How should we assess a leader's fitness to govern?

The Olympic motto, “Faster, Higher, Stronger”, provides clear criteria for competing nations. But presumably, selectors for the forthcoming Paris Olympics are not having to screen athletes by seeing if they can stand without falling over. Yet, something comparable was demanded in the US , where an apparently faltering 81-year-old Joe Biden was competing for the presidency with an reportedly incoherent 78-year-old Donald Trump . They were urged to undergo cognitive testing to assess brain functions such as thinking, learning, remembering, using language and exercising judgment. However, that test is designed for dementia screening (questions include subtracting 7 from 100 and differentiating a lion from a camel) rather than for assessing the ability to govern the most powerful nation on Earth. Besides, the contentious 2020 election has created a peculiarly American problem as the standard test includes a question on “Who’s the president?” Mr Biden was eventually persuaded to withdraw his candidature. But with Mr Trump still in the race, the ability of leaders is of legitimate public interest. Their immense powers shape the lives of citizens and the destinies of states, or even the world. How do we assess the fitness to govern? This is a subjective idea loaded with vague notions of qualifications and competencies, integrity and intelligence, heath and vigour, and in some countries like the US yet more virtues sought by an endlessly demanding electorate. In frustration, Americans have even elected several dogs as town mayors. And satirised the political system when Marvel Comics’ Howard the Duck garnered thousands of votes in the 1976 presidential election. The past is not a reliable guide either. Over the ages, there have been many enlightened leaders, but we can hardly name them while the record is dominated by strongmen. History tells us much about the conditions under which bad leaders arise and thrive but little about how to foretell and forestall them, let alone select good ones. Can science provide better insight? We start with the impact of age on leadership. The median age of current world leaders is 62, with two thirds in their 50s and 60s while a fifth are in their 70s and 80s. Aged leaders are supposed to bring experience and wisdom even if they are slower than their youthful counterparts. But no correlation is shown between governance quality and leader age. Meanwhile, it is debatable whether a quick-and-firm or a slow-and-shaky finger is better if required to press the nuclear button. What about the consequences of ageing? Reflecting general disease prevalence, two thirds of our leaders are probably suffering from chronic disorders, according to a study conducted by academics at the University of Melbourne and Kings College London. In principle that should not affect governing capabilities, if their underlying conditions are managed effectively. However, the practice is less perfect. In the US, Franklin Roosevelt was paralysed from polio and John F Kennedy was debilitated by Addison’s disease. Chester Alan Arthur battled with constant fatigue from kidney disease, Grover Cleveland had compromised speech and hearing after operations for oral cancer, Woodrow Wilson suffered several strokes, and Dwight Eisenhower had serious gastro-intestinal and cardiac problems. Medical historians assess many American presidents as mentally disordered: Roosevelt and Lyndon B Johnson (bipolar disorder), Wilson, Calvin Coolidge, and Herbert Hoover (major depressions), William Taft (sleep apnoea), Ulysses S Grant, Franklin Pierce and Richard Nixon (alcohol abuse), and Ronald Regan (pre-dementia). Are American presidents excessively afflicted, or is it that the US political system is more open with disclosure? Elsewhere, former French president Francois Mitterrand’s prostate cancer was assiduously hidden from the public. Former UK prime minister Gordon Brown functioned with one eye and Winston Churchill conducted business from bed although declared “gloriously unfit for office”. At least he had sound cognition, unlike former Israeli prime minister Ariel Sharon who suffered a catastrophic stroke but remained formally in office for a year. Recently, German chancellor Angela Merkel’s tremors hit the headlines. Earlier, Soviet leader Yuri Andropov was incapacitated by his lungs and rarely left hospital. Cuban leader Fidel Castro had serious bowel inflammation affecting his temperament. Pakistan’s founding leader, Mohammed Ali Jinnah, struggled continuously with tuberculosis. That leaders sicken like anyone else is hardly surprising. The concern is when their governing capabilities are compromised and cause strategic policy and security challenges. Real-time cases are concealed as state secrets, and it is left to history sleuths to expose them later. Thus, we learn that England’s tempestuous 16th-century monarch Henry VIII caused terrible lasting consequences by splitting Christendom when deluded by syphilis. The 18th-century King George III’s mental complications from porphyria cost the British Empire its American colonies. The 1945 Yalta summit obliged a seriously hypertensive and weakened Roosevelt to negotiate with Joseph Stalin, the legacy being a divided Europe and lengthy Cold War. A decade later, then UK prime minister Anthony Eden, dosed with brain-numbing barbiturates following a complicated gall bladder operation, mishandled the Suez Canal crisis, a precursor to some of today’s Middle East problems. Did former Soviet premier Nikita Khrushchev take advantage of Kennedy’s amphetamine dependency to sneak nuclear missiles into Cuba in 1962? During the 1980s Aids peak, spies were pre-occupied by determining which African presidents and generals were infected and causing instability. Intelligence agencies expend significant resources to construct complex health profiles to determine the vulnerabilities of opponents. Hence the current interest in assessments of Russian President Vladimir Putin or of African protagonists in the continent’s coups and wars. This is a generally futile exercise, but new AI tools may improve predictive ability. Meanwhile, and despite ethical questions, covert profilers need clandestine collection of confidential medical data. For example, American intelligence attempted to track Osama bin Laden through his medical supplies. French President Emmanuel Macron refused a Kremlin request for a Covid-19 test before meeting Mr Putin, to prevent Russia getting hold of his DNA. Our world is critically shaped by the physical and mental illnesses of those who govern us. But those who wreaked most havoc – Adolf Hitler, Benito Mussolini, Stalin, Saddam Hussein, Pol Pot, Idi Amin – were not sick nor mad in a medically certifiable sense. They were afflicted by what psychologists call the “Hubris Syndrome“, caused by the power intoxication, lofty isolation and excessive deference. Its symptoms include impulsive judgments and reckless behaviours, alongside delusions of personal infallibility and impunity from accountability. Personality tests devised to detect susceptible leaders are notoriously unreliable. Medical screenings, and cognitive and personality tests are commonly used in many sectors such as for determining aptitude for executive leadership or in occupations such as airline pilots and train drivers where public safety is paramount. But not so for the most consequential job of leading a nation. The problem is that, with current tools and technologies, there is no test to guarantee protection from physically and mentally unsuitable or downright dangerous leaders. This is the case even in liberal democracies, where in principle, there are checks and balances such as balanced constitutions, elected legislatures, independent judiciaries, robust civil societies and free media. But, as we see in many places, these are easily subverted through the same democratic processes that create them. Back to the American presidential debate, complicated further by the assassination attempt on Mr Trump. He credited his survival to divine providence. Insofar as that could represent proof of his fitness for office, American voters will simply have to take his word for it.