Articles - What is going to drive the next mortality improvement wave

Long-term mortality trends have grown increasingly complex across many markets this past decade. Overall, people in advanced economies – from the US and Canada to the UK and Japan – are living longer, healthier lives. Pharmaceutical innovations have lowered blood pressure and cholesterol, while a push to quit smoking has helped spare millions from tobacco-related disease since the 1970s.

 By Paul Murray, CEO L&H Reinsurance, Swiss Re
 However, the significant advanced-market gains that had characterised the 20th century have slowed or plateaued in the last decade or so. But what are the drivers behind this slowdown? Dramatic gains in the UK that accelerated in the 1960s to lift life expectancy to now more than 80 years from 65 at the close of World War II have, unfortunately, tapered off. The US experience has been more sobering: Life expectancy began faltering a decade ago and stands at around 76 years; in longevity, the world's biggest economy now trails its peers.

 The culprit? A drop in cardiovascular disease improvements has emerged as populations in the UK and US struggle with obesity and diabetes that accompany more sedentary lifestyles and ultra-processed food. Dementia and respiratory illnesses also contribute to higher mortality in ageing populations.

 In the US, opioid abuse has also been a factor contributing to this decline. COVID-19 took a severe toll, in people suffering from co-morbidities but also broader groups, though it is estimated that mortality rates will eventually return to pre-pandemic levels.

 Even in countries famed for their citizens' longevity, unabated improvement isn't inevitable. In Japan, mortality improvement flattened some 15 years ago, potentially linked to factors like declining physical activity or increased sugar intake. Life expectancy in Japan is still seen increasing steadily in coming decades from the current 85 years, but fluctuations show it's important to keep an eye on this metric.

 Even modest rate changes can have an impact on L&H insurance portfolios. Our industry has a role to play when it comes to bending the curve in a more positive direction.

 Cancer advancements – the next wave?
 History teaches us that progress in lifespan improvements often comes in waves, driven by medical, nutritional, or lifestyle advances that aid healthy aging. Significant gains that accompanied the golden era of antibiotics in the 1950s, awareness of smoking risks, or cholesterol-lowering drugs were often trailed by slowdowns, perhaps similar to what we're now experiencing.

 But what’s going drive the next big mortality improvement wave? Current analysis from Swiss Re indicates that cancer diagnostics and treatment are among advances due to feature prominently in helping fuel coming decades' longevity gains.

 Cancer is a tough foe. It's not just one disease but a collection of more than 200 that may share common drivers. While the cancer death rate in places like the US has fallen by about a third in recent decades, I see even more headway possible.

 Understanding of tumour genetics is expanding and we're increasingly able to individualise approaches with immunotherapies, tumour-agnostic drugs and CAR-T therapies. As progress in diagnosing cancer continues, we must ensure science guides our decision-making, to avoid pitfalls like testing that produce false positives.

 We're also finally seeing nascent signals of progress in the race to halt the advance of Alzheimer's disease. As societies age and suffer from growing neurodegenerative disorders, therapies to delay, stop, or reverse such conditions could become mortality-improvement gamechangers.

 I'm also hopeful that we'll see advances against antimicrobial resistance that now leads to millions of hard-to-treat, potentially fatal infections, though we'll likely need new development and financing models given challenges of recent years.

 And though cardiovascular interventions and smoking cessation have fulfilled much of their longevity-boosting power, there's untapped potential in behavioural factors to help counteract obesity and diabetes epidemics.

 A key role for insurers
 There is huge potential for L&H re/insurers to extend their remit to guiding clients toward proper nutrition and sleep, adequate exercise and mental health and wellbeing, lifestyle factors that Swiss Re has built into its underwriting. Modifiable behaviours help create a better experience for clients, our industry and for society.

 Clearly, long-term mortality improvement is not a static set of mathematical calculations. It's a dynamic, fluid process that's been at the centre of the story of human progress for centuries. Understanding improvement trends and the obstacles that interrupt them remains key to a sustainable, modern insurance protection offering.

 Improvements in healthy longevity are the building blocks of resilient societies. The progress of each country towards becoming a 21st century longevity champion highlights what can potentially be accomplished, if this calculation is made correctly.

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