The past few years have been arguably the most significant ever to those studying longevity and mortality, with a range of issues impacting the field, and consequently, actuaries and risk holders. Greg Winterton spoke to Nicola Oliver, Director of Life and Health at consulting firm Medical Intelligence, to get her thoughts on the current state of the space.
GW: Nicola, you advise actuaries and companies about the impact of the provision of healthcare on longevity and mortality. So, let’s start with Covid-19. What are some of the hangovers in terms of the provision of healthcare that the industry is still reeling from?
NO: Healthcare provision in the UK, for example, was already under strain even before the onset of the pandemic which made the impact of the pandemic so much worse. This was driven by declining bed stock, staff shortages, and lengthening waiting times.
A lack of system capacity meant all but the most urgent of non-Covid care had to be cancelled, including many cancer treatments.
As a consequence, there was no robust built-in preparedness; indeed, many clinical areas were running at close to or even over 100% capacity prior to the pandemic.
If we look at waiting lists, which serve as good barometer for how well the NHS is coping with workload, analysis by the Health Foundation shows that the waiting list for routine hospital treatment (‘elective care’) in England could rise to over eight million by mid-2024 regardless of whether NHS industrial action continues.
The knock-on effect from this alone could mean delayed identification of chronic diseases that rely on timely diagnosis to ensure an optimum outcome such as cancer and heart disease. This could mean more advanced disease at diagnosis leading to increased mortality rates at younger ages, an increase in premature mortality is possible.
GW: There has been coverage in the news media in recent weeks and months about the persistence of excess deaths. What are some of the drivers of this and are these short, medium or long-term issues?
NO: The drivers for persistent excess mortality are indeed multiple and complex to disentangle. As mentioned above, it is likely that some of it is driven by the immense pressure on the NHS, as well as the ongoing impact of Covid. Deaths from cardiovascular causes show a relative excess greater than that seen in deaths from all-causes. This could be as a result of both NHS pressures and the direct effect of Covid. It is known that the virus responsible for Covid is able to damage the cells of the heart and blood vessels.
The impact of both NHS pressures and Covid are likely to play out into the long-term.
GW: You wrote a guest article last year for Life Risk News where you analysed the impact of climate change on mortality. Have you seen any increase in how actuaries consider this issue when modelling mortality, or is it still one where not enough folks are paying attention to it?
NO: I think that awareness is increasing; and this is being translated into action, albeit gradually. The message needs to keep being sent; we’re seeing climate change in action here in the UK, there is really no excuse for a head-in-the-sand approach any longer.
GW: The recent – maybe even ongoing – cost of living crisis is also very relevant to the provision of healthcare. Is consumer finance and debt currently having a significant impact on mortality or is it less of an issue than others?
NO: The effects of recessions on health differ across different health conditions, as well as by mortality and morbidity. There is also the time frame to consider; short-term events seem to have a positive impact on health on a population wide scale, whereas longer-term recessions are shown to be negative. There is no doubt, however, that psychological and physical health are affected by debt as well as by increased financial concern. These impacts are clearly socioeconomically driven. Those in poorer circumstances do not have wealth resilience and will suffer the most.
GW: Lastly, Nicola, at a previous Life ILS Conference, you discussed developments in wearable technology in the health space. Is that still an exciting area in terms of how it could impact the public health arena, or has it plateaued at all?
NO: Yes, I would say this is still an exciting area, particularly when partnered with big data analytics. Wearables not only encompass those devices which we traditionally think about as being associated with this area, such as fitness trackers and specific clinical devices such as continuous glucose monitors, but also the humble smartphone. Complementary metal-oxide-semiconductor (CMOS) image sensors that are in smartphones may be used to monitor heart, eye, and skin-related diseases. Heart rhythm disorders can be identified and even symptoms of Parkinson’s disease.
Nicola Oliver is Director of Life and Health at Medical Intelligence
