Analysis: Legitimacy, health, and power

Khaled Hanafi Ali , Saturday 14 Nov 2020

Recent incidents of presidents of countries contracting the coronavirus have provoked debate about how far their physical health can affect legitimacy and political stability

Legitimacy, health, and power
Legitimacy, health, and power

One of the lessons learned thus far from the Covid-19 pandemic is how health issues and the political stability of different countries are interrelated. Not only has the pandemic wreaked havoc on the world’s economy, but the very fact that some of the world’s presidents and political leaders have contracted Covid-19 has also provoked debate about how far the physical and mental fitness of presidents could impact on their political power and the ability to exercise their authority. 

A president’s illness may be the impetus for change. This could occur within a constitutional framework by exempting the president from his position on the grounds of his health. Or it could take an unconstitutional alternative route through his ousting in a coup or popular uprising on the grounds that he has become physically unable to lead his country, especially if his illness is associated with economic and political deterioration provoking a public uproar.

This would explain why presidents recovering from coronavirus have been keen on showing off an aura of physical strength, insisting that they are stronger than the virus itself. US President Donald Trump, for instance, went public after spending a few days in hospital, telling his supporters that he was in good health and that they should not fear the virus.

In the same vein, Brazilian President Jair Bolsonaro gave a similar gesture of bravery when he told the country’s public that he had not worried much when he had found out that he had tested positive for coronavirus a few months ago. His gesture of power, which also gave the message that precautionary measures are a sign of weakness, immediately provoked public criticism.

In the same vein, when it was announced on 2 October that Trump had tested positive for coronavirus, the issue raised political concern since the infection had occurred only a few weeks prior to the presidential elections in the United States. If this is the case in a stable democratic system with the rotation of power like that in the US, it remains questionable how such incidents could affect the stability of countries run by authoritarian regimes, where the presidential position is synonymous with power and the illness of political leaders could easily shake the country’s stability.

It is, of course, extremely difficult to prove that the health of presidents could actually affect the stability of their countries, since governments always keep a lid on such issues. They remain largely confidential unless the illness of a president reaches the point that it cannot be hidden. Besides, it remains challenging to decide what kind of physical or mental illness could negatively affect the performance of a president. 

However, that said, there have been several cases in Africa, specifically in Angola, Zimbabwe, Algeria and other countries, where the deteriorating health of the president has impacted their power to the extent that they have been pushed off the political scene. 

Of course, we cannot assume a direct relationship between illness and the loss of power in these cases since there were other factors involved in the toppling of such regimes such as the length of the presidential term and the old age of the president, not to mention deteriorating living conditions, rampant corruption, and other factors that all helped reduce the popularity of the presidents concerned.


Laws generally stipulate that candidates who run for president in any country should be physically qualified; that is, they should be in good health and not have any kind of disease that could undermine their ability to fulfil their duties. 

There are two reasons for this. First, it sounds logical that those enjoying good health are more qualified to lead and protect the national interests of their countries. Second, it is the political right of citizens in any democratic system to vote for those they see as eligible to protect their interests and whom they trust will not make decisions that could harm the national interests of their countries.

There are thus several factors determining the eligibility of a presidential candidate other than the voters’ satisfaction with his agenda or political stance. Physical and mental fitness are added factors affecting the presidential race. Or at least that was the case in the 2016 US presidential elections when Democratic Party candidate Hillary Clinton suffered from pneumonia, raising expectations that her illness could make her lose ground to her rival, Trump.

More or less the same argument was made when Trump tested positive for coronavirus only a few weeks ahead of this year’s presidential race.

The right of citizens to choose the most physically and mentally eligible person to protect their interests does not only apply to those running for the presidential office, but also to those already in that office. This is due to the fact that any sudden absence of the president would likely affect relations between the different institutions within the state, thus shaking the stability of the whole.

Many countries have, therefore, included terms in their constitutions that limit the period of the presidential office to two or three terms. This is not only meant to guarantee a fair rotation of power, but is also based on the assumption that the ageing of a person could naturally involve the deterioration of his or her physical and mental health and that political leaders are no exception to the rule, even if some individual cases have proved otherwise. 

