This House believes African leaders should be transparent about their health

John Atta Mills the President of Ghana died suddenly on the 24th July 2012. Or at least it appeared sudden to Ghanaians at the time. In fact he had been suffering from throat cancer for some time but his administration had not been open about his health. Serious questions had already arisen about Mills’ health, indeed there had been reports of his death on two prior occasions. However the relentless speculation was always met with the response that he was not facing any health problems; the ruling party feared that disclosing their leader’s health condition would affect their chances of winning the upcoming general elections1.

However in some ways the Ghanaian government was quite open; it announced Mills’ death within hours. The government of Malawi waited two days before telling the world that their President wa Mutharika had died.2 Secrecy is often the norm.

Some African nations not only avoid transparency but don’t allow even discussion of a leader’s health; it can even be considered a crime punishable by death3. The issue is however important regardless of whether it is considered to be a crime. By avoiding disclosure of their health, leaders are compelled to continue their duty not only at the risk of their own health but also damaging the ability of their government to function. The condition in Africa is so drastic that with a mortality rate of 15% an infant in Sierra Leone has more chance of surviving the next 5 years than an African leader serving a few terms; Africa lost eight heads of state from 2008-2012.4 The death of a President is therefore not an isolated occurrence so the issue of transparency with regards to their health is important. The state has the option to be transparent about their leaders in order to psychologically prepare the people for a transition. But it has its disadvantages too due to the uncertainty it creates. Should African states be transparent?

1 Committee for Social Advocacy, 'Who and what killed President John Evans Atta Mills?', Modern Ghana, 13 August 2012,

2 Phiri, Milli, ‘Why journalists resort to rumor to disclose political news’,, 4 February 2013,

3 Songwe, Vera, and Kimenyi, Mwango S., 'The Health of African Leaders: A Call for More Transparency', Brookings, 7 August 2012,

4 Allison, Simon, 'Why do African presidents keep dying', Daily Maverick, 1 August 2012,


The head of state/government must be accountable to the people

Secrecy in relation to the leader’s health shows a distrust or distain of the electorate. Not being open about health issues almost invariably means that the administration is lying to those who elected them, those who they are accountable to. A couple of days before John Atta Mills died Nii Lantey Vanderpuye a candidate for Mills’ party stated “He [Mills] is stronger and healthier than any presidential candidate”, information that in retrospect was clearly untrue.1

1 Takyi-Boadu, Charles, ‘Confusion Hits Mills’, Modern Ghana, 21 July 2012,


If a candidate has a condition during an election campaign then there is a clear right to know when the electorate is making the decision. But does such a right to know apply at other times when it will make no difference to the people? There can only be a right to know if it is going to affect the people, something that many illnesses won’t do.

The people are interested in the health of their leader

The health of the leader of the state is an issue that the people and the media inevitably want to know about. There will always be a lot of interest in it. Occasionally this can be played by the administration as with Kissinger saying he was ill and using time to fly to Beijing to arrange for Nixon’s visit without press attention. But most of the time keeping things from the press is purely negative; it drives rumors.

This was the case of John Atta Mills, people were not allowed to know about his health. The presidential staff and communication members constantly lied about his health but there were two reports that he had died. Mills spent time in a US hospital, on returning to Ghana, he was made to jog around the airport to show the media that he was healthy.1

1 Committee for Social Advocacy, 'Who and what killed President John Evans Atta Mills?', Modern Ghana, 13 August 2012,


The media always want a good story; they are interested in the health of celebrities when there is no clear reason why they should have any right to this private information. The health of the leader is not something that the press or public needs to know about unless it is an illness that is likely to affect the president’s capacity to make decisions. A government’s decision should not be based upon the possibility that information on the leader’s health will leak and should take a consistent line that it is a private matter or provide a bare minimum of information.

