Medically Clear #17: The Life Tax of Leadership

Over the past seven years do you think President Obama has grayed at an alarmingly rate? Do you remember the same thing happening to former President Clinton in the 90s? Have you noticed that George H. Bush and Jimmy Carter both look really, really, really old? It’s long been conventional wisdom that the stress of national leadership accelerates aging, but investigations to date have not generated firm evidence of such a link. That is, not until this past month and a new study published in the British Medical Journal (BMJ).

Listen to the Medically Clear Podcast in iTunes or here

Andrew R Olenski and colleagues at Harvard and Case Western Reserve examined the fates of world leaders from 1722 to present. The investigators compared, across 17 first-world countries, the age-adjusted years of survival after last elected office term to historic controls (runner-up candidates who never served in highest office.) They examined the fates of 540 candidates (279 winners and 261 runners-up), 380 of whom are no longer alive, and subjected them to two separate analyses, both incorporating the life expectancy of each leader/candidate, given their age and the time period in which they lived. The authors chose a runner-up control group — as opposed to comparing elected leaders to the general population — based on the fact that most politicians are likely better-off financially than the public and thus likely have better access to health-preserving measures (like good health care).

Their findings seem to suggest that he or she who finishes first in head-of-state elections, may also be finished first (in the most absolute way). For example, Olenski reports that among the 380 deceased politicians, world leaders lived 4.4 fewer years after their last election than those who never served as world leaders, and this difference held up after statistical adjustment. In a second analysis, the investigators included all candidates — alive and dead — in something called a Cox Proportional Hazards Analysis and found a similar difference in life span expectations.

The researchers didn’t dig too deeply into the question of why world leaders may be at risk of an untimely demise. Nor could they fully account for all of the potential confounders that this type of study attracts (e.g., they included politicians who were assassinated, this being a rather unique world leader hazard.) But, for the sake of interest, let’s assume that their findings are real and consider some of the unhealthy consequences of being in charge.

First, there is sleep. We know that sleep is important — for mood, productivity and health. And we can expect that world leaders, for a myriad of reasons, lose sleep regularly and we marvel that they (mostly) maintain civility despite this. We also know that rats that don’t sleep don’t just become grumpy; they become dead (within four to five weeks.) World leaders, at least some of them, aren’t rats, but either way they aren’t immune to biology — skimping on sleep may also mean skimping on life expectancy.

Similarly, we know that stress is not healthy, especially mixed with certain personality mindsets. Consider a 2013 study in Psychosomatic Medicine that reported that men between the ages of 50 and 64 with higher Type A personality scores had a significantly higher risk of developing heart disease within nine years than those with lower scores. Furthermore, people with Type D personalities — characterized by a negative outlook on events and frequent “catastrophizing” about doom and gloom events — probably also have a higher risk of heart attack. If we combine these two personality type characteristics — as could easily occur in a world leader (i.e. a Type A gunner who is also forced, like a Type D, to continually worry about worst case scenarios such alien invasions, nuclear war, etc) and you can imagine there just might be some impact on longevity.

I asked the BMJ article’s senior author, Dr. Anupam Jena, about this and he responded:

“I’d say two factors are possible. The first is the stress of governance, which entails stress around making tremendous decisions, being in the public spotlight, and the stress of political rivalry. The second is the time investment required to take care of one’s health (exercising, eating healthy, etc.) that may be reduced if one is elected to office. We compared world leaders to runner-up candidates precisely to address the issue of whether certain personality types were likely to run for office.”

So, at this point, you may be asking yourself: “How does this topic pertain to me? I don’t want to be a world leader and I don’t think anyone would elect me to be one even if I did!” Ok, you’re right, there is no direct link. But, indirectly, I hope this topic helps you and I to try harder to control and limit unhealthy variables that we know can cause poor health.

In that vein, I’d like to reinforce some tenets of the Marin health mantra — exercise; time spent outdoors, healthy food, and healthy relationships. And, for those of us with Type A and Type D personalities, please don’t stop there. Consider adding mindfulness, meditation, and possibly even a change of profession. If you choose the latter, my advice would be to avoid politics.

Listen to the Medically Clear Podcast in iTunes or here

Catch up with Medically Clear, start here with Episode #1