Over the past few days, video of a swaying, buckling Hillary Clinton entering a Secret Service van after being overcome with the late summer heat has agitated the active imaginations of 2016 campaign watchers. The incident fueled conspiracy theorists that have for weeks insinuated, baselessly, that Clinton might be suffering from a life-threatening ailment (her doctor later announced that she had been diagnosed with pneumonia). But it also led to reasonable discussions of what the public is entitled to know about the health of presidential candidates, especially ones who are Clinton’s and Trump’s age. She is 68. He is 70.
Mortality, that ultimate wedge issue, had entered the political arena at long last.
If Trump wins in November, he will be the oldest person elected for a first term as president. Clinton would tie current record-holder Ronald Reagan, who was 69 (Clinton’s birthday is in late October). It is an undeniable fact, an un-spinnable assertion, that as the body ages, gets closer to its biological end, its systems start to go on the fritz. David Scheiner, who was Barack Obama’s physician during the 2008 presidential race, recently raised the issue of the 2016 candidates’ age, writing: “I can attest that the American people need much more medical information from these candidates. … At these ages, stuff begins to happen.” Before Reagan, William Henry Harrison was the oldest man to win the office; he did so in 1840 at age 67 and died 31 days after his inauguration.
Age isn’t a perfect proxy for health. The life expectancy of Americans has risen over time.
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During the 2008 presidential election, Republican candidate John McCain, who was 71 and had a history of skin cancer, released eight years of medical records, a step well beyond the summary letter of health from a candidate’s doctor that modern campaigns usually release. Pitted against a much younger man — Barack Obama was 46 — McCain surely felt compelled to prove his medical mettle, but his robust disclosure sets an interesting example for the modern, more aged candidate.
Age is a potent risk factor for any number of diseases — the incidence of heart disease, cancer and Alzheimer’s disease all increase in advancing years. Data on the relationship between these conditions and age is published in a variety of formats, but here are some relevant statistics:
- According to the American Heart Association, the incidence of cardiovascular disease (including heart disease and stroke) among women ages 55 to 64 is 8.9 per 1,000 person-years (a measure of incidence that accounts for the amount of time a patient was followed). For men, that number is 21.4. The incidence climbs to 20.0 per 1,000 for women ages 65 to 74 and 34.6 for men in that age group. By the time women reach the 75 to 84 age category, the incidence reaches 40.2 per 1,000; it’s 59.2 for men in that group.
- Cancer also becomes more common with age. Statistics from the National Cancer Institute show that the incidence of all types of cancer combined is 7.7 per 1,000 people between the ages of 50 and 64, and the number jumps to 17.4 per 1,000 people between the ages of 65 and 74. Cancer incidence among men and women ages 75 and older is 21.5 per 1,000.
- Reagan announced that he had Alzheimer’s disease in 1994, a few years after he left office, and some have speculated that the signs of the disease might have started showing during his second term in office. Alzheimer’s disease is another condition associated with age. The Alzheimer’s Association has calculated that in 2016, the U.S. population ages 65 to 74 can expect two new cases of Alzheimer’s per 1,000 people. Approximately 13 new cases per 1,000 can be expected among people ages 75 to 84, with 37 new cases per 1,000 among those ages 85 and older.
Longevity is one arena where Clinton could have an advantage — “It’s well-known that women live longer than men,” said Reid Blackwelder, a professor of family medicine at East Tennessee State University and past president of the American Academy of Family Physicians.
Life expectancies have risen substantially during the past century, and today, a woman of Clinton’s age can expect to live, on average, an additional 17.8 years (2.4 years longer than a man of the same age), while a man of 70, like Trump, can expect to live an average of 14.1 more years. The campaign trail itself is a pretty good test of a candidate’s health and stamina, and that both candidates are wealthy and college-educated further increases their chances to live longer lives than average.
Applying statistical truths about general populations — women live longer than men, for example — to specific individuals is problematic, of course. But there is limited health information available on each of the candidates. Clinton and Trump have each released only summary letters from doctors. Clinton’s addressed her hypothyroidism, allergies and an incident in 2012 when she fainted, got a concussion and developed a blood clot. The letter from Trump’s doctor, which has been widely criticized for its far-from-clinical language, says that he takes a daily aspirin and a statin — a cholesterol-lowering drug.
Trump hasn’t shared enough data for his risk of heart problems to be calculated with the standard calculator, but doctors prescribe these two drugs to patients at risk of heart disease, Blackwelder said. “Being an older male puts Mr. Trump at risk just from those two factors,” he said. “If someone is completely healthy, then they’re rarely on prescription medications.”
After this weekend’s events, Clinton’s campaign has said it will release additional information about her health — what it would be wasn’t specified — and Trump said he would release the results of a physical he had last week. Trump didn’t offer to go back further in his medical history. Neither candidate is obligated to release information that he or she isn’t inclined to share, though. In 2008, some noted that despite McCain’s extensive record release, little information was provided on his mental health, a fact that was noted at the time with allusions to his imprisonment for more than five years during the Vietnam War.
So many of the conventions surrounding presidential vetting, such as the disclosure of tax returns (something Clinton has done but Trump has declined to do thus far) are “gentlemen’s agreements” that are not mandated by law, but rather demanded by historical expectation and national peer pressure. Perhaps 2016 will be when expectations that the public holds for candidate health disclosure will change. Blackwelder said it might be reasonable to scrutinize candidates’ health — “If you look at the before and after photos of every president, you can see physically the impact of that job — it’s demanding” — but cautioned that doing so would raise some ethical issues.
“The challenge is going to be — are there disqualifying medical conditions?” he said. “That starts to make me nervous; it starts to be like a religious test to be able to run.” If the public is going to get a look into candidates’ medical data, Blackwelder said, it should be clear how it’s going to happen. He suggested that six months before the general election, candidates could receive a standardized medical exam.
“That will at least create a template of balance,” he said.
Research contributed by Christianna Silva.