Mortality trends driving life expectancy in insurance

The future of life expectancy
Catching the next wave in mortality improvement

A century of longevity gains

Better nutrition, public health advances, antibiotics and progress in medical technology over the course of the 20th century have all contributed to rising longevity in the world's most important insurance markets.

In particular, advances in cardiovascular medicine coupled with declining smoking rates played a key role in pushing the bounds of longevity in the latter half of the century. Switzerland and Japan have emerged as longevity champions.

But progress hasn’t been linear.
Advances have often been followed in close succession by periods of slower mortality improvement.

Even before the COVID-19 pandemic, many societies had already witnessed a deceleration in longevity gains over the preceding decade, particularly in the United Kingdom and United States.

Starting around 2010, long-term mortality improvement in important insurance markets such as the UK and the US has plateaued, as gains in areas including cardiovascular health lost momentum and the numbers of people with obesity and diabetes soared.

Where does this leave us, as we look to understand future longevity trends?
The 20th century gives us reason for optimism: Sometimes with luck, but often human ingenuity, our species increased its lifespan by decades - overcoming headwinds that included geopolitical conflicts and waves of disease.

While the recent deceleration and its often lifestyle or nutrition-related drivers is more sobering, we still see important catalysts likely to drive the future of life expectancy – and longer, healthier lives – as the 21st century unfolds.

The 20th century was characterised by profound medical progress

Key advances on the healthcare and medical technology fronts have played a significant role in helping people live longer, healthier lives.

The age of antibiotics

The accidental discovery of penicillin in 1928, followed by its use in humans starting in the early 1940s, has saved countless lives and has been a big boost to 20th century mortality improvement.

The golden age of antibiotics in the 1950s and 1960s saw the development of half of the antibiotics still used today.

The hunt for a magic bullet

The history of modern chemotherapy dates to the early 1900s, when scientists like Paul Ehrlich were hunting for a magic bullet to kill microbial pathogens.

A half century later, doctors in 1956 deployed methotrexate against a rare metastatic tumour, marking an important milestone in using chemotherapy to destroy fast growing cancer cells.

It laid the groundwork for chemotherapy’s role today in oncology, helping drive gains in life expectancy.

Breaking the habit

In 1964, the US Surgeon General released a landmark report with a powerful conclusion: Cancer is caused by cigarette smoking. It arrived in an era when 42% of Americans – and much of the rest of the world – were smokers.

Progress has been slow and imperfect, including in regions like Asia and Eastern Europe where smoking-related death rates are still among the highest in the world.

However, a steep decline in the number of smokers in advanced insurance markets such as the US, where smoking rates have fallen to around 11%, has been a significant contributor to reducing premature death.

Lowering cholesterol, lifting heart health

The US Food and Drug Administration approved the first lipid-lowering statin in 1987, ushering in a new era of treatment and prevention for heart disease.

The arrival of statins and anti-hypertensives to boost cardiovascular health are among top contributors to mortality improvement in recent decades.

But heart disease unfortunately remains the top killer worldwide. Heart health requires more than taking a pill. Exercise and nutrition play key roles.

Diabetes and other factors help drive early 21st century longevity plateau

After the 20th century’s progress, however, life expectancy gains since 2010 have plateaued in important insurance markets.

The causes are manifold: cardiovascular improvements have tapered off as obesity rates have risen, contributing to heart disease, stroke, diabetes and cancer.

These are among leading causes of preventable, premature death.
Opioids, suicide, and violent crime are of concern in the US, whereas the UK faces risks including rising numbers of people struggling with excess weight or diabetes.

Catching the next longevity wave

Despite the current slowdown, it's important to remember human mortality improvements often come in waves. Stagnating or even declining life expectancy like that which we’ve experienced since 2010 may be succeeded by a new round of acceleration.

Potential drivers include not only medical technology advances against cancer and neurodegenerative disorders but also a renewed focus on lifestyle behaviours that may bend the longevity curve further into positive territory.

Getting personal with cancer

Advanced therapeutics and personalised medicine are progressing rapidly and should produce benefits including better diagnostics and treatments tailored to individuals.

Therapies are becoming more personalised and precise based on our growing understanding of cancer biology and our improved ability to unleash the immune system to fight disease.

Consequently, cancer mortality over the next 25 years could experience the greatest magnitude of improvements.

Tackling the ailments of an ageing society

Gerontologists predict the world's centenarian population will increase eightfold by 2050. But longer lives come with strings attached, as we're seeing rising incidence of neurodegenerative diseases such as Alzheimer’s disease.

Progress against ageing-related diseases is likely to accelerate over the next 20 years and beyond, as scientists and doctors expand their arsenal of effective treatments. Some signs of progress are already emerging, with the approval of new treatments.

This offers hope against diseases increasingly being diagnosed in older members of society.

Lifestyle modification: the most powerful drug of all?

There are fewer opportunities for cardiovascular breakthroughs such as those that helped drive the mortality improvements of the late 20th century.

Consequently, Swiss Re Institute experts anticipate some of the biggest opportunities to spur future longevity gains will emerge from lifestyle interventions like better nutrition and the shift to more physical activity.

Such trends are seen playing a role in reversing conditions including obesity, hypertension, pre-diabetes and diabetes that are now dragging on mortality improvement.

Accurately gauging mortality gains is key to good underwriting

Mortality improvement (MI) forecasts underpin life insurers’ long-term mortality and longevity lines of business. For forecasts beyond 20 years, a holistic view of mortality factors that incorporates future trends is superior to historical data alone.

Building long-term mortality improvement assumptions allows actuaries and underwriters to forecast risk.

Stronger mortality improvement means people live longer, helping ensure the sustainability of our protection. For these reasons, Swiss Re has taken an active role in helping people live longer, healthier lives.

In Swiss Re Institute’s new report, The future of life expectancy, our experts examine drivers of long-term mortality improvement over the last 100 years, head- and tailwinds that are behind current trends and some likely catalysts of future trends.


Click here to learn more.