On the Chinese Internet outside the wall, there is a profession called "Zhongnanhai Bed Listener". This is a very unkind irony: on issues such as the health of CCP leaders, some people cannot distinguish between conjectures, rumors and facts and spread rumors to satisfy their own expectations; some people deliberately mix truth and falsehood to attract audiences.
The hubbub has overlooked one point: aging, illness and treatment of leaders, as well as the processing of this information, have always been serious political issues. Some scholars examine it from the perspective of biohistory: disease is not a private matter, but a public risk that may reshape history.
The Fifth Plenary Session of the CPC Central Committee, which opens next Monday (October 26), will review the decision to “persistently promote comprehensive and strict governance of the Party.” It is widely expected that Xi Jinping will start his fourth term on the 21st of next year. His health became a topic again.
What are the health risks of a man in his seventies: smoking, being overweight, not exercising, and drinking too much?
Some public scenes received media attention.
In Macau in December 2024, Xi Jinping held Peng Liyuan's hand tightly when he walked down the gangway. Some overseas Chinese media interpreted it as needing support, while Chinese official media praised the couple's love. In Bishkek in August this year, CCTV reports cut out the scene of him walking down the gangway.
In New Delhi in September, Xi Jinping was temporarily absent from the BRICS summit dinner, and Wang Yi attended on his behalf. The Wall Street Journal, citing people familiar with the matter, said he was unwell.
When Xi Jinping arrived in Washington on September 23, the British "Independent" wrote not lyrically that he held on to the railing with one hand and held his wife tightly with the other as he slowly stepped off the plane.
The "Wall Street Journal" report pointed out that these signs "do not constitute a diagnosis" and there is "no evidence that he was seriously ill or had a stroke"; but "there is no dispute that Xi Jinping has common risk factors for men in their seventies." Former CIA analyst Dennis Wilder described Xi Jinping as a lifelong smoker, overweight, inactive and a heavy drinker. Wei Dening said that former Chinese Foreign Minister Qin Gang once told him that Xi Jinping "likes to drink." Qin Gang and Xi Jinping drank Moutai together during long-distance flights, and their relationship became increasingly close. "They would get very drunk."
It has to be said that some of the speculations from the outside world come from Beijing’s tight-lipped approach. Around the same summit in New Delhi, South African President Ramaphosa also reduced his schedule due to health reasons. His office directly stated that the medical team recommended that he rest. Beijing said nothing.
When leaders get sick, democracies hide it. After President Wilson suffered a stroke, the White House concealed the severity of his illness for a long time. However, psychiatrist Jerrold Post and political scientist Robert Robins examined more than a hundred cases in "When Disease Knocks Out Leaders" and concluded: "Democratic constitutional countries are better at handling succession issues than autocratic regimes - not so much because of the spirit of democracy, but because of the systems that accompany democracy." The failure of autocratic systems can be seen at three levels.
First, in medicine, aging makes people look at the present in terms of the past. Aging does not have to be a disease, but it can change judgment. The two authors calculated that the average age of Eastern European Communist Party leaders was 76 when they stepped down, and they had been in power for an average of 27 years. "This is not stable data, but stagnant data."
The author writes that in a crisis, older people tend to "look past the present" and fall back on the methods that made them successful in their prime. When the East Germans fled in 1989, Erich Honecker remembered how he used the Berlin Wall to block the flow of refugees. In the author's opinion, when Deng Xiaoping saw the students in the square that same year, he thought of the Red Guards during the Cultural Revolution. Led by senior citizens, the official government characterized the student movement as "unrest."
A section about Deng Xiaoping in the book begins with a quote from a slogan in Tiananmen Square, "Xiaoping Xiaoping, 80 years old, in good health, but not mentally sound..."
The author also quoted a popular joke at the time: a group of 80-year-olds were telling a group of 70-year-olds which 60-year-olds should retire.
Second, in terms of information, without free media, the disease can only become rumors. In authoritarian societies, the illness or disability of leaders is rarely reported due to the lack of a free press. In Brezhnev's later years and during the tenures of Andropov and Chernenko, age-related diseases brought the Soviet Union's domestic and foreign policies to a "virtual standstill."
Western media reported at the time that "the Soviet public was almost completely kept in the dark." The author believes that a free society with a tradition of independent journalism is "in a better position to monitor and evaluate the ability of leaders than a closed system."
