A convergence approach to longer, healthier lives

The 20th century's life expectancy gains are among humankind's great achievements. Still, longevity improvements have plateaued over the past decade, and COVID-19 impacts continue to fuel excess mortality. To restore a more positive trajectory, insights from the life sciences, information technology, and engineering are all needed. Such a "convergence approach," with support from the re/insurance industry, can help people not just live longer, but live better.

As a leading global mortality reinsurer, Swiss Re is deeply invested in understanding the complex forces driving life expectancy. The future path of human longevity is central to our business and how we balance risks in our portfolios, something highlighted by two recent publications from our Life & Health Reinsurance experts.

In The future of life expectancy, we noted a plateauing of population mortality improvement in places like the UK and US starting around 2010. And just a few weeks ago, Swiss Re published The future of excess mortality after COVID-19, illuminating how lingering effects of the pandemic could mean that deaths in the UK and US general populations remain above pre-pandemic expected levels through 2033, according to a pessimistic scenario.

When considered together, these two Swiss Re reports reveal some fresh insights into how factors like metabolic ill health and waning progress against cardiovascular disease, among culprits in the recent slowing of life expectancy gains, could now be exacerbated by COVID-19, heightening potential for elevated death rates to persist.

This is a clear call to action: societies must work together, across public and private sectors, to harness all the tools at their disposal to tame excess mortality and drive the next wave of healthy life expectancy gains. An interdisciplinary "convergence approach" drawing from the life sciences, physical sciences, engineering, information technology, and healthcare policy is necessary to support holistic improvements that benefit broad populations.

Just such an approach is already taking shape. With the growing availability of health data, artificial intelligence (AI) promises to help us analyse risk factors or patterns in clinical markers more effectively, enabling earlier detection and improving healthcare delivery. Predictive models to identify people and populations vulnerable to certain conditions may lead to more timely interventions.

Leveraging advances in genomics and molecular biology, scientists can better understand underlying factors contributing to cardiovascular disease, cancer, and a host of other illnesses. This is aiding development of personalised medicines tailored to fight an individual's own unique disease.

Wearable health monitoring devices and telemedicine platforms are also broadening healthcare access, helping patients manage chronic conditions remotely and enabling more effective treatment strategies for cardiovascular disease, neurodegenerative diseases including Alzheimer's disease that are associated with ageing, cancer, or mental health challenges.

By fostering collaboration among researchers, health professionals, policymakers, technology experts and the re/insurance industry, a convergence approach can enhance understanding of the complex dynamics of growing public health challenges like antimicrobial resistance, as well, paving the way toward lasting  solutions to what many call "the silent pandemic."

Of course, this merging of health data, scientific discovery, and engineering technologies must inevitably align with public policy initiatives to create more inclusive healthcare systems, especially as we work to reach historically underserved groups.

Profound new insights into gene, cell, and tissue biology are driving advances in medicine that promise longer health spans – lives lived in good health.  Prevention is the best strategy against disease, and the first-in-class RNA-based vaccines against COVID-19 demonstrated that vaccines against novel pathogens can be designed with high specificity, at unprecedented speed and scale, and afford extraordinarily effective disease prevention. This has opened a promising new era for vaccines with great potential against a broader variety of pathogens, from those we've long known to those that may yet emerge. 

And when prevention fails, the next-best strategy is early detection. New strategies for early detection increase the accuracy and the sensitivity of diagnostic tests. The promise of the liquid biopsy, aimed at early and accurate diagnoses for cancer and other diseases from a few drops of blood, has advanced significantly.  There are still challenges, but earlier and more accurate diagnoses offer hope for more favourable outcomes. 

For many diseases, donor-derived cell and tissue transplants have been available as therapies but carry the burden of required suppression of the recipient’s immune system – a difficult and dangerous procedure. Now, through discoveries of biological factors that can turn back a cell’s developmental clock to create a source of replacement cells for, potentially, any diseased cell or tissue, a new era of cell replacement therapy has become reality. The concept is ingenious: your own cells will provide your cure, obviating the need for immunosuppression.

Therapies to replace defective or diseased genes and cells are rapidly becoming realistic approaches. However, providing costly therapies at scale, for the poor and rich alike, requires technological breakthroughs to accelerate production and delivery. While cell therapies now require laborious, time-intensive, manual processes, emerging technologies for automating cell production that use laser-enabled automation supported by artificial intelligence and machine learning offer the promise of deploying “your cells – your cures" with greater efficiency. This could speed treatment and make these options available to more people.

Amid these technological breakthroughs, insurers and reinsurers also have a key role to play in enabling and supporting longer, healthier lives. For instance, Swiss Re's research and educational partnerships have long promoted nutrition, exercise, and mental well-being, part of what we call our "Big 6 Lifestyle Factors", to combat not only metabolic diseases but also improve broader health outcomes as we work to restore momentum to mortality improvements that recently have tapered off.

As people live longer, they'll inevitably need additional capital to finance longer post-work lives. Ageing societies are exerting intensifying pressures on traditional pension systems, shifting more retirement savings responsibility to individuals. With this profound demographic shift, our industry has the experience and scale to contribute protection innovations for people that meet their needs, even as their needs evolve.

Our ultimate goal remains helping people stay healthy, or helping to restore their health in the face of setbacks, while working to ensure they and their families have the resources to sustain them over the course of longer, better, more fulfilled lives. That is a convergence that we can all rally behind.

Dr. Hockfield is a member of the Swiss Re Strategic Council, an advisory panel that provides strategic insights, advice and recommendations to Swiss Re on the global economic, political, regulatory and societal environment.