For a long time, there has been an expectation that Presidential candidates will release their health information.  Being president is a highly stressful job, and a president who is not fully competent has the tools to do a lot of damage to the country and the world.  As such, there is an expectation among voters that candidates will release health information.  Of course, as with every other expectation, President Trump made a farce of this expectation by releasing medical summaries that were not particularly credible to any neutral observer, but there was so much that was wrong with the Trump campaign in 2016 and the mainstream media tries to avoid the appearance of taking a side that the lack of a real report on Trump’s physical and mental health was only a semi-big deal even on MSNBC.

This week, we had a bit of a health scare with Senator Bernie Sanders.  From every report, Senator Sanders is recovering from his surgery and should be able to resume his campaign.  However, this medical emergency does bring back into sharp focus an underlying issue in the nomination process.  President Trump and the top three candidates for the Democratic nomination (according to the polls) are all in their seventies.  And that means that issues of age and health will be in the background of this campaign.  Unfortunately, a healthy discussion of health is not likely.  But there are several things that should be on the table.

First, heart disease is a serious problem in this country impacting people of all ages.  A heart attack or a stroke can occur at any age.  I have known people who have died from a heart attack in their forties and fifties, and I have known people who have survived a heart attack in their seventies and eighties and have returned to a mostly fully functional life.  While people have become more health conscious in the past several decades, there are a lot of dietary and other factors that contribute to heart disease being one of the top causes of death in the U.S.

Second, many people do recover from heart attacks and with appropriate care and treatment are able to return to their normal lives, albeit with a focus on eating healthier, reducing stress,  taking medication to prevent further heart attacks, etc.  As such, a health attack or stroke does not disqualify a person from the Presidency.

Third, life expectancy has changed over the years.  Life expectancy is about the “mean” life of people, and that is impacted significantly by infant and child mortality rates as well as other factors that over the centuries has resulted in a large number of people not making it to forty.  A good chunk of the improvement in life expectancy has been increasing the number of people who make it to forty.  And, while we generally talk about life expectancy at birth, that life expectancy changes as people age for two reasons:  1) improvements to health care; and 2) the average is significantly impacted by those who die at young ages,  When the odds of a young death were much higher, it was easy to see sixty or seventy as old because such a tiny percent made it to that age.   Twenty-six of the first thirty-five persons to serve as President died before they reached seventy-five.  However, since President Truman, the only President who died a natural death before their seventy-fifth birthday was Lyndon Johnson.  President Ford, President Reagan, and President George H.W. Bush were in their nineties when they passed and President Carter is still alive and kicking at ninety-five (the oldest ex-president ever).  Before President Ford, only John Adams and President Hoover made it (just barely) to ninety.   The bottom line is that — unless there is something specific to the individual candidate hidden in their medical records — there is no reason to expect that any specific candidate will die before January 2025 for health reasons.

Fourth, we really still have a lot to learn about the aging process.  President Carter seems to still have most of his faculties well into his nineties.  President Reagan had a significant mental decline in his last decade — which some believed began while he was still in the White House.  Having a mother still alive at almost ninety and a father who died at eighty-three, I have seen two very different patterns of physical and mental decline in my own personal life.  While we have no neutral neurological evaluation of President Trump, some individuals have speculated as to whether his current behaviors are signs of a mental decline associated with his aging.  The problem is, of course, that every person is different.  While seventy-five used to be very old, it no longer is.  There is a need to be aware of the possibility of a mental decline among the older candidates (and that issues could develop over the next four years), but there is nothing about turning seventy or seventy-five which means that a person is incapable of serving as President.  Aging is a risk factor for the loss of mental abilities, but there is no bright line of how old is too old.  Age is more than just a calendar-based number.  And, unfortunately, while candidates are more than willing to release positive evaluations of their health, they are less likely to release negative information.

In short, as voters, both in the primary and the general, we need to be aware of the health of the candidates as a factor in our ultimate decision.  However, we really lack the information to make a decision based on health.  Undoubtedly, if we get further health scares, this issue will arise again during this campaign.