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The Actuary The magazine of the Institute & Faculty of Actuaries

Mortality: Joining forces

“The long run is a misleading guide to current affairs. In the long run we are all dead.”
John Maynard Keynes

As actuaries grapple once more with apparent contradictions between market valuations and the value of assets held against pensions and annuities, the above quote reminds us of a challenge to actuaries that will remain long after the current market turbulence, namely predicting future rates of mortality.

A new collaborative research model
In this article, we describe the work of the Mortality Research Steering Group, developing a new model for working with others to better understand the state of knowledge in mortality and directing the development of future research to provide a more robust foundation for advice to life offices, pension schemes and governments.

Actuaries have been active in the study of mortality since the earliest days of the profession, with pioneers such as Gompertz, Makeham, Perks, Beard and Barnett leading the field in the 19th and 20th centuries. The Continuous Mortality Investigation continues the profession’s research into mortality and morbidity experience, publishing reports and working papers. With lower inflation and interest rates in recent times, the importance of mortality risk to actuarial practice has increased, just as the difficulties in predicting future mortality have become more apparent. Society as a whole, government, and industry, are all having to deal with an ageing population and increased life expectancy. The profession recognises that collaboration with other disciplines can help us better understand past, present and future trends. The Mortality Research Steering Group was set up with the aim of better understanding the current state of knowledge in mortality.

Scoping study
The Group’s first initiative was to commission a scoping study to identify where future research might be required. The contract was awarded to Dr Catriona Macdonald, an academic researcher whose doctoral thesis investigated the relative contribution of medicine and standards of living to Scotland’s falling mortality rates. The aim of the scoping study was to map the principal areas of current research into mortality across a range of disciplines including medicine, epidemiology, gerontology, demography, health economics, medical sociology, social policy and psychology, to identify overlaps and gaps.

A group of experts in those disciplines was asked to recommend what they regarded as the five most important pieces of research on mortality and to identify further leading authorities. This approach had strengths and weaknesses. While it did not provide a comprehensive review of the literature and contained potential bias in the selection of specialists, it was based on expert recommendations and created an informal network, which was aware of the profession’s interest in mortality developments.

On 3 March 2008, the experts met at Staple Inn to review the report. The meeting was chaired by Professor Tom Kirkwood, director of the Institute for Ageing and Health at the University of Newcastle. The meeting received the report and concluded with a discussion and debate on the best way of supporting a multi-disciplinary research effort. The report had also been presented at a Faculty sessional meeting on 14 January 2008 and a revised version was presented at an Institute sessional meeting on 22 September 2008.

Finding the gaps
A surprising finding was that few papers, if any, had been recommended on certain specific aspects of mortality, including:
>> Diet, obesity, alcohol and physical activity
>> Causes of death other than CHD (chronic heart disease) and stroke
>> Influences on mortality amongst younger and middle-aged adults
>> Dementia and frailty
>> Death certification
>> Adverse influences on future longevity increase
>> The effects of climate change.

Other gaps identified included cancer, the developmental origins of health and disease (in particular risks in early life), the prospects for those currently in their 30s and 40s, and the availability of social networks and social support.

The importance of identifying and understanding drivers of change was raised both in the report and in a presentation by Tom Kirkwood at the March meeting. Professor Kirkwood posed three questions:
>> Life is getting longer already – do we understand why?
>> What is the likelihood of further increases in life span?
>> What is likely to happen to age-related health, quality of life and capacity for independent living?

The potential benefit of a multidisciplinary approach, particularly in relation to the availability, reliability and granularity of data was agreed. It was noted that some biomedical research is not as useful as it might be, because important information, such as age and gender, is often omitted or the age range covered may be limited. Cause-specific data may be suspect, as the practice in completing death certificates may vary between doctors. While there was a consensus that a cause-specific mortality model, spanning all causes of mortality, would be an excellent long-term objective, it was accepted that, at this stage, it is a distant goal, suggesting a need for a methodology which breaks down the project into component parts.

What does the future hold?
The three stages of young, middle and old age, which were previously compressed into the first 50 years of life, now span 80 years or more. Yet human ageing is malleable and can be influenced through improved nutrition, healthy lifestyle and a supportive environment, by enhancing natural mechanisms for protection and repair and by the use of novel drugs and new therapies.

The coming decades are likely to see expanded research on the mechanisms underpinning both normal ageing and age-related diseases. Some of the mechanisms that might be part of the disease-generating process — for example, heart disease — may be the same as those which are part of the disease-generating mechanisms in dementia or in osteoporosis. In targeting these diseases we may be targeting generic underpinning mechanisms that may have a broad-scale impact.

The 2009 conference
A high-profile multidisciplinary conference was strongly supported by those involved in our work to date. Joining forces on mortality and longevity will take place on 21-22 October 2009 at the Royal College of Physicians in Edinburgh. The conference, which will be chaired by Professor Tom Kirkwood, will focus on three workstreams, each led by an acknowledged expert in the field, and will provide a unique opportunity for networking between disciplines:

1 What are the drivers for change? (Leader: Stephen Richards, Richards Consulting)
2 How do cohorts differ and why? (Leader: Professor Carol Jagger, University of Leicester)
3 From populations to individuals — drilling down to individualised risk (Leader: Professor Diana Kuh, director of the MRC Unit for Lifelong Health and Ageing and of the MRC National Survey of Health and Development).

‘Double-header’ sessions will present the differing perspectives of medics and actuaries, or of researchers and practitioners. Contributions from PhD students will be encouraged, either as papers, posters or presentations. The Steering Group looks forward to seeing you there.

Lessons for other research projects
This is an exciting initiative in its initial stages of development. It is clear that we, as actuaries, must link up with and understand the work of others as an input to our work and, crucially, to influence the direction of future research. This is not easy and will not happen without a willingness to find ways of working that attract and engage those other experts. After all, the implications of an ageing population and increasing longevity are of concern to us all.

Linear Increases
Investigations into life expectancies for various countries indicate extraordinarily linear increases, despite the fact that causes of the increase have changed over time and that life expectancy over the last two or three decades has confounded the predictions of forecasters.

Mortality Research Steering Group
For further information about the Mortality Research Steering Group and the conference, visit the Steering Group’s webpage in the Practice Areas section of the profession’s website: www.actuaries.org.uk/practice_areas/mortality_steering_group

James Orr is chair of the Profession’s Mortality Research Steering Group