The pursuit of healthiness and why life expectancy gains matterby Neil Sprackling Mr. Sprackling is CEO ,L&H Reinsurance US, Swiss Re. Visit www.swissre.com.
With over three decades of experience in the Life & Health insurance industry, I’ve learned that we cannot be complacent in assuming that life expectancy will always be on the up. Steadily improving longevity through advances in healthcare, technology and lifestyle choices has been a gift of the 20th century. The gains have been hard-won… but can be easily knocked off course.
Swiss Re’s recent study, “The future of life expectancy,” shows that the US is already losing ground, with only modest improvements about 2010 onwards, through a range of socioeconomic disparities and other health & lifestyle factors.
This small improvement over the last decade or is a key concern for insurers who are there to support and navigate times of uncertainty or unexpected challenges. At Swiss Re, we are passionate about harnessing technological innovation for a better understanding of health and wellbeing. We want people to live longer, healthier lives!
There are two areas of development potential to support this goal: new technologies for disease prediction and new, scientifically proven approaches to prevention of ill health. Deeper awareness of these trends will help life insurers deliver more accurate predictions of future mortality improvements.
Prediction: The significant life expectancy gains of the past 100 years originate in large part from medical advances like immunizations, and in treatments for cardiovascular diseases. The positive effects of these on life expectancy eventually plateau and new advances are needed if mortality rates are to improve further. We remain attuned to breakthroughs that hold promise of revitalizing the just tepid improvements in life expectancy observed over the past decade. Medical research is doubling down on earlier and more accurate diagnoses of more complex and challenging-to-treat diseases. Some of the promising developments on the horizon include:
Advances in cancer detection: Companies such as GRAIL Bio UK® are working on a single blood test known as a liquid biopsy that can enable early detection of more than 50 cancers. If liquid biopsies can detect cancers early enough, the technology would have huge scope to improve survivability. The biggest gains would likely be for those cancers typically detected only in later stages of disease and which come with the highest mortality rates. Think of the likes of lung, colon and pancreatic cancers. Alongside new testing, we can also expect to see improvements in current diagnostic testing. We are already seeing AI enhancing the diagnosis of breast cancer through mammograms and assisting in CT scan analysis, freeing up healthcare staff time and shortening the pathway to patient treatment by finding a higher percentage of cancers quicker.
Further, the adoption of personalized treatments like mRNA vaccines for cancer treatments is gaining momentum. Clinical trials, like the one at the Memorial Sloan Kettering Cancer Center in New York are exploring the use of these vaccines in conjunction with more conventional treatments, to reduce the risk of pancreatic cancer relapse following surgical tumor removal.
Treatment Of Neuro-Degenerative Conditions
New treatments against the life-limiting diseases of old age have emerged in quick succession. Since 2020, the drugs aducanumab, lecanemab and donanemab, have offered new hope for the treatment of Alzheimer’s disease and memory decline. Nevertheless, there are ongoing questions regarding their efficacy and potential side effects.
While I eagerly await further advancements, we can continue to expand our knowledge base to champion new treatments as their efficacy becomes more evident.
Societal shifts towards making healthier life choices are other drivers of mortality improvement. Increased public awareness of what good health means and, notably, more people quitting smoking are very encouraging examples of this. However, there have also been negative shifts that increase mortality risk. For instance, today the US is grappling with high obesity rates: 70% of the population now classed as overweight or obese. Diabetes rates are also rising, alongside other obesity-linked causes of death. All of these are indicative of poor metabolic health, a topic that my colleague, Dr Schoonbee writes about in his latest report “Tackling wellbeing from the inside out”. Poor metabolic health is responsible for over 70% of all non-communicable diseases worldwide. Our society can make a positive impact on health through better nutritional control, resulting in better outcomes for factors like blood pressure, blood fat levels and diabetes.
The US is facing societal challenges and unhealthy living behaviors of a different slant too, such as opioid addiction, alcohol abuse and deaths resulting from violent crime. These cut short the lives of people involved, although the magnitude of impact varies by socioeconomic background, often affecting areas where insurance penetration is limited, to a greater degree.
A focus on prevention can encourage individuals to adopt positive lifestyle choices, and the re/insurance industry can be an agent of positive change by raising awareness of the impact of healthy behavioral choices. Namely longer, healthier and happier lives. These are some examples of how insurers can inform, raise awareness and promote healthy living:
- Promoting healthier choices such as nutritionally balanced diets, more physical activity and to avoid smoking, excess alcohol consumption and/or drug use.
- Technological Assistance: smartwatches and apps can track step counts, physical activity and heart rate. Some insurance companies have already started offering incentives for tracking your metrics. Swiss Re is exploring this landscape further with our partnership with the University of Oxford, to broaden our understanding of the impact of physical activity and sleep, and their ability to be predictive markers for long-term mortality and morbidity outcomes.
