How actuaries, along with insurance and health care professionals, are addressing concerns around adverse mortality trends.

By Nate Worrell

A Dire Situation

“There, along the strip of wet sand that marks the tide, death walks hugely and in many forms.”

In “The Star Thrower,” by Loren Eisley, we find a coastline strewn with starfish on the brink of succumbing to various fates: consumed by gulls, drying out in the sun, or being collected and boiled by a collector.

Like the battered beach, current trends in U.S mortality and many other global regions present a dire scene.

• Mortality rates remain above pre-pandemic levels
• Mortality improvement rates have been flattening or declining
• Payouts from life insurers have been at record highs

Excess deaths became news headlines throughout the various Covid pandemic surges, but more recently, other causes of death seem to be driving inflated mortality. Most troubling is that this trend appears to be driven by the younger, working ages between 15 and 45, as shown by the spikes in Figure 1.

A Defiant Act

Standing on the shore, at the base of a rainbow, is a mysterious figure, the “star thrower.” He is flinging starfish back into the sea.

“The stars,” he said, “throw well. One can help them.”

The narrator is skeptical. He views the effort as feeble.

“He is just a man, I considered sharply, bringing my thought to rest. The star thrower is a man, and death is running more fleet than he, and along every seabeach in the world.”  

Taking on the tempest of mortality is no small task. The Insurance Collaboration to Save Lives (ICSL) has set their face to the wind. The ICSL is a collection of individuals from across the insurance, regulatory, and health care industry hoping to save a million lives by encouraging active interventions from life insurers, including such tactics as targeted screening, testing, and triage to identify those policyholders most at risk for sudden death or critical care incidents.

They have scanned the stricken sands and identified their first target—heart disease. It is a cause of death that has a long history of producing a high body count. Per the CDC, heart disease was the No. 1 taker of lives in 2021—more than Covid and cancer.

Recent research from the Society of Actuaries (SOA) on cardiovascular disease (CVD) indicates similar troubling trends. “In most age groups up to 55-59 years, the CVD mortality rate was higher in 2019 compared with 2003, most notably in the 35- to 39-year-old age group (female: annualized rate change of 1.2% or 20% higher; male: annualized rate change of 0.8% or 13% higher).” The heat maps show ‘hotter’ areas in the lower ages as mortality rates increase for both males and females.

Certainly advances in diagnostics, surgery, medicine, and medical technology have helped over the past decades. The American Heart Association, which has done a lot to promote CPR education, smoking cessation, and other programs, is celebrating its 100^th anniversary this year. Diet, exercise, and surgery may all be part of the solution to reduce mortality, but many times they come after someone is fortunate enough to survive an impairment.

The ICSL approach is to begin by soliciting insurers to create awareness via diagnostic testing, with the hope to encourage action and change, and ultimately save lives. Many people may be a lot closer to a cardiac event than they realize.

ICSL’s screening pilot of 29 people revealed 14% of their participants had three or more cardiac circulatory, inflammation, or injury bio-markers. 28% had elevated homocysteine levels, a toxic and significant contributor to heart attacks and stroke. While this group may not be representative of the whole population, the results do raise concerns about how many individuals may be holding a ticking time bomb in their chest. With the right testing and triage, people may have the information they need to act. Test by test, the tide might begin to turn.

Testing does not have to be a high-cost effort. The ICSL identified a battery of tests that could be administered for around $100. And it only takes a handful of successful interventions to make the math make sense and deliver a meaningful return on investment.

A Dedicated Effort

“I understand,” I said, “call me another thrower.” Only then I allowed myself to think. He is not alone any longer. After us there will be others. We were part of the rainbow—like the drawing of a circle in men’s minds, the circle of perfection. “

Among the obstacles for the ICSL, getting buy-in is a critical one to overcome. 

Yet, this is not the first time that insurers and industry partners have banded together to spur positive change. Sometimes this is through advocacy, other times policy language may restrict insurance to only certain preconditions.

• Insurance companies created the first fire departments.
• Insurer concerns on fire risks also influenced building codes including fire escapes and sprinklers as highlighted by Sara Wermeil’s book The Fireproof Building.
• The Insurance Institute for Business and Home Safety currently seeks to push for policies and practices to reduce loss due to severe weather hazards.
• Airbags in automobiles were a results of lobbying and research and policy provisions led by the Insurance Institute for Highway Safety.

More pointedly in 1909, a time in which infections like tuberculosis permeated society, economist and scholar Irving Fisher addressed the Association of American Life Insurance Presidents.

“Concerted action by the life insurance industries would mark, I believe, one of the greatest steps, if not the greatest step, ever taken toward the extension of human longevity.”

This admonition spurred a flurry of activity in the life insurance space to promote, fund, and advocate for a variety of welfare program, including sponsorship of a traveling nurses program.

ICSL member and historian Robert E. Wright adds, “Life insurers in the 1910s and 1920s provided insureds with crucial health information in a period when scientific understanding of the causes of disease and infection, etc., was outstripping what people knew from their schooling or own experience.”

More than a century later, the ICSL finds itself renewing Fisher’s call. In the early stages of this initiative, collecting buy-in and getting “investors” is critical. In the months and years to come, there will be challenges. Insurers will want vetted solutions. Consumers may still feel a post-pandemic fatigue around health interventions, which will have to be met with compassion and empathy.

The work is slow, and may seem formidable, but we can follow the parable of the Star Thrower, and one by one, a life may be saved. With help, perhaps a million starfish can return to the sea.

NATE WORRELL, FSA, is a client relationship actuary with Moody’s Analytics. His passions include longevity and nutrition.