Third, in terms of system, the more authoritarian the system, the more fatal the effects of the leader’s disease. "In a hierarchical and highly authoritarian system, the leader's illness is actually equivalent to beheading the country." On July 14, 1989, Honecker fell ill while attending the Warsaw Pact Conference in Bucharest and did not return to work until September 25. That summer, the democratic wave in Eastern Europe spread to East Germany, and the government was paralyzed by the absence of a leader. The authors argue: "The more authoritarian a leader is, the more his absence will be felt."
The example of Tunisia’s founding president Habib Bourguiba is more like a mirror. He once announced that he would retire at the end of his term, but in 1974 he accepted the title of "President for Life". He had been ill for twenty years. The book quotes one minister as saying that even the most carefully worded dissent could anger him and "endanger his health"; and anyone who made decisions without authorization in his absence could be dismissed.
On November 7, 1987, based on a medical report, Ben Ali invoked Article 57 of the Constitution to declare Bourguiba "completely unable to perform the duties of the president" and took over the power. According to the book, the doctor who issued the report made the determination based on internal requirements and did not examine Bourguiba himself.
Post and Robbins attribute these situations to a "captured king and a captured court": in a closed society, losing power can mean death, the moderate people who try to control the leader are expelled and replaced by submissive ones, and the king and the court "neither trust the other, but each needs the other to survive."
Those in power in Zhongnanhai enjoy the highest level of medical care. But what appears again and again in these books is that the people with the best medical conditions get the worst treatment. In an authoritarian system, power harms the health of those in power in at least three ways.
First, fear replaces medicine. David Owen wrote in "Disease and Power" that starting in 1950, Stalin ordered the arrest of a group of Jewish doctors, creating the "doctor case", and his long-term health doctor Vladimir Vinogradov also became an "enemy." After that, he became disgusted with doctors and asked his close associates who were not doctors to give him pills and potions. In 1953, he suffered a stroke and collapsed. The frightened senior officials around him ordered not to call a doctor. For twelve hours, no doctor came to see him. Post and Robbins write that in a "political system that thrives on killing its opponents," the internal medical system can be as much a source of danger as the military or the secret police, so leaders often select doctors based on political loyalties. Stalin "tightly guarded his medicines for fear of being poisoned."
Second, secrecy replaces treatment. Post calls it the "medico-political paradox": receiving the best possible treatment can be politically fatal, and subordinating medicine to politics can be medically fatal. In democracies, the price of this paradox is losing an election; where losing power can mean losing a life, the price is much higher.
Bourguiba of Tunisia did not trust his doctors. He traveled to France, Switzerland, Germany and the United States to seek medical treatment, and took his own medicine. He became "a walking pharmacy". Many of his symptoms were likely to be side effects of medicines. The official communiqué repeatedly stated that he had "caught a cold", "cold" and "fatigue", or that he had gone to France for "dental treatment". The Shah of Iran, Mohammad Reza Pahlavi, has been suffering from cancer for many years, and the outside world has not known about it.
Third, power changes the mind. Owen proposed the "hubris syndrome": power itself may change a person's mind, making him overconfident, disdainful of opinions, and behave out of touch with reality.
On September 3 last year, on the day of the military parade in Beijing, Xi Jinping and Putin walked side by side to the Tiananmen Gate and talked about longevity. The conversation was recorded by a microphone that was not turned off and was broadcast live on CCTV.
Xi Jinping said: "In the past, people rarely lived to be 70 years old, but now you are still a child when you are 70 years old." Putin said through a translator: "With the development of biotechnology, human organs will continue to be transplanted, and even live younger and younger, and even become immortal." Xi Jinping said: "There are predictions, this century, you may live to be 150 years old." Putin later confirmed this conversation.
Organ transplantation can save the lives of patients with organ failure, but there is no evidence that by constantly replacing organs, people can live younger and younger, up to 150 years old, and the human brain cannot be replaced.
If this conversation was a true reflection of the two dictators' views on health, it was also an example of how power changes minds.
Owen emphasized that the "arrogance syndrome" "usually worsens with the length of time in office." Democracies defend themselves against such leaders with cabinets, parliaments and the media, with term limits as the last gate. In 2018, China abolished term limits for the president. In this sense, it is also a decision about personal health.
