The World

Why Leaders Lie About Their Health

Nobody wants a weak strongman.

Mugabe slouched back in a chair wearing sunglasses and speaking into a microphone
Former Zimbabwean President Robert Mugabe addresses the media on July 29, 2018. Jekesai Njikizana/Getty Images

If something resembling President Donald Trump’s current health crisis were happening in another country, perhaps one with a shorter history of peaceful transfers of power, we might be wondering right now if a member of the president’s inner circle, or commanders of the military, were about to seize power. That’s not the case here, but the impulse to hide information about the president’s health in order to protect his hold on power is awfully familiar.

Particularly in more authoritarian political systems—though not exclusively—physical illness often precedes political downfall. In one case, Zimbabwe’s Robert Mugabe, the world’s oldest head of state, had long denied and downplayed rumors of his ill health, even as he appeared more and more frail in his increasingly rare public appearances and disappeared for weeks at a time in Singapore and Hong Kong where he was rumored to be receiving medical treatment. In 2017, leaders of his own party and the military removed him from power in a coup. He died at the age of 95 in a Singaporean hospital two years later.

Before he was overthrown in 2011 in the first wave of the Arab Spring, Tunisian President Zine al-Abidine Ben Ali had been secretive about his health, refusing to allow himself to be photographed except in heavily airbrushed official portraits. He fell into a coma just weeks after fleeing his country. Similarly, there had been widespread rumors about the health of 82-year-old Egyptian leader Hosni Mubarak, who had undergone gallbladder surgery in Germany the year before he was overthrown.

Going back further, the insurgency that led to the collapse of Mobutu Sese Seko’s 32-year-old dictatorship in what is now the Democratic Republic of the Congo kicked off when he was hospitalized with prostate cancer.

Political scientists Bruce Bueno de Mesquita and Alastair Smith argue that when leaders lie about their health, they’re actually less concerned with public perception than with that of their political allies and immediate subordinates—the people with the best chance of overthrowing them. “The shortened time horizon induced by a leader’s ill health increases the chance that regime supporters will remain passive in the face of protest,” they wrote for Foreign Policy in 2012.* Meanwhile, “people inclined toward rebellion watch closely to see signs of declining health among their leaders, realizing…that even loyal backers will waver in their support for a dying leader.”

In all the cases above, the leader’s downfall came when his core supporters—military commanders, senior party members—would no longer stand by him in the face of public opposition. The leader’s frail health may have played at least some role in their calculus. By contrast, Syria’s Bashar al-Assad—seemingly spry and healthy at 55—has kept most of his core supporters behind him through almost a decade of civil war.

Leaders including Russia’s Vladimir Putin, China’s Xi Jinping, and North Korea’s Kim Jong-un have all disappeared from public view for weeks at a time as rumors about their health swirled, only to return to public appearances with little or no explanation. Especially for a leader like Putin, whose public image leans heavily on his toughness and virility, any sign of physical weakness has to be quashed.

There’s also an extensive list of leaders in recent years who’ve succumbed, while in office, to conditions they downplayed or denied. These include Venezuela’s Hugo Chavéz, who kept his cancer diagnosis a closely guarded secret for years before he died in 2013; Ethiopia’s Meles Zenawi, who was out of view for public for weeks while suffering from an undisclosed illness before dying in a hospital in Belgium in 2012; and King Abdullah of Saudi Arabia, whose family continued to downplay the severity of his illness—perhaps to avoid spooking oil markets—even as lay in the hospital for months before his death in 2015.

One of the more extreme cases was Nigerian President Umaru Yar’Adua, who made no public appearances from January 2010, when he was hospitalized with kidney and heart ailments, until he was finally pronounced dead in May. Throughout this period, there was a dangerous power vacuum as the country debated whether the president was recovering or brain-dead.

Burundi President Pierre Nkurunziza died this June of what his government called a “heart attack,” though many believe it was actually the coronavirus.

Sometimes the secrecy may be in hopes that the leader will recover; in other cases, it’s to minimize risk during a moment of uncertainty as power is transferred. That was clearly the case in North Korea in 2011, when officials kept the news of Kim Jong-il’s death secret for two days as they prepared to transfer power to his young son.

Another reason for secrecy is that national leaders often receive treatment—either in their own countries or in hospitals abroad—that is out of reach for most of their citizens. That’s certainly a parallel to the experimental treatments received by Trump this weekend.

We tend to associate this secretive behavior with autocratic regimes or fragile democracies, but many democratic leaders don’t like to reveal too much about physical illness either. The German government, for instance, has been tight-lipped about the cause of Angela Merkel’s visible tremors. By contrast, former Japanese Prime Minister Shinzo Abe was fairly open for years about his struggles with ulcerative colitis, which finally forced him to step down in August.

In the U.S., Woodrow Wilson suffered a stroke in the fall of 1919, the White House hid the severity of his condition, and it is now believed that his wife, Edith, was actually handling many of his affairs during the last year of his presidency. It was only years later that the public learned how close Ronald Reagan had come to dying after he was shot in 1981, and aides later concealed concerns within the administration about whether he was showing signs of dementia. While American presidents are less concerned about colonels bursting in to put them under house arrest at the slightest sign of weakness, they’re not immune from the same pressure to reassure their allies and supporters that they’re still fully in command.

A military coup is still pretty unlikely in the U.S., but Trump may be feeling vulnerable heading into an election next month that he’s currently projected to lose, and he hasn’t ruled out that he would spark a constitutional crisis by challenging the results of that election. He can’t afford to lose the confidence of any his supporters right now. And, as has been widely noted, he exhibits more than a few characteristics of authoritarian leaders, is obsessed with the loyalty of his subordinates, and frequently belittles what he perceives as weakness in opponents—including the wearing of masks to prevent the spread of the coronavirus. Trump was reportedly furious at his chief of staff, Mark Meadows, for contradicting the White House physician’s upbeat assessment of his health over the weekend, and demanded that he be taken back to the White House because hospitalization makes him “look weak.” The videos, tweets, and a bizarre public appearance for his supporters over the weekend, bring to mind unconvincing authoritarian stunts like the time Hugo Chavéz brought reporters in to watch him throw a baseball around to dismiss reports of his ill health. Now, Trump is heading back to Pennsylvania Avenue, insisting that he’s not only in stable condition, but feels “better than I did 20 years ago!”

The obfuscation doesn’t mean the president is dying, and it doesn’t mean he’ll be removed from office, but it makes perfect sense that—at a moment of political peril—he doesn’t want the country to know just how bad things really are.

Correction, Oct. 5, 2020: This piece originally misstated the date when a Foreign Policy piece on sick world leaders was published. It was published in 2012, not 2008.