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Unknown (00:00):
Music,
Ronora Stryker (00:05):
Hi listeners,
and welcome to the Research
Insights Podcast. I'm RonoraStryker, a Senior Practice
Research Actuary here at theSociety of Actuaries Research
Institute. And welcome back toour special podcast series
focusing on the paper Long TermDrivers of Future Mortality that
was part of our 2023 Living to100 Symposium. The paper is
(00:28):
authored by Yair Babad,Professor Emeritus at the
University of Illinois Chicago,and Al Klein, Principal and
Consulting Actuary at Milliman.Today we're exploring Chapter
Three on Lifestyle. I'm joinedby two members of our Mortality
and Longevity Strategic ResearchProgram Steering Committee. Our
first member is Al Klein, one ofthe authors of our paper.
(00:52):
Welcome Al!
Al Klein (00:53):
Thanks Ronora, and
welcome everyone from near and
far.
Ronora Stryker (00:56):
We also have
Eric Pickett, actuary and Chief
Content Officer of Club, Vita,Hi, Eric!
Eric Pickett (01:03):
Hello, Hello. It's
great to be here!
Ronora Stryker (01:05):
Okay Listeners.
As a quick reminder, if you want
to download the paper, just goto soa.org and click on the
research institute tab, look forresearch by topic, and click on
Mortality and Longevity. Thiswill take you to the M & L
landing page, where you willfind the link to the paper and
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this podcast in the upper righthand corner. And with that, I'll
pass you over to Al and Eric,take it away. Al!
Al Klein (01:35):
Thanks Ronora, as you
mentioned today, we're diving
into Chapter Three, where weexamine how lifestyle choices
impact mortality and longevity.Lifestyle choices are some of
the more significant drivers offuture mortality. Actuaries need
to consider how evolvinglifestyle trends, both positive
and negative, will shapemortality and population
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forecasts and projection models,whether for life insurance,
annuities or pension plans.Lifestyle choices also affect
demographers and public healthofficial's future estimates.
Eric Pickett (02:09):
Exactly and
lifestyle factors such as
physical activity, diet,smoking, alcohol consumption and
stress management all playsignificant roles in determining
health outcomes, longevity andquality of life. Understanding
trends in these behaviors at thepopulation level and for
different socioeconomic groupsis crucial when building long
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term mortality and populationprojections. And unlike many of
the other drivers featured inthis paper, these are ones over
which individuals actually havesome control. So there's a
really wide range of influenceson how these trends may develop
into the future. Are behaviorsimproving? Are new risk factors
emerging? Are attitudes towardsdifferent behaviors changing?
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Are there any changes to publichealth interventions on the
horizon? How will such changesaffect different groups of
people? These are the keyquestions that actuaries need to
consider.
Al Klein (03:03):
That's a lot to
consider, but you're right,
Eric, even small shifts inbehavior over time can have
significant implications formortality rates of individuals
and society as a whole. Let'sstart by discussing one of the
most influential factors,exercise. Why don't you start
with this one?
Eric Pickett (03:20):
Yeah, thanks Al!
So regular physical activity is
known to improve many healthoutcomes, including reducing the
risk of cardiovascular disease,diabetes, obesity and even
mental health issues likedepression. And the amount of
data we have to study on thisdriver has recently increased
with the use of pedometers andother activity tracking through
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mobile health apps.
Right now, physical inactivityis a growing concern. The US
Physical Activity Guidelines foradults recommends at least two
and a half hours of moderateaerobic activity per week, but
the latest figures from the CDCin 2020 show that less than half
the US adult population achievesthis recommendation with some
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big differences betweendifferent geographical and socio
economic groups across the US.Conversely, there's also a push
towards more health consciousliving with wearable technology,
corporate wellness programs andfitness tracking becoming more
popular, although this hasslowed some with COVID. That
said, while there's thepotential to mitigate some of
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the sedentary behavioral trends,there's also the potential to
increase the differentialbetween groups as unemployment
increases.
Yeah, a really interesting setof interactions there, I think,
and it certainly will be achallenge to predict their
overall effects on the futuremortality rates, some of the key
questions for actuaries toconsider then are, how have
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inactivity levels changed overrecent decades, and how are they
likely to change in the future?Are we becoming more or less
sedentary, and how does thisdiffer between socio economic
groups or geographical groups?Also, how long does it actually
take for inactivity levels tofilter through into mortality
and morbidity statistics. Forexample, when does a change in
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behavior for a 40 year old nowshow up in the data? Is it right
away, or is there a lag untilthey reach their 60s or their
70s?
