Unequal Suffering of War: Combat Participation,Regime Type,and Leaders’ Health

Abstract

Numerous studies have examined the health impacts of combat on ordinary people, but few have focused on state leaders whose well-being can shape global affairs. To fill this gap, we analyze over 2,000 state leaders from 1875 to 2001 using logistic regression and doubly robust estimation. The results show no significant overall relationship between combat experience and health among state leaders. However, this relationship depends on regime type. In democratic regimes, combat experience is linked to poorer health outcomes, consistent with the trauma framework observed in ordinary populations. In contrast, in nondemocratic regimes, the negative association disappears or reverses, aligning with a resilience framework. These differences may be due to the unique selection processes for state leaders. Thus, regime type explains the lack of an overall significant relationship. This study provides a nuanced understanding of how combat experience intersects with political context to influence leaders’ health.