Some political systems also impose a maximum age limit for presidential candidates so as to guarantee that the president will be physically fit to fulfil his duties. There is also the idea that there should not be wide generational gaps between presidents and the rest of the country or within the social structure of countries, especially when young people constitute a majority of the population like in Africa.

However, a few years ago the parliament of Uganda ratified an amendment to the country’s constitution that abolished the maximum age limit for candidates, allowing those over 75 years of age to run for the office of president. The new amendment was meant to allow President Yoweri Museveni, who is over 75 and has been in office since 1986, to run for a new term in the next presidential elections. In 2019, the Ugandan Supreme Court accordingly allowed Museveni to run for president in the elections due to be held in February 2021 despite his being overage.  

The opposition in Uganda has been critical of Museveni for remaining in office despite his age. But the ageing president has been keen on sending counter messages of his being healthy and physically fit for the post, circulating social-media pictures of himself exercising during the Covid-19 quarantine, and reiterating media statements that he “has no time to get sick”.


The issue of a president’s health and its impact on political stability tends to get more complicated when it also involves mental health and not just physical fitness. 

A president’s mental health is, of course, also of paramount importance because when he is mentally and psychologically balanced, he can rationally manage his country and the interests of his nation. Experts, however, argue that physical fitness and mental health are interrelated in a way that suggests that many diseases could also negatively affect a person’s psychological well-being, and so his performance and decision-making ability. 

This was the argument that some in the US made when former US president George Bush waged the Gulf War, known as the Desert Storm, in 1990. Critics at the time suggested that Bush’s decision was part of his having developing an aggressive attitude due to suffering from hyperthyroidism.

But this argument, albeit viable, seems to have overlooked the nature of the US institutional system, in which the president is not the only one taking such dreadful decisions as going to war. But it seemed to remain popular, nevertheless, and it has even strongly resurfaced with Trump, who was over 70 when he took office, with some analysts suggesting that Trump’s “shocking statements” are the result of a deterioration of his physical and mental health.

In his book Fire and Fury, award-winning US author and columnist Michael Wolf seems to support this argument when he refers to an incident in which Trump repeated the same story three times over within 10 minutes during one of his public statements. According to Wolf, this incident could be seen as a sign of the poor memory that could develop into the kind of dementia that often affects the elderly. Trump, for his part, was quick to refute such claims, insisting that he was “a genius” and “mentally stable”.

It is noteworthy here that raising doubts about Trump’s health is also related to other broader issues in the United States. The fact that the president himself has been bogged down in trouble with his own advisers, a number of whom have already resigned, in addition to accusations related to alleged Russian meddling in the 2016 presidential race, seems to have contributed to the overall fuss over his health.

That said, the question of Trump’s physical health jumped back to the fore recently when he contracted coronavirus in early October. Nancy Pelosi, the speaker of the House of Representatives, announced that she would present a bill that stipulated forming a committee to investigate Trump’s physical ability to remain in power.

Members of the US Democratic Party have also joined forces, grabbing the chance of Trump’s contraction of the virus to pressure for the activation of Article 25 of the US constitution, which allows for removing the president from office and appointing his vice-president instead in cases where the president has proven physically incapable of leading the country.

Ironically, former US presidents have developed signs of physical ailments that were not recognised or disclosed at the time, allowing them to remain in post. Former US president Ronald Reagan, who was in office in the 1980s, was one case in point. He was diagnosed with Alzheimer’s disease only five years after he had left office, but as many scientists insist, this particular disease usually has earlier symptoms that can be tracked decades earlier.


If we assume that the physical competence of a president has a dual realistic and symbolic significance in any given political system, making a president’s rule even more legitimate, then there is no doubting that this significance may be more profound when it comes to Third World countries. 

This is due to two interlinked variables. The first has to do with the ageing of presidents who stay long in power. Some African presidents, for instance, are over 70 or 80 years old and have yet remained in office for three to four decades. The 78-year-old president of Equatorial Guinea, for instance, has been ruling his country since 1979, while president of Cameroon Paul Biya, aged 87, has been in office since 1982. 

The second variable has to do with the personalisation of the post of president in some countries in which presidents stay for long periods in office and have broad powers within the structure of their political systems. In those cases, the person of the president and his post become almost identical, and so his presence becomes crucial for the maintenance of the country’s political stability.

