HEALTH SECOND OPINION

ONE of the few encouraging trends in recent politics in Britain and the United States is that the leading figures are younger than at any time this century. John Major, Bill Clinton and Tony Blair are all in robust health, contrasting vividly with Ronald Reagan and George Bush, whose health gave rise to repeated anxiety during their time in office. Even the indestructible Lady Thatcher suffered during her years as prime minister from varicose veins and a detached retina. Little wonder that supporters of Michael Heseltine were reported recently as claiming that he "had the arteries of a man aged 40".

Around the world, however, there is little evidence of a trend for political leaders to be younger. Dictatorships have leaders who hold on to power long past a sensible retirement age, and within Europe there seems no generally accepted age barrier for candidates for high office. Does this matter? Is there conclusive evidence that older politicians make more mistakes than younger ones?

In recent British history, the most striking examples of sick premiers are Churchill in his declining years and Eden at Suez. As the Second World War has been examined more critically, many examples have emerged of incompetent old generals, notably the French high command in 1940. The UN's disastrous defeats in Korea are now blamed mainly on the 70-year-old General Douglas Mac-Arthur, described by a younger colleague as "hysterical, stupid, even mad". All these have been documented by Dr Hugh L'Etang in Ailing Leaders in Power, 1914-1994 (Royal Society of Medicine Press), which presents evidence to support two propositions: that the health of leaders should be assessed as rigorously as that of pilots, and that a retirement age should be imposed on politicians.

Pilots undergo medical checks every six months, looking for evidence of disorders such as raised blood pressure and coronary heart disease which may cause no symptoms. Psychiatric disability raises more difficult issues: as L'Etang observes, charismatic leaders may exhibit bizarre changes and still retain their disciples' support. Nevertheless, some sort of medical assessment would surely be better than the existing system, in which doctors who look after presidents and prime ministers claim their responsibility is to their patient and not to society as a whole.

The optimum retirement age for politicians is another important issue. Of course signs of brain failure occur earlier in some people than in others (leaving aside brain disorders such as Alzheimer's disease and Parkinsonism). Loss of concentration, failing memory and loss of fluency in speech are pointers to declining brain function, but even people who retain their intellectual powers are likely to show some of the changes that occur with age - an unwillingness to accept new ideas, suspicion of the motives of others, especially younger colleagues, and a tendency to rely on an inner circle of trusted advisors, often people in the same age range.

If a retirement age of 60 is appropriate for civil servants, why should politicians be thought to have brains that last longer? At the least, decision-makers who want to go on working after 60 should be required to pass some medical equivalent of the MOT test.