The Pulse

Life Expectancy & The Global Economy

Earlier diagnosis of disease and better public health policies can drive further gains in future life expectancy

New SIGMA report from Swiss Re estimates that reversing the trend of slowing improvement will depend on technology and public health policy to identify and treat growing threats. Read the report here.

Zurich, 5 December 2018 – Life expectancy has steadily improved internationally for well over a century. In recent years, however, there are signs that the rate of mortality improvement has slowed in a number of advanced countries. Statistically, it is difficult to determine if the recent slowdown is simply a short-term blip or more permanent.

The latest sigma report from the Swiss Re Institute, “Mortality Improvement: Understanding the past and framing the future“, suggests that future gains in health and longevity will depend on the success of public health policy. For governments and private financial institutions that are exposed to longevity risks, shifts in the underlying mortality trend are crucial as this risk cannot easily be diversified or perfectly hedged.

Since 1990, mortality rates – the number of deaths in a standardized population over a particular period – have been declining relatively rapidly in developed countries at around 1-2% per year. This reflects improved living conditions, advances in medicine and innovations in health technology. However, since around 2011, age-standardised mortality rates in the US, UK and Germany, for example, while still declining, are doing so at a slower pace than in earlier decades. The recent US mortality experience has been impacted by additional deaths caused by opioid drug overdoses. Statistically,
it is difficult to conclude whether the slowdown represents a structural change or simply reflects typical annual volatility in death rates.

The longer it persists, the more likely it is that the underlying trend has changed. For now, it is too early to tell.

Drivers of slowing mortality improvements

Cause-of-death statistics indicate that some of the recent slowdown in mortality improvement might reflect the lack of additional progress in treating major illnesses such as cardiovascular diseases. Worsening trends in circulatory-related disease have been a key influence on the slowdown. To the extent that these can be linked to behavioral factors, lifestyle choices regarding diet and physical exercise rather than smoking/alcohol consumption are the most obvious explanations.

Importance of targets in driving mortality

“Differences in mortality between healthy sub-groups and the general population provide a lens through which to quantify potential, but as yet untapped, mortality gains”, says Dan Ryan, Head of Insurance Risk Research
at Swiss Re Institute. By defining such a sub-group (ie, target population), perhaps in terms of diet or blood pressure, policies can be directed towards closing the gap in mortality experience between the general population and that of the target group.

Research on an anonymized patient database from the UK indicates that if current mortality among a target healthy group with no diagnosis of 30 major diseases were to be targeted across the wider population (and this was realized over twenty years), the rate of mortality improvement would broadly return to that observed over the past four decades.
Some healthy characteristics may be easier to replicate than others; certain behavioral traits and medical conditions may simply be hard to address. If we close the mortality gap for the majority of these conditions, we could still see mortality improvement pick up from recent rates, but differences to the target group would need to narrow faster.

How technology can help improve longevity

The sigma study also emphasises that the future of healthcare has to be focused on identifying early signs and symptoms of disease, and attempting to prevent disease progression and overall poor health. Digital health tools like
telemedicine and wearables can play an important role in driving future mortality improvement. These technologies not only improve access to care, but also encourage healthcare markets to compete for lower, more affordable options. A key challenge is how to encourage consumers to sustainably adopt new technology and change their unhealthy behaviour.

Implications for insurers and pension plans

For governments and private financial institutions that assume longevity risk on behalf of individuals, shifts in the underlying mortality trend are crucial as this risk cannot easily be diversified away. “We may be entering a new period where we see no improvements to life expectancy. Decision makers in insurance will need to be alert to how the
uncertainty plays out in the coming years in regards to pricing, reserving decisions and policy”, says Paul Murray, Chief Pricing Officer, Life & Health Products Centre at Swiss Re.Insurers and pension schemes need to form a view on the likely success and availability of public and private health interventions to influence behavior and prevent disease and death. This is especially the case given that the reported slowdown in mortality improvement for the general population has
yet to be echoed among people in higher socioeconomic classes, who typically make up the bulk of insureds.
Overly conservative pricing to cover the range of future mortality outcomes will make products such as annuities and life insurance unnecessarily expensive. At the same time, prematurely adjusting assumptions about underlying mortality trends will almost inevitably stretch insurers’ balance sheets once the liabilities are ultimately re-rated to reflect revised life
expectancy realities

the future of healthcare has to be focused on identifying early signs and symptoms of disease, and attempting to prevent disease progression and overall poor health. Digital health tools like telemedicine and wearables can play an important role in driving future mortality improvement...