This personalisation of the presidential post survived the 1990s democratic movement, and as a result the principle of the rotation of power became largely void and presidents continued to stay in office for long periods through tailoring constitutional amendments in their favour. This was the case in many African countries including Rwanda, Burundi, Djibouti, Chad, Cameroon, Equatorial Guinea, and others.

In this context, the health of the president becomes crucial for him to maintain his symbolic power and in order not to lose his legitimacy. It is only in very rare cases that African leaders voluntarily leave office. In fact, it has only happened once, in 1982, when Cameroonian president Ahmadou Ahidjo resigned because of serious health issues and after having spent 22 years in his post. But it is also almost a norm for African presidents to receive medical treatment outside their countries in order to keep a lid on the seriousness and type of their illnesses for fear of losing ground to the opposition.

President of Nigeria Muhammadu Buhari, 77, is a case in point. He had received treatment in the United Kingdom for several months, and his long absence from Nigeria sparked criticism on the part of the opposition, which insisted that he had either to come back or resign, casting doubt on his physical eligibility to run the country.

The spokesman for the presidency, however, insisted on reiterating statements assuring the nation not to worry about the president, whom he claimed had only mild problems of the ear and throat. Despite this fuss, Buhari got over his health crisis and won a new term in office in February 2019.


But there have been other cases in which a president’s health has had negative ramifications on his political influence. 

In Zimbabwe, for instance, late president Robert Mugabe was ultimately forced to step down at the age of 93 due to the deterioration of his health. Mugabe had always rebutted opposition claims that he was in bad health despite his frequent trips to Singapore to receive treatment.

But he was ultimately pressured to resign when all national forces joined hands in a dramatic scene to topple him, including the army, the parliament, and the streets. His deputy, Emerson Mnangagwa, then took over in November 2017, and Mugabe died just two years later in 2019. 

However, Mugabe’s deteriorating health at the time did not seem to be the only factor putting an end to his long rule. His legitimacy had already been severely eroded some time earlier, and all the country’s political powers were fretting that an alternative scenario of a difficult political transition would shake the stability of the country.

One main factor that almost destroyed Mugabe’s popularity was the fact that his wife Grace, 56 and aspiring to succeed her husband in the country’s rule, had meddled in the government, intervening in decisions taken by the ruling party the Zimbabwe African National Union-Patriotic Front (ZANU-PF). Mugabe’s wife was thus a main catalyst for the military coup that finally ousted Mugabe in an attempt to curb the rampant corruption and put an end to Grace’s influence.

In Algeria, the deterioration of the health of former president Abdelaziz Bouteflika, who was over 80, similarly put an end to his rule. Bouteflika had had a stroke in 2013 and yet had remained in power and insisted on running for a fourth term in the 2014 presidential elections in a wheelchair.

A popular uprising erupted in 2019 and eventually toppled Bouteflika, who had been preparing to run for a fifth term in office. The demonstrators lambasted Bouteflika’s intentions as an insult to the nation after his repeated failures to manage crises including low oil prices, rampant poverty, unemployment, and low living standards among others.

In some other cases preemptive steps may be taken to ensure a smooth transition of power in cases where a president has health issues in order to curb potential chaos. 

In Angola, for instance, former president Eduardo dos Santos resigned in March 2017 at the age of 77 after having spent 38 years as president since 1979. Dos Santos had been secretly receiving treatment in Spain for many years before he stepped down, and the ruling party candidate and defence minister Joao Lourenco then took over and won the August 2017 elections with a majority.

It is clear in the Angolan case that the president’s health was a strong impetus for loyal circles in the ruling party to bring about a smooth regime change through elections. 

It is also clear from the above examples that a president’s health provides the legitimacy for a candidate to run for the office of president and for a president to remain in post. Showing that they have good health is considered to be a political asset for presidents to maintain their legitimacy, public image, symbolic power, and actual power at the helm of their countries and in the face of possible regime-change attempts on the part of the opposition.  

Russian President Vladimir Putin, for instance, has been keen to appear in a judo outfit and as a competent wrestler as part of his soft-power programme that aims to deliver the dual local and international message that he is capable of exercising power at home and that Moscow will play a strong role in the international order.

*A version of this article appears in print in the 12 November, 2020 edition of Al-Ahram Weekly

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