“COVID-19 is far from over.”
A recent Swiss Re report suggested potential excess mortality in the general population of up to 3% in the US and 2.5% in the UK by 2033 in a pessimistic scenario, highlighting the lingering impact of COVID-19 – both as a direct cause of death and as a contributor to cardiovascular mortality.
Discussing the report with Re-Insurance Business, Paul Murray (pictured), CEO of L&H Reinsurance at Swiss Re, outlined some of the key ageing and mortality trends shaping the life and health reinsurance market today. “Of course, we saw excess mortality when we were locked down and experiencing the pandemic but now we’ve returned to normal life, we think it’s over and it’s not. People are still getting ill with the COVID infection and they’re still dying.”
The debate for the market now is how long that trend is likely to continue, and whether its impact will fade over time – with Swiss Re’s recent report offering multiple scenarios into the reinsurance giant’s viewpoint on that question. Top of mind is understanding the key factors driving future mortality trends and changing life expectancy statistics – and how these influencing factors may change going forward.
Pinpointing some of the key considerations driving future mortality trends, Murray underscored the need to look at historical data. “The headline for me is always that there has been a phenomenal period of mortality improvements, of life expectancy extending. This is probably one of the biggest social transformations that the human race has been through.
“One of the main drivers of that has been cardiovascular improvements. Smoking cessation helped a lot towards that in the 20th century and is continuing now as well. There’s also new technology that enables low-intervention cardiovascular surgery, like stents. We’ve shifted from a lot of surgery having to be open-heart and high-risk in an operating theatre to in-and-out in a day with injected stents. It has been completely transformational.”
The ”plumbing” of the human body and the way it’s protected and healed by modern medicine has been largely optimised, he said, but now some of the benefits of that is starting to level off. Looking to the future, he sees that there is still the potential for some further improvements as a factor driving increased life expectancy, particularly amid improving access to information and education about healthy living choices – and improving intervention techniques.
“When we look forward, I anticipate the area where we have the best chance of improvements is on the cancer side,” he said. “Comparatively to cardiovascular risk, improvements to cancer treatments have been relatively low in the past. Of course, it’s very complex as 'cancer' is a bucket term which combines 200-plus types, but we are seeing some very promising technologies emerging here that will help address that.
“Take mRNA vaccines, for instance, which are not new but became very prominent in the pandemic, specifically as it helped us develop vaccines very quickly. mRNA capabilities, combined with immunotherapy, are currently in trials, and showing very significant improvements in outcomes for cancer patients in specific causes. And we've only really started scratching the surface of that. Looking 10-to-30 years out, which is the duration we have to think about as life insurers, we think that’s a prominent contributor to future improvement.”
Alzheimer's is another pressing area for consideration, he said, as, with people generally living longer, this is becoming a much more significant risk. Due to a myriad of reasons, more people than ever are living with Alzheimer’s today and society is being increasingly challenged to deal with it and to support those living with the disease. “Again, improvements in dealing with Alzheimer's historically have not been that great, and I think this is one area where there's the potential for a meaningful breakthrough, and we're starting to see some signs of that in scientific research.”
An interesting element shaping discourse in the life and health reinsurance market is the question of the impact of lifestyle factors on future mortality trends. Murray noted that if you characterize overall mortality rates into lifestyle or non-communicable diseases, between 30-40% of mortality is driven by lifestyle choices – including such factors as what you eat, whether you smoke, whether you exercise, how much sugar you eat, and how you manage your stress.
The insured population are typically quite happy to engage with that, he said, and Swiss Re is seeing improvement on those metrics, but there remain large swathes of the overall population who don’t engage in that conversation. As more data emerges over time, he believes the market will start to see stronger connections between activity and outcomes which, in turn, will help it to drive better results.
“An interesting area here is diabetes and Swiss Re is taking a leadership position on this globally,” he said. “We regularly engage with policymakers around the world – with doctors and thinkers on nutrition and food policy in particular – to [highlight] how your diet has a big impact on your health, but also to assess whether the current advice is appropriate for the future.
“Obesity and diabetes continue to increase. That debate has a long way to go, but if it continues to evolve positively, it will have a positive impact on mortality.”
Poor metabolic health drives obesity and diabetes, which are offsetting previous advances made by treating cardiovascular diseases and smoking cessation. The emergence of GLP-1/GIP weight loss injectables has shown early promise in reducing weight and improving baseline clinical risk factors, when combined with long-term lifestyle alterations. Although long-term data doesn’t yet exist on the impact of GLP-1 drugs, in the short term these medications are showing positive results in reducing all-causes, and specifically cardiovascular mortality. In addition, the drugs appear to positively affect a range of other conditions such as cancer, liver and kidney diseases, and even neurodegenerative diseases.
Underpinning the broader conversation is the big question on the minds of many across the life and health reinsurance market – when, or if, excess mortality will return to pre-pandemic levels. Swiss Re’s recent paper posited both a pessimistic and an optimistic scenario because its role is not to say what will happen, but rather to encourage people to think about the tail risk of the COVID crisis and how it might play out.
“There is a huge delusion at the moment that COVID is over and when we talk about it, we say ‘when the pandemic happened’ but actually it is still happening,” he said. “So, insurance companies need to be very conscious of that and to be thinking ahead. Swiss Re has a powerful role across the market to make sure that this is being thought about.
“In our view, there are a range of scenarios, but most of them anticipate a return to normality in five to 10 years, depending on your level of optimism. And we think that because of the other more fundamental movements happening around cancer, lifestyle risk and eventually Alzheimer's, to name the three biggest ones, that mortality improvements will also return over the longer term.”
