my eating of my sandwich), governments to push, novels to read.
In a short memoir published this year, Morris quotes Philip Roth’s Everyman: “Old age is not a battle but a massacre.” The line was widely received as a beautiful restatement of an ancient truth. But Morris writes: “Is he not plain wrong?”
Simon Kuper is an FT writer based in Paris.