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Healthspan: What chronic illness and lifestyle mean for life insurance

SUMMARY
  • Longer lifespans are an incomplete measure of how Americans look after their own health.
  • A better yardstick may be healthspan—time lived free from significant physical impairment.
  • Chronic diseases afflict 60% of U.S. adults,1 with heavy implications for healthspan and lifespan.
  • Life insurers need to better grasp human health metrics that tie chronic disease to healthspan and lifespan.

This article is the first in a series exploring how people live with chronic disease and what that means for life insurance sales, underwriting, and risk management.

Mission statements of leading life insurers express a widespread commitment to customers’ quality of life and health as well as their financial security. But longer lifespans for many Americans may present the industry with an unexpected challenge: To look beyond a superficially favorable trend and grasp the opportunities and risks in how well or poorly people live with chronic disease.

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Healthspan—the period when a chronically ill person remains capable of day-to-day living in reasonable comfort.

Complacency could come easily from a transformative century in which the life expectancy of a 40-year-old grew by 11 years for men, and 13 years for women between 19102 and 2010.3 Those gains may owe much to medical advances that make once-hopeless conditions treatable and survivable while driving countless improvements in therapies and prevention.

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In particular, the Society of Actuaries’ Longevity Advisory Group noted a steep decline in coronary artery disease. And a study of members of one religious group—known for exercising regularly and abstaining from alcohol, tobacco, and meat—showed significant gains in life expectancy from behaviors that are gaining wider traction in the general population.4

Advancements in public health and medical science can and often do drive mortality and morbidity improvements for life insurers. But the most generalized statistics can mask nuances that emerge from detailed human health metrics, from basic measures such as height and weight to factors such as blood pressure, cholesterol levels, and glucose. These measures, which may be collected by a range of means from electronic health records to wearable devices, can further delineate subsets of the population, especially among those living with chronic diseases and conditions. One study found potential gains in life expectancy ranging from about one year to nearly six years for type 2 diabetes patients who mitigated one or more of these risk factors: smoking, HDL cholesterol, glucose, and blood pressure.5

Two kinds of patients

    People who have chronic noncommunicable diseases (NCDs) manage or neglect their condition to varying degrees. Medical advances have helped enable longer life for both patient groups—those who comply with treatment regimens and lifestyle recommendations and those who don’t.

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    Taken together, they show undeniable growth in average lifespan. But within this larger cohort is a wide variance in lifespan and in healthspan—the period when a chronically ill person remains capable of day-to-day living in reasonable comfort.

    • Those who change their lifestyle may be able to keep the worst effects of their disease at bay and extend both their healthspan and their lifespan. This includes adhering to prescribed treatment: One clinical trial found that intensive diabetes therapy reduced risk of certain complications by 39 to 76 percent.6
    • Those who resist change may come to depend on ever more heroic medical measures to prolong their lifespan—but with a shorter healthspan.

    While still living longer than they might have a generation ago, this group may ultimately die sooner on average than if they had embraced changes to extend their healthspan.7 If it’s recognized and measured through human health metrics and managed in part by encouraging responsible behavior, healthspan can drive meaningful differences in lifespan for individuals and entire cohorts. That, in turn, has implications for life insurers across sales, underwriting, portfolio management, and product design that can become clear. The industry need not be a passive observer of unfolding trends.

    Behavior and risk

    Evolving science and technology have helped reduced risk in countless ways that can mute the indicators of individually risky behavior that lie at the heart of insurance underwriting. For example, a selective reading of crash data could suggest that auto insurance risk has become negligible: From nearly 22 deaths per 100 million vehicle miles in 1923 to about 1 in 2019.8

    Modern cars and roads have gotten better and better at protecting motorists, and modern medicine can help makes many crash injuries more survivable than they were a century ago. But millions of crashes still occur every year, and auto insurers still pursue more predictive data to measure the risk each driver presents.

    In the same way, medical advances can skew high-level statistics in ways that mask how people are “driving” their bodies day by day. But while technology can assist motorists with safer behavior that reduces death and injury rates on the roads, people’s health habits are often in tension with the gains in medical science. The increases in lifespan noted above have many sobering counterpoints in numbers that reveal the state of Americans’ health.

    The downward pull of lifestyle

    Chronic diseases afflict 60 percent of U.S. adults, and 40 percent have two or more such conditions, according to the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).9 Poor nutrition, inactivity, smoking, and excessive drinking are the key lifestyle risks driving these numbers, according to the NCCDPHP, part of the Centers for Disease Control and Prevention (CDC).