Al Klein (05:14):
Understanding how
different sub populations engage
with physical activity is keywhen modeling future mortality
rates, factors such as urbanplanning, access to recreational
spaces and the integration ofexercise into daily life can all
impact long term trends inmortality and the overall
population, which in turn, canaffect public policy and
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community service budgeting. Andbefore we leave this topic, it
is my hope that as you researchthings like exercise for
projecting future mortality, youalso consider it personally. Now
let's turn to the next topic,diet. Dietary trends are another
major lifestyle factor impactingmortality, and understanding
this impact is made morechallenging as there does not
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seem to be a wide consensus on arecommended healthy diet. That
said, if you see me in person atany of the SOA or other
meetings, I'd be happy todiscuss this topic further,
maybe over a healthy lunch!
Eric Pickett (06:11):
I might take you
up on that Al, I think I need
all the help I can get!Nevertheless, by various
measures, dietary habits seem tohave been getting worse over the
years, and this is correlatedwith the increase in overweight
and obesity rates. A keyquestion for actuaries is
whether we will see a reversalin unhealthy dietary trends.
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While some populations areshifting towards more plant
based and whole food diets, thewidespread availability of high
calorie low nutrition processedfoods remains a concern.
Additionally, food insecurityand nutritional inequality could
exacerbate health and mortalitydisparities. We are also eagerly
awaiting more information on thelong term effects and take up
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rates of the recent appetitesuppressing obesity medications,
which is still a relativeunknown.
Al Klein (06:59):
Forecasting dietary
trends is challenging, but
actuaries must monitor thelevels of obesity in the
population at large as well asthe insurance population.
Obesity typically leads toconditions like diabetes,
cardiovascular disease andmetabolic disorders, each of
which are significant drivers ofmortality.
Eric Pickett (07:18):
Okay, next, let's
turn our attention to one of the
big ones, and that's not a pun.After talking about obesity, I
now want to discuss smoking.Smoking remains one of the
leading causes of preventabledeaths worldwide and is one of
the major behavioral drivers ofdifferences in mortality rates.
Al Klein (07:38):
That's right, Eric,
although smoking rates in the US
have decreased significantlyover the last 60 years. The
latest figures estimate around11.6% of the US population
smokes down from about 40% orover 40% in the 1960s and this
large reduction in smoking ratesis at least partially
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responsible for the mortalityimprovements we have seen in the
US over the recent decades.
Eric Pickett (08:05):
So when
considering changes to future
mortality rates, we'll need tothink about where the further
reduction in smoking rates willbe possible over the coming
years. Remember, someone whodoesn't smoke can't give up
smoking.
Al Klein (08:17):
That should be pretty
easy to remember, Eric.
Something else to consider isthe difference in smoking rates
among different groups insociety. There are more smokers
among men than women, and lowersocioeconomic groups are more
likely to smoke than highersocioeconomic groups, so there
may be even more room formortality improvements among
these populations, assuming theyreduce their rate of smoking.
Eric Pickett (08:41):
Yeah, that's a
really good point. Al, we've
recently seen higher mortalityimprovements among higher socio
economic groups in the US, butfrom a smoking perspective,
maybe there is more potentialfor future gains among lower
socio economic groups. Also,actuaries must consider the
prevalence and potential impactof movements from tobacco
cigarettes to electronicsmoking.
Al Klein (09:03):
Again, to monitor
these developments, we'll need
to monitor emerging data ontobacco related mortality and
consider e cigarettes, but alsopublic health efforts and
changes in generationalattitudes towards smoking. Now
moving on to our next topic,alcohol and drug use. Present
another lifestyle factor thatwill affect future mortality,
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morbidity and overall quality oflife, while moderate alcohol use
may not significantly impactmortality, and according to some
studies, may even have aslightly positive effect on
mortality. Heavy drinking andsubstance abuse are problems
that contribute to prematuredeaths.
Eric Pickett (09:40):
As far as alcohol
and recreational drugs are
concerned, we again need toconsider if there are any major
changes to consumption thatmight develop over time, apart
from the gradual relaxation ofmarijuana laws, it doesn't seem
that major regulatory changesare on the horizon. However,
there may be some generationalchanges in attitudes towards
consumption. It seems thatlarger numbers of Gen Z may be
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turning towards sobriety, with anumber of surveys showing
abstinence from marijuana andalcohol reported in in higher
numbers in younger generation.