Transparency allows citizens to choose for a healthy leader as to ensure proper functioning

The health and fitness of a leader is a vital issue when choosing a leader; the electorate deserves to know if they are likely to serve out their term. When health conditions are hidden from the people they may mistakenly elect a leader who is unable to serve a full term or is at times not in control of the country. There would be little point in voting for a leader who will often not truely be in charge of the country, if voters are told it becomes their choice whether this is a problem. Transparency in terms of clear, accurate and up-to-date information is necessary for the electorate to judge the fitness of a leader which is a necessary precondition for election. In a democracy a leader needs to be accountable, he can only be accountable if the elctorate knows such vital information.


Administrative capabilities should not be compared to health. Unhealthy leaders may perform better than the healthy ones, people could be misled to choose inappropriate leaders while taking health as a black spot while the leader could actually have a better potential than the rest. If the electorate had just elected on the basis of health, or had been fully informed about presidents health then it is plausible that neither FD Roosevelt of JF Kennedy would have been elected. Neither completely hid their illnesses but they were not discussed and did not become election issues as they would have in a modern election.1

1 Berish, Amy, ‘FDR and Polio’, Franklin D. Roosevelt Presidential Library and Museum

A lack of transparency can endanger the leader

A person is most likely to survive when they have an accident, a heart attack, or some other condition if they get prompt treatment and doctors are aware of any underlying conditions. Mills may well have lived, or lived longer if there had been more transparency about his death. There had been no prior warning that the president might be rushed to hospital despite the doctors having been called in the previous day. For the same reason his outriders were not available leading to indecision over whether to send off the ambulance. And finally he was initially turned away from the emergency ward because they did not know it was the President they were being asked to treat.1 Transparency would allow procedures to be in place and advance notice given possibly gaining a few minutes and enabling survival.

1 Daily Guide, ‘How Mills died: Sister tells it all’, My Joy Online, 31 August 2012,


All of these procedures could be put in place even if there is secrecy. Doctors are already committed to patient-doctor confidentiality so are unlikely to tell the press if they are told beforehand to be ready to receive the President.  

Denial of privacy to the leaders

The leaders of states deserve privacy in exactly the same way as anyone else. Just like their citizens leaders want and deserve privacy and it would be unfair for everyone to know about their health. Leaders may suffer from diseases such AIDS/HIV or embarrassing illnesses which could damage a leader.

The people only a need for the people to know when the illness significantly damages the running of the government. The government can function on its own without its leader for several days; only if the illness incapacitates the leader for a long period is there any need to tell the people. Clearly if the President is working from his bed he is still doing the job and his government is functioning. William Pitt the Younger, Prime Minister of Great Britain was toasted as 'the Saviour of Europe' while he was seriously ill but still running the country during the height of the Napoleonic Wars.1

1Bloy, Marjie, 'William Pitt the Younger (1759-1806)', Victorian Web, 4 January 2006,


When leaders choose to serve the country they should be ready to sacrifice their privacy for the country. There is clearly a different standard for those who are in government and should be publicly accountable to those who are not. Even more minor illnesses can damage the running of the country through either affecting the judgment of the leader or limiting the amount of time he can work. The people have the right to demand their leader has his full attention of the issues affecting the nation. If he can't do that then he should resign.  

Rivals could misuse the opportunity

While the leader suffers from an illness, rivals can use the opportunity to ease the leader out of office. A period of illness is a period of vulnerability in which the government is less able to respond to external and internal threats. Not telling the public about the leader's health during an illness helps prevent such attempts. The same is the case with a leader's death; a few days of secrecy allows for smooth succession as the appointed successor has the time to ensure the loyalty of the government, army and other vital institutions. In 2008 when General Lansana Conte of Guinea died power should have been transferred to the president of the National Assembly Aboubacar Sompare with an election within 90 days. Instead a group of junior military officers took advantage of the quick announcement to launch a coup.1

1 Yusuf, Huma, ‘Military coup follows death of Guinea’s President’, The Christian Science Monitor, 23 December 2008,


Transparency is still better than secrecy. There are several reasons why the opportunity of instability is as present when keeping the leader's health a secret. The first is that it is likely that at least some of the leader's rivals are in government so are likely to be in the loop on any illness. In this case secrecy simply gives these individuals more opportunity to do as they wish. Secondly a lack of transparency creates uncertainty which can be filled by a rival wanting to seize power; if the leader is just ill and there is a void of information it is simply for rivals to seize the narrative and claim he is dead enabling their takeover.

