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

Numerous studies have exmained the health consequences of combat participation, often finding negative consequences in most cases (the trauma framework) or nonnegative consequences in others (the resilience framework). However, these studies primarily focus on ordinary veterans. There has been no large-scale, quantitative research on how combat participation affects the health of state leaders – a group whose health can have profound impacts on a country or even the world.

To address this research gap, we analyze over 2,000 state leaders worldwide between 1875 and 2001 using conventional logistic regression and doubly robust estimation. The findings are consistent across both analytic methods.

The results reveal that, contrary to the trauma framework observed among ordinary people, there is no significant relationship between combat experience and health among state leaders overall. Further analysis shows that this relationship is contingent upon the regime type.

In more democratic regimes, the negative association between combat experience and leaders’ health becomes more pronounced and statistically significant, aligning with the typical trauma framework. Conversely, in nondemocratic regimes, this negative association either disappears or even reverses, which is consistent with the resilience framework. This difference may be due to the selection processes for state leaders that set them apart.The varying patterns across different regimes collectively explain the overall lack of a significant relationship.

By revealing how the health impacts of combat experience on state leaders differ across regime types, this study provides a nuanced understanding of the intersection between political context and individual health outcomes.