No one likes to go to the doctor. But for a political leader, even the news of such a trip can sound the death knell for his political career. It is small wonder therefore that a leader's health is the most important state secret in many countries and why.
Examples of this type of secrecy abound. In recent weeks, the world media was riveted by the mystery of the whereabouts of Xi Jinping, presumed to be next in line for the Chinese presidency. Xi disappeared from public view for weeks while undergoing treatment for a condition that may have been either back pain or heart troubles, depending on which reports you believe. In Venezuela, voters will head to the polls Oct. 7 to vote on whether to reelect President Hugo Chávez, who has been less than forthcoming about his cancer diagnosis, claiming a number of dubious miraculous recoveries while periodically jetting off to Cuba for treatment. Rumors of 88-year-old Zimbabwean President Robert Mugabe's death turned out to be false in April, but citizens were likely not reassured by the government's ham-handed efforts at message control.
This year has also seen the deaths in office of four African leaders -- in Ethiopia, Ghana, Guinea-Bissau, and Malawi -- all of whom had sought treatment abroad and kept the state of their health a carefully guarded state secret before their deaths. Although the recently deceased leaders varied in age from a quite young 57 to a moderately elderly 78, careful studies show that leaders, especially in undemocratic countries, outlive their countries' life expectancies by a significant margin. Those very national life expectancies, however, are already short because of the miserable way those leaders rule. Presumably, all leaders could have access to the best medical care, but getting that care can be a kiss of political death.
For heads of state, there's also an inherent tension between maintaining good health and revealing to cronies or the public that all is not well. The difficulty, especially in autocratic systems, is that medical care can only be sought at the risk to one's hold on power -- a risk worth taking only in extremis. After all, "loyal" backers -- even family members -- remain loyal only as long as their leader can be expected to continue to deliver power and money to them. Once the grim facts come to light, the inner circle begins to shop around, looking to curry favor with a likely successor. No wonder that when medical care is needed, country leaders like Mugabe or the late Meles Zenawi of Ethiopia tend to seek it in a foreign hospital, usually in a country with strict respect for patient-client privilege. Doctors at home are too risky -- they might talk to their buddies and spread the word that their leader is gravely ill, thereby hastening the incumbent's political, if not physical, demise. Any leader worth his salt must keep terminal illnesses hidden from public view as best as possible. Terminal illness or even extreme old age, which is after all, the most terminal of illnesses, are excellent indicators that the beloved leader won't be reliable for long. Then the view is: Out with the old, in with the new.
Politics, especially autocratic politics, requires symbiosis between leader and supporters. In return for power, perks, benefits, and privileges, a leader's backers support him over rivals and, when necessary, suppress the people, bash in the heads of opponents real and imagined, and make life miserable for all but the elect (but not elected) few. These tasks can be unpleasant, which is why a successful leader rewards his supporters well and why corruption and graft are so prevalent in autocracies.
This symbiosis fails once either side of the relationship can no longer sustain the other. If the leader fails to take care of his loyalists, then he can expect they will plot a coup to overthrow him. If backers won't suppress the people on behalf of the leader, then protest and revolution threaten the entire regime. Supporters know that their leader, no matter how generous and beloved, simply cannot deliver from beyond the grave. Once their privileges and perks are in jeopardy, the inner circle looks for its next meal ticket. When the essential symbiosis fails, especially due to the discovery that the incumbent is gravely ill, upheaval is likely and, under the right circumstances, can even have a plus side for society. After all, even many normally nasty elites may be reluctant to turn their guns on the people when the new revolutionary leadership may be drawn from those very people.