What Do These Developments Mean For Life Insurers?
Medical advances engender optimism. Progress on early cancer diagnosis and personalized treatments should benefit the L&H sector. The potential to identify cancers in early stages should lead to improved health outcomes and better long-term prognoses. Should these medical technologies develop as expected and deliver more insights into disease progression, we could predict risk more accurately.
Ever-improving diagnostics techniques deliver greater granularity and thereby facilitate improved risk assessments and potentially better outcomes in claims management. However, like any emerging technology, it may require scrutiny to balance insurers’ interests with those of policyholders. There may also be a need for regular reviews of underwriting and claims definitions. And one thing insurers should not forget about is the potential for anti-selection. Some new testing tools can be administered at home, but the results may not be reported on electronic health records, nor have medical confirmation from a doctor, leading to non-disclosure in insurance applications.
Aging societies may change life products: The effects of population aging on life insurers and their product lines could be significant. Improvements in testing for Alzheimer’s would likely allow for early confirmation of diagnosis, perhaps at a pre-symptomatic stage. Slowing disease progression could improve a patient’s quality of life, and longevity. These advances could lead to reassessment of certain life products, such as Long-term Care policies. Note, however, Alzheimer’s and dementia mostly impact individuals aged over 60, so improved treatments are unlikely to have a major effect on Group Life or Group Disability policies.
Progress on lifestyle factors is a key concern: Since the COVID-19 pandemic, dietary habits have gotten worse, and people are doing less physical activity. Metabolic health and factors that drive obesity and diabetes, ultimately impact mortality risk within a given population, regardless of the specific cause of death. Mental health is a further challenge, often under-diagnosed and poorly treated. The US is also seeing increased alcohol consumption and an increase in early claims for liver cirrhosis. This includes among people with high levels of education, a group that represents a notable subset of the insured population.
Lack of equal access to good medical care may further compound health risks in the US. Today, there are fewer healthcare providers than in the past, and more people are heading to ER for routine treatments that in the past were provided by primary care physicians. ERs do not offer follow-up care for those routine treatments. Instead, individuals need to administer any next steps themselves, which increases the risk of non-adherence and ultimately, sub-optimal treatment outcomes.
Socioeconomic disparities exacerbate poor health outcomes: Low-income individuals tend to have shorter life expectancy than the better off, affirming the pressing need for more affordable, available and accessible insurance. Our life expectancy research of 2019 shows that most well-off socioeconomic groups in the US outlive the lowest by an average of 5-7 years. At the same time, healthcare outcomes for lower-income groups have “deteriorated sharply” since 1980, with more deaths due to alcohol abuse, drug overdoses, suicides or violent crime. Certainly, the limited access to healthcare facilities for this segment of the population does not make things any better.
Almost half of all Americans have no life insurance. According to LIMRA’s latest Insurance Barometer survey data, the need is greatest among those earning less than USD 50,000 annually. The insurance industry needs to help address this challenge. Unlocking new business models to make insurance more inclusive for all is at the same time a tremendous growth opportunity for the industry. Integrating Knowledge Into Insurance
Our industry needs to align with the interests of our end customers. We should focus on providing relevant information and tangible actions to help people navigate healthy lifestyle choices and actively manage their health. We can equip distribution channels with accessible, evidence-based information, and adapt communication methods to reach consumers wherever they are, through social media, email, messaging services or even interactive chatbots. In order to increase ease of adoption of these initiatives, we continue to facilitate partnerships with carriers to share our knowledge and expertise.
At Swiss Re, we’ve extended our Life Guide’s risk prediction capabilities by incorporating more lifestyle and clinical risk factors into our cardiometabolic calculator (CMC). Our goal is to build a comprehensive picture of health, and the CMC now considers more novel metrics such as levels of physical activity and sleep, nutrition and mental health alongside traditional risk factors such as BMI, blood pressure and a variety of lipid (cholesterol) markers.
We can also support our carrier clients in actively managing their in-force portfolios. This could take the form of on-going policyholder engagement, or by implementing lapse management programs .
The first step towards more inclusive life insurance is to expand our market research and increase our e first step towards more inclusive life insurance is to expand our market research and increase our industry’s understanding of different population segments. Working with social interest groups, charities and across the financial services industry, we see an opportunity for insurers to widen access and close the protection gap, particularly in the underserved segments of society.
Finally, as an industry, we can help to innovate new L&H insurance solutions. Building on our global experience, Swiss Re can help to design products and programs that support L&H insurers to narrow the health protection gap in the US.
By embracing change, we can ensure a resilient and thriving insurance landscape for years to come. Personally, I am very happy and proud that I work in an industry that can shape a future that not only mitigates risks, but also enhances longevity and quality of life for everyone.