The longer it persists, the more likely it is that the underlying trend has changed. For now, it is too early to tell.
Drivers of slowing mortality improvements Cause-of-death statistics indicate that some of the recent slowdown in
mortality improvement might reflect the lack of additional progress in treating major illnesses such as cardiovascular diseases. Worsening trends in circulatory-related disease have been a key influence on the slowdown. To the extent that these can be linked to behavioral factors, lifestyle choices regarding diet and physical exercise rather than smoking/alcohol
consumption are the most obvious explanations.

Importance of targets in driving mortality

“Differences in mortality between healthy sub-groups and the general population provide a lens through which to quantify potential, but as yet untapped, mortality gains”, says Dan Ryan, Head of Insurance Risk Research
at Swiss Re Institute. By defining such a sub-group (ie, target population), perhaps in terms of diet or blood pressure, policies can be directed towards closing the gap in mortality experience between the general population and that of the target group.

Research on an anonymised patient database from the UK indicates that if current mortality among a target healthy group with no diagnosis of 30 major diseases were to be targeted across the wider population (and this was
realised over twenty years), the rate of mortality improvement would broadly return to that observed over the past four decades. Some healthy characteristics may be easier to replicate than others; certain behavioural traits and medical conditions may simply be hard to address. If we close the mortality gap for the majority of these conditions, we could still
see mortality improvement pick up from recent rates, but differences to the target group would need to narrow faster.

How technology can help improve longevity

The sigma study also emphasises that the future of healthcare has to be focused on identifying early signs and symptoms of disease, and attempting to prevent disease progression and overall poor health. Digital health tools like
telemedicine and wearables can play an important role in driving future mortality improvement. These technologies not only improve access to care, but also encourage healthcare markets to compete for lower, more affordable options. A key challenge is how to encourage consumers to sustainably adopt new technology and change their unhealthy behaviour.

Implications for insurers and pension plans

For governments and private financial institutions that assume longevity risk on behalf of individuals, shifts in the underlying mortality trend are crucial as this risk cannot easily be diversified away. “We may be entering a new period where we see no improvements to life expectancy. Decision makers in insurance will need to be alert to how the uncertainty plays out in the coming years in regards to pricing, reserving decisions and policy”, says Paul Murray, Chief Pricing Officer, Life & Health Products Centre at Swiss Re.

Insurers and pension schemes need to form a view on the likely success and availability of public and private health interventions to influence behaviour and prevent disease and death. This is especially the case given that the
reported slowdown in mortality improvement for the general population has yet to be echoed among people in higher socioeconomic classes, who typically make up the bulk of insureds. Overly conservative pricing to cover the range of future mortality outcomes will make products such as annuities and life insurance unnecessarily expensive. At the same time, prematurely adjusting assumptions about underlying mortality trends will almost inevitably stretch insurers’ balance
sheets once the liabilities are ultimately re-rated to reflect revised life expectancy realities.

How to order this sigma study:
The English, German, French, and Spanish versions of the sigma No 6/2018, “Mortality improvement: understanding the past and framing the future” are available electronically on the Swiss Re Institute’s website: institute.swissre.com
Printed editions of sigma No 6/2018 in English, German, French and Spanish are available. The printed versions in Chinese and Japanese will be available in the near future. Please send your orders, complete with your full postal address, [email protected]

Printed editions of sigma No 6/2018 in English, German, French and Spanish are available. The printed versions in Chinese and Japanese will be available in the near future. Please send your orders, complete with your full postal address, [email protected]

 

Swiss Re
The Swiss Re Group is one of the world’s leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. It anticipates and manages risk – from natural catastrophes to climate change, from ageing populations to cyber crime. The aim of the Swiss Re Group is to enable society to thrive
and progress, creating new opportunities and solutions for its clients. Headquartered in Zurich, Switzerland, where it was founded in 1863, the Swiss Re Group operates through a network of around 80 offices globally. It is organised into three Business Units, each with a distinct strategy and set of objectives contributing to the Group’s overall mission.