Al Klein (10:13):
That is an interesting
development. Another thing to
keep an eye on is the impact onthe recent COVID 19 pandemic.
There was an increase in alcoholrelated deaths during the first
few years of the pandemic, andthe data is not yet in to show
whether this effect hasdissipated. And before we move
on, we can't forget to mentionthe widely reported opioid
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crisis seen in the US overrecent years that has
significantly increasedmortality in certain
demographics, especially theworking age, age bracket, the
addictive nature of opioidsmakes this difficult to stop.
Actuaries need to assess whetherpolicies aimed at reducing
addiction and overdose deaths,or even the availability of
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opioids will be effective inreversing this trend.
Eric Pickett (10:58):
Okay, so the final
area for us to talk about today,
then, is stress. Stress is oftenoverlooked when we talk about
mortality, but chronic stresscan have an impact on health
outcomes, contributing to higherlevels of inflammation and
increasing the risk of heartdisease, stroke and cognitive
decline. Actuaries shouldconsider the long term impact of
stress related diseases and therole of mental health support in
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reducing these risks.
Al Klein (11:22):
That's right, and I
don't think the mental health
issue is considered oftenenough. Another important thing
for actuaries to consider hereis the increase in stress levels
through the COVID 19 pandemic.The American Psychological
Association has warned that thenation is facing a mental health
crisis that could yield serioushealth and social consequences
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for years to come, so this willbe something to monitor in the
future.
Eric Pickett (11:47):
Thanks Al, so
listeners, we've now touched on
the key areas of the chapter,and we hope that gives you a
good overview of lifestyleconsiderations for future
mortality before we both headoff to the gym. Al, would you
like to run through a summary ofhow you and Yair saw the likely
impact for the generalpopulation.
Al Klein (12:05):
Yes of course, as a
reminder at the end of each
chapter, Yair and I included atable where we highlight the
outlook for the impact on futuremortality expectations of the
different areas covered in thechapter, the key drivers
included in the table for thischapter were diet and obesity,
physical activity, smoking,addiction and stress. Of these
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drivers, we projected modestimpacts in the short term, but
we thought diet and obesity, aswell as stress, were likely to
have larger negative impacts onlong term future mortality
rates. Please remember that youneed to adjust these
expectations so they arerelevant to the specific
population for which you arepredicting future mortality
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assumptions.
Eric Pickett (12:49):
Thanks. Al. So to
summarize the key takeaways from
today, then lifestyle factorsplay significant roles in
shaping health outcomes andlongevity, and they are one of
the key determinants ofdifferences in both current and
future mortality rates betweensocio economic groups and
geographical groups across theUS. Reductions in smoking rates
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have made large contributions tomortality improvements over
recent decades, but there is nowa question around whether it is
possible for these rates toreduce even further. We've seen
increases to overweight andobesity levels in the US in
recent years, likely driven bythe changes in physical activity
and diets. But how will thisdevelop into the future, and
what impact will new weightmanagement drugs have? And a few
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other emerging questions that Iwill be keeping a close, close
eye on are, will changingattitudes to things like alcohol
consumption and exercise amongyounger generations, resulting
greater mortality improvementsin the future. And what long
term impact has the COVID 19pandemic had on lifestyle
behaviors?
Al Klein (13:51):
Eric thanks for that
summary. The only thing I will
add is that while what tomonitor makes a lot of sense,
how to monitor it and predictthe outcomes remains a
challenge. That said, this iscertainly an interesting and
ever evolving field. That's itfor now Listeners. Please join
us for our next podcast wherewe'll be tackling the topic of
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inequality. Back to you, Ronorato close out this podcast.
Ronora Stryker (14:17):
Thanks Al and
Eric. I really appreciate your
time and sharing your thoughtsand expertise about lifestyle
and how it might impact futuremortality. Okay, listeners,
that's all we have time fortoday. Join us at the end of
next month for our next episode,which is focused on chapter
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four, Inequality and its impacton longevity. We'd love to hear
your feedback on this podcastseries and thoughts on topics
for future research. Just emailus at Research-ML@soa.org.
Thank you listeners for joiningus on our chapter by chapter
journey through The Long-TermDrivers of Future Mortality
(15:02):
podcast series. We alwaysappreciate your support and
engagement. For the Mortalityand Longevity Strategic Research
Program Steering Committee andthe Research Insights Podcast,
I'm Ronora Stryker for theSociety of Actuaries Research
Institute.
Rose Northon (15:20):
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(15:43):
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