Monitoring the Pulse of World Leaders

9 MINS READOct 2, 2016 | 13:32 GMT
Taking the Pulse of World Leaders
(LEO RAMIREZ/AFP/Getty Images)
Venezuelan President Hugo Chavez, who battled cancer during his last years in office, makes an appearance in Caracas in 2011. Two years later, he would die.

Diplomacy at the highest level was on conspicuous display at the recently concluded 71st General Assembly of the United Nations, which drew leaders from across the globe. But the high-profile pomp and circumstance was only part of the attraction for those at the highest levels of power who took advantage of their distance from public and media scrutiny in their home countries to undergo medical procedures and checkups in New York City. Those little-noticed medical trips — and the health status of some heads of state in general — can carry implications for a country's stability. And while the international media might not cover those side trips to visit doctors, others place great importance on tracking the health of world leaders.

A quote attributed to U.S. Gen. George S. Patton, that "all glory is fleeting" presents a lesson on humility and the impermanence of power that is not always grasped by some of today's world leaders. The hubris of aging or ill despots who cling to power, reinforced by sycophantic aides and fawning followers, can lead to instability for their countries should they succumb to death. It is an issue that stretches back to antiquity. Alexander the Great's sudden death after an acute illness at the age of 32 led to the division of his vast empire. Had the great conqueror had access to the benefits of modern medicine, his reign might have been long extended.

That is the case in many countries today, as heads of state cling ever longer onto power thanks to medical advancements and the political environments in which they operate. In some cases, leaders have engineered constitutional means to extend their mandates. In systems that do not impose term limits, their ambitions may be thwarted only by death. In 2016, three aging African presidents have won re-election: Uganda's Yoweri Museveni (age 72 and in office since 1986), the Republic of Congo's Denis Sassou-Nguesso (also 72 and in office from 1979-1992 and again starting in 1997) and Equatorial Guinea's Teodoro Obiang Nguema Mbasogo (74 and in office since 1979). Uzbek President Islam Karimov, who won re-election in 2015 at age 77, died Sept. 2, ending his 25 years in office and unleashing concerns over a rise in clan competition that would follow Uzbekistan's ambiguous succession process.

Other countries have sought to circumvent such ambiguity, amending their constitutions to prepare for presidential succession. In Zambia, where presidents died in office twice in less than 10 years, the office of vice president was created to reduce uncertainty in the event of leadership crisis. Still, other countries are not even able to publicly contemplate the eventual passing of their strongman. In Zimbabwe, where 92-year-old President Robert Mugabe has stated his intentions to run for re-election in 2018, the ruling Zimbabwe African National Union-Patriotic Front has been mute on the subject of the country's first power transition since independence, but intense political jockeying rages behind the scenes. Despite regular trips abroad to attend to medical issues, there could soon be a reckoning for Mugabe, who has said of his long political survival, "I have died many times — that's where I have beaten Christ. Christ died once and resurrected once." His death after decades of despotic rule could well unleash a nasty power struggle.

While the health status of world leaders can certainly affect state or regional stability, in some cases, health concerns could even reverberate internationally. In Russia, for instance, Vladimir Putin's consolidation of power sets up a situation where an increasing amount of its governing system revolves around his personality. Thus, it inevitably becomes more intertwined with his wellbeing, too. While Putin, 63, is quick to demonstrate his good health and athletic abilities, if he remains atop the system he continues to craft, it will inevitably become increasingly unstable as his health fades and others try to exploit his growing weakness.

Succession problems can occur even in the most advanced of democracies. On Oct. 2, 1919, U.S. President Woodrow Wilson had a stroke that confined him to the White House. During that period, questions arose over who was actually running the country in light of Wilson's feeble state. As World War II continued to rage in April 1945, Vice President Harry Truman was thrust into the Oval Office after the death of President Franklin Roosevelt, whose longtime health issues had grown more acute just before his re-election to an unprecedented fourth term. Truman — and the world at large — had been kept in the dark about Roosevelt's deteriorating condition, and about the broader U.S. strategy to win the war and manage its aftermath, including the secret development of the atomic bomb. It eventually fell to Truman to give the order to drop the weapons over Hiroshima and Nagasaki later that year.

Choosing Your Health Care Provider

Not every country has world-class medical facilities. In many cases, leaders from underdeveloped countries seek medical care abroad. Nigerian President Muhammadu Buhari's 10-day trip to London in June, reportedly to visit specialists for treatment of a persistent ear infection, is one such example. One of Buhari's predecessors, Umaru Yaradua, took office in 2007 only to suffer from rapidly declining health. Eventually Yaradua was confined to a hospital in Jeddah, Saudi Arabia, in 2009 before returning to Nigeria under a cloak of secrecy. (It is unclear where he in fact died). His death essentially paralyzed the Nigerian political system until his successor, Goodluck Jonathan, could take over. Venezuelan leader Hugo Chavez made frequent trips to Cuba for cancer treatment, with the ruling United Socialist Party of Venezuela keeping the extent of his disease a secret from the public. He died sometime in 2013, but the exact time frame of his death remains unclear. Some accused the government of delaying the announcement of his death.