Markets like stability

Business and the markets prize political stability. Clearly when the leader of a country is ill this stability is damaged but the damage can be mitigated by being transparent. The markets will want to know how ill the leader is, and that the succession is secure so that they know what the future holds. Secrecy and the consequent spread of rumour is the worst option as businesses can have no idea what the future holds so cant make investment decisions that will be influenced by the political environment.

Leaders do matter to the economy; they set the parameters of the business environment, the taxes, subsidies, how much bureaucracy. They also influence other areas like the price of energy, the availability of transport links etc. It has been estimated that “a one standard deviation change in leader quality leads to a growth change of 1.5 percentage points”.1 The leader who follows may be of the same quality in which case there will be little difference but equally it could mean a large change.

1Jones, Benjjamin F., and Olken, Benjamin A., 'Do Leaders Matter? National Leadership and Growth Since World War II', Quarterly Journal of Economics, February 2005,


Deputy leaders are appointed and they are well versed with how the leader is managing issues and are capable of taking up the role immediately after the leader resigns or dies. Being open and transparent about a leader being ill simply creates the lack of stability. If he lives it is best if the illness is not revealed as everything will carry on as before. If the leader dies then it is best nothing is known until his successor is announced so reducing the period of uncertainty.

Damages diplomacy to be too open

Diplomacy can be very personal; diplomatic initiatives are often the result of a single person, and the individual leader is necessary to conclude negotiations. Transparency about a leader's health may therefore prevent deals being done; Nixon went to China despite Mao's ill heath meaning the supreme Chinese leader contributed little to the historic change in diplomatic alinements.1 Would such a momentous change in alignment have been possible if both the Chinese and American public knew about Mao's ill health? The Americans would have considered any deal unreliable as they could not be sure it was Mao who made the decision, while opponents in China could have argued that it was advisers like Zhou Enlai who made the deal not Mao himself potentially enabling them to repudiate or undermine the deal.

1Macmillan, Margaret, Seize the Hour When Nixon met Mao, John Murray, London, 2006, p.76


If the leader in-charge is in illness, to avoid any repudiation, the representative from the other side could meet the leader in order to confirm or even have a video conference with the leader in charge. The leader only needs to set the overall policy, not negotiate the fine details. When Nixon went to China the Americans knew Mao was ill but realised that he still set the overall direction of policy.


Allison, Simon, 'Why do African presidents keep dying', Daily Maverick, 1 August 2012,

Berish, Amy, ‘FDR and Polio’, Franklin D. Roosevelt Presidential Library and Museum,

Bloy, Marjie, 'William Pitt the Younger (1759-1806)', Victorian Web, 4 January 2006,

Committee for Social Advocacy, 'Who and what killed President John Evans Atta Mills?', Modern Ghana, 13 August 2012,

Daily Guide, ‘How Mills died: Sister tells it all’, My Joy Online, 31 August 2012,

Jones, Benjjamin F., and Olken, Benjamin A., 'Do Leaders Matter? National Leadership and Growth Since World War II', Quarterly Journal of Economics, February 2005,

Macmillan, Margaret, Seize the Hour When Nixon met Mao, John Murray, London, 2006

Phiri, Milli, ‘Why journalists resort to rumor to disclose political news’,, 4 February 2013,

Songwe, Vera, and Kimenyi, Mwango S., 'The Health of African Leaders: A Call for More Transparency', Brookings, 7 August 2012,

Takyi-Boadu, Charles, ‘Confusion Hits Mills’, Modern Ghana, 21 July 2012,

Yusuf, Huma, ‘Military coup follows death of Guinea’s President’, The Christian Science Monitor, 23 December 2008,