    About 60 percent of all deaths in the United States are traceable to five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes.10 The course of those conditions often includes a greatly shortened healthspan that reduces the ultimate lifespan.Life Insurance

    The CDC has estimated that through healthier eating, more exercise, and smoking cessation—voluntary behaviors that can profoundly affect health—as much as 80 percent of ischemic heart disease, stroke, and type 2 diabetes could be eliminated, as well as 40 percent of cancers.11 But if childhood obesity rates are any indication, the trends aren’t promising: A near-unbroken string of increases from 1971 to 2018—from 5.2 percent to 19.3 percent, according to the CDC.12

    Beyond behavior-driven conditions lie an array of factors, beyond individual control, that inhibit the growth of healthspan: the effects of aging itself as people live longer; diseases arising from genetics, pathogens, pollution, and even drug toxicity; and socioeconomic inequality, to name a few. Nor should communicable disease be set aside as a concern; the COVID-19 pandemic vividly demonstrated how quickly a new contagion can upend settled expectations.

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    Evaluating choices

    When attacked at the societal level, many threats to human health can seem intractable, but individual choices can change with the right influences. Among the chronically ill, evidence shows more people will comply if they’re shown helpful resources.13 These can help overcome some common hurdles:

    • Forgetting to take or reorder medications – apps can remind patients or automate the process
    • Concern over drug interactions – multiple websites address these issues
    • Fear about drug administration such as injections – alternatives may exist
    • Cost – available prescription coverage or pharmaceutical companies’ assistance programs may ease this burden

    Many people are already choosing to use available tools as they modify diets, habits, and levels of activity and adhere to treatment regimens to live longer, healthier lives. But life insurers have historically limited their engagement with policyholders’ wellness to the underwriting process. They gather medical history and run lab tests for a one-time assessment of the risk the customer presents—fundamentally, the anticipated lifespan. But it may be time to embrace the full significance of healthspan and its connection to lifespan, especially for the chronically ill.

    This is more than an expression of corporate benevolence; it’s recognizing a concept that can help life insurers shape their approach across the value chain. A critical first step could be a closer examination of the emerging data science of human health metrics.

    Telematics and health

    Look for the next article in this series, which will further explore the risks and opportunities surrounding chronic illness and lifestyle for life insurers: How companies can use the lens of healthspan to help rethink their marketing, underwriting, and portfolio risk management. Subscribe to be notified of the latest life thought leadership from Visualize, and explore Verisk’s full scope of capabilities and solutions for life insurers.


    Dr. Paul Beven

    Dr. Paul Beven is global managing director of Verisk Risk Rating. He can be reached at paul.beven@verisk.com.

    Terry Cummings, FSA

    Terry Cummings, FSA is life behavioral insurance lead at Verisk. He can be reached at terrence.cummings@verisk.com.


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    1. Chronic Diseases in America, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), < https://www.cdc.gov/chronicdisease/tools/infographics.htm >, accessed on September 13, 2021.
    2. James W. Glover, United States Life Tables, Bureau of the Census, 1921, < https://www.cdc.gov/nchs/data/lifetables/life1890-1910.pdf >, accessed on October 25, 2021.
    3. Elizabeth Arias, “United States Life Tables, 2010,” National Vital Statistics Reports, November 6, 2014, < https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_07.pdf >, accessed on October 25, 2021.
    4. Larry N. Stern, Drivers of U.S. Mortality Improvement Expert Panel Forum Report, Society of Actuaries, January 2019, < https://www.soa.org/globalassets/assets/Files/resources/research-report/2019/drivers-of-us-mortality-improvement.pdf >, accessed on September 13, 2021.
    5. Jose Leal, Alastair M. Gray, Philip M. Clarke, “Development of life-expectancy tables for people with type 2 diabetes,” European Heart Journal, December 24, 2008, < https://academic.oup.com/eurheartj/article/30/7/834/524247 >, accessed on October 14, 2021.
    6. D.M. Nathan, S. Genuth, J. Lachin, P. Cleary, O. Crofford, M. Davis, L. Rand, C. Siebert, “The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus,” New England Journal of Medicine, September 30, 1993, < https://pubmed.ncbi.nlm.nih.gov/8366922/ >, accessed on October 12, 2021.
    7. Stern, p. 9.
    8. Car Crash Deaths and Rates, National Safety Council, < https://injuryfacts.nsc.org/motor-vehicle/historical-fatality-trends/deaths-and-rates/ >, accessed on October 25, 2021.
    9. NCCDPHP
    10. Mortality in the United States, 2019, National Center for Health Statistics, < https://www.cdc.gov/nchs/products/databriefs/db395.htm >, accessed on October 25, 2021.
    11. The Growing Crisis of Chronic Disease in the United States, Partnership to Fight Chronic Disease, < https://www.fightchronicdisease.org/sites/default/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf >, accessed on September 13, 2021.
    12. Cheryl D. Fryar, Margaret D. Carroll, and Joseph Afful, “Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2017–2018,” Health E-Stats, December 2020, < https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/obesity-child.htm#table1 >, accessed on September 13, 2021.
    13. Living Well with Chronic Illness: A Call for Public Health Action, Institute of Medicine of the National Academies, 2012, < https://www.nap.edu/download/13272 >, accessed on October 26, 2021.