The United States, which has many of the world's most highly regarded medical clinics, plays a big role in providing health care to heads of state. Leaders often fly into New York City ahead of U.N. events, where they can take advantage of renowned facilities such as New York Presbyterian Hospital, where Iran's ousted shah, Mohammad Reza Pahlavi, received cancer treatment in 1979. In time, loyalties can form among those leaders. The Saudi royal family has a relationship with medical facilities in Houston, Texas, spanning decades. The royal Al Nahyan family of Abu Dhabi has relied upon the Cleveland Clinic in Ohio, enjoying its care so much that it opened a Cleveland Clinic in Abu Dhabi in 2015.

In addition to top medical facilities, some world leaders look for discretion. The health of a country's leader is often a closely guarded state secret, even more so in places with rigid or authoritarian systems, given their inability to quickly adapt to changing circumstance and reliance on the continued support of government elites, such as military and security services leaders. Consequently, when a strongman who presides over a system built on fear and widespread patronage displays serious health symptoms, it can cast doubt in the minds of the powerbrokers who carry out his orders. Additionally, a strongman who becomes preoccupied with health concerns and focuses less on the affairs of state may be more prone to making mistakes, possibly creating an opening for internal or external leadership threats.

If a leader's health starts to fade, it can give rise to internal dissent as well. This is why keeping medical problems a secret can buy governments time to set up a transition. Algeria is case in point. In 2013, Abdel Aziz Bouteflika, currently 79 years old and Algeria's longest-serving president, reportedly suffered a massive stroke. Even after spending time hospitalized and out of the public light, he managed to win re-election in 2014. For nearly three years now, Bouteflika has rarely been seen in public, and there are concerns over his ability to function. It is possible that the president is simply being used as a prop for those in his inner circle to continue to exercise power. What will happen when the president dies is relatively uncertain, given the amount of jockeying within the Algerian political elite.

The United States is not the only country to provide health care to world leaders. The United Kingdom, France, and others have opened their arms to leaders seeking medical care. For example, Singapore has been a favored destination for Mugabe for years. France has been particularly forthcoming for leaders of its former colonies in Africa, as it sought to bolster the positions (and security) of leaders favorable to French interests. France has also made it a policy to open its military hospitals, with their stricter security measures, to heads of state seeking maximum confidentiality.

That policy was employed in 2012 after Mauritanian President Mohamed Ould Abdelaziz was mistakenly shot by his own troops. The incident immediately caused concern that the nation was in the midst of yet another coup (Abdelaziz took power with a coup). However, he was quick to make a televised speech from his hospital bed to defuse tensions in the country and reassert his authority. After an initial operation at a hospital in Mauritania, a former French colony, the president was flown to a military hospital outside Paris to receive extended treatment out of the spotlight.

The Privilege of Office

While it is difficult to ascertain whether a country opening its medical facilities to a foreign leader gives it any specific leverage later, it is entirely possible that it establishes a quid pro quo, especially when the visit is kept tightly under wraps. Moreover, if the leader is from a friendly country, it is likely considered a simple gesture of goodwill. Nevertheless, a foreign leader's medical trip to another country provides an opportunity for those with curious eyes and open ears. National intelligence agencies are known to keep detailed files on world leaders, including physiological profiles. When a leader visits a medical facility in a foreign country, that information could be noticed and logged. In addition, news of any especially grave medical issues would be highly valuable, enabling decision-makers to be ahead of the game in regard to a potential change of leadership.

In fact, in some situations intelligence agencies keep doctors and specialists on call to provide discreet help in pressing situations. This is also important for agencies that are responsible for the protection of visiting foreign dignitaries. Oftentimes part of the preparation for a visit includes gathering information on specific health concerns that in case of emergency would provide faster action — and thus increase the dignitary's chances of survival.

Heads of state, given their position, can afford the best health care options available. Consequently, aging leaders can take advantage of the latest medical advancements. Sultan Qaboos bin Said, 75, of Oman has made frequent trips to Germany to receive advanced treatments for cancer. This has given the ailing monarch time to find an heir, as he never married, has no children and has not named a successor despite dominating the entire Omani government.

The health of heads of state is both a closely guarded secret and of great concern to other countries given the potential ripple effects should infirmity strike them down. And as aging leaders around the world cling to power, the odds that their medical problems will catch up with them and provoke instability inevitably increase with time. For many of them, the notion that "all glory is fleeting" will become all too real.

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