Many former leaders of the world's nine nuclear-armed nations were impaired by health conditions while in office, raising concerns over their decision-making abilities while they had access to nuclear weapon launch codes, a study from the University of Otago, New Zealand, has found.
The study analysed the health information of 51 deceased leaders of nuclear-armed countries: China, France, India, Israel, North Korea, Pakistan, Russia, the United Kingdom and the United States. Eight of the leaders died from chronic disease while still in office, five from heart attacks or strokes. Many of the leaders had multiple serious health issues while in office, including dementia, personality disorders, depression and drug and alcohol abuse.
The research was led by Professor Nick Wilson, from the Department of Public Health at the University of Otago, Wellington – Ōtākou Whakaihu Waka, Pōneke, with Associate Professor George Thomson and independent researcher Dr Matt Boyd.
Professor Wilson says that of the leaders who left office while still alive, 15 had confirmed or possible health issues which likely hastened their departure.
Professor Nick Wilson
"Probably all of this group of 15 leaders had their performance in office impaired by their health conditions. In some cases, the degree of impairment was profound, such as in the case of two former Israeli Prime Ministers: Ariel Sharon, who became comatose after suffering a stroke in office, and Menachem Begin, whose depression was so severe he spent his last year as leader isolated in his home. Impairment during crises was also seen in the case of Richard Nixon's bouts of heavy drinking – including during a nuclear crisis involving the Middle East.
"There have also been occasions where health information about leaders has been kept secret at the time."
This was the case for multiple US presidents, including Dwight D Eisenhower, whose doctor described his 1955 heart attack as a digestive upset; John F Kennedy, whose aides lied about him having Addison's disease, a serious, chronic condition; and Ronald Reagan, whose administration hid the extent of his injuries after he was shot in 1981, and the likely signs of his dementia near the end of his term.
Professor Wilson says Kennedy was in poor health during his first two years in office in 1961 and 1962, with his performance likely impaired from Addison's disease, back pain, and his use of anabolic steroids and amphetamines. It was in 1961 that he authorised the failed CIA-backed Bay of Pigs invasion of Cuba and that his poor performance at a Cold War summit with Soviet leader Nikita Khrushchev in Vienna was noted. In turn, Khrushchev's poor mental health probably contributed to him triggering both the Berlin Crisis and the Cuban Missile Crisis.
In France, long-serving President François Mitterrand clung onto power until the end of his term in 1995, despite keeping secret his advanced prostate cancer and after his doctor had concluded in late 1994 that he was no longer capable of carrying out his duties.
This latest study follows previous research involving Professor Wilson on the health of former New Zealand Prime Ministers. It found the performance of at least four of the leaders was impaired, in three cases by poor health, and, in the case of Robert Muldoon, by his heavy drinking.
Professor Wilson says with the rise in international instability following the Russian invasion of Ukraine in 2022 it has become even more important to ensure there is good leadership and governance in those countries with nuclear weapons.
"This is particularly the case for the United States, where a leader can in principle authorise the release of nuclear weapons on their own, a situation referred to as a 'nuclear monarchy'."
He says there are a range of measures which could reduce global security risks from leaders whose judgement is in question. They include removing nuclear weapons from 'high alert' status, adopting 'no first use' policies where nations refrain from using nuclear weapons except as a retaliatory second strike, ensuring any weapon launches need authorisation by multiple people, and progressing nuclear disarmament treaties.
Professor Wilson says democracies could consider introducing term limits for their leaders, as well as recall systems, so voters could petition for politicians to step down. Requirements for medical and psychological assessments could be introduced for leaders before they take office, and during their terms.
"Maintaining a strong media with investigative journalists can also help expose impairment in leaders."
Professor Wilson says politicians in general are exposed to high levels of stress, which can affect their mental wellbeing. A study of UK Members of Parliament has found they were 34 per cent more likely to experience mental health problems than other high-income earners.
"Finding ways to reduce stress on politicians and better address their mental health needs is another way global security risks can be reduced."
Publication details
Nick Wilson, George Thomson & Matt Boyd
BMC Research Notes
The associated recent study of impaired New Zealand Prime Ministers is detailed in this University of Otago media release.
