Mortality improvement: The force behind healthy longevity

With long-term mortality improvement losing momentum in key insurance markets, Swiss Re is tracking drivers of future longevity. Advances against cancer and dementia, as well as lifestyle changes, may fuel a next wave of gains, Swiss Re's report "The future of life expectancy" shows. Underwriters must stay vigilant as our industry contributes to efforts to lift average life expectancy.

As I prepare to move from Singapore to Zurich, Switzerland, to start my new role as CEO of Swiss Re's L&H Reinsurance business, my surroundings will change dramatically. I'm exchanging a vibrant business center in the heart of coastal Asia for another one with a picturesque view of the rugged Swiss Alps. From sea level Singapore to Switzerland's highest point, the difference is 4,600 metres.

But if you look closely, Switzerland and Singapore aren't so different, at least when it comes to health outcomes.

Their respective residents are some of the earth's longest-living people, each having benefited from strong economies, robust health care and insurance systems, healthy food, and technological advances that have reduced premature mortality. People in both nations can expect to live around 84 years, according to the Human Mortality Database.

Broadly, advanced insurance markets from the US and Canada to the UK and Japan have also benefited from the same factors that have helped men and women in Switzerland and Singapore live longer, healthier lives. Pharmaceutical innovations have lowered blood pressure and cholesterol. A push to quit smoking has helped spare millions from tobacco-related disease since the 1970s.

In many markets, however, this long-term mortality improvement trend has grown more complicated over the last decade. The significant advanced-market gains that characterised the 20ᵗʰ century have slowed or plateaued in the last decade or so, due to forces re/insurers like Swiss Re have a key interest in understanding.

That's because 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.

For instance, 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 expectations are 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 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.

One thing we have learnt is historical 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 like the one we're now experiencing.

This begs the question: What will drive the next big mortality improvement wave? My Swiss Re colleagues who authored the "The future of life expectancy" report, suggest 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. Our 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 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. And progress on smoking cessation isn't exactly complete: My new home, Switzerland, still has some work to do here, with smoking rates double those of Singapore.

For L&H re/insurers, our remit extends to guiding clients toward proper nutrition and sleep, adequate exercise and mental health and wellbeing, lifestyle factors that Swiss Re has already built into its underwriting. We see modifiable behaviours as creating 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.

The stability and prosperity of Singapore and Switzerland are signs that improvements in healthy longevity are also building blocks of resilient societies. The progress of each country toward becoming a 21ˢᵗ century longevity champion highlights what can be accomplished, if we get this calculation right.