It can be difficult to remember a time when tourists did not find themselves confronting a maze of mandatory quarantine requirements, cancelled flights, and closed borders. And yet, like all pandemics, COVID-19’s grip on the globe will ease, restrictions will end, foreign travel and residence will resume, and insurers will need to underwrite these risks.
Well, that was fast. Practically overnight, the coronavirus pandemic has grounded travelers throughout the world.
It can be difficult to remember a time when tourists did not find themselves confronting a maze of mandatory quarantine requirements, cancelled flights, and closed borders. And yet, like all pandemics, COVID-19’s grip on the globe will ease, restrictions will end, foreign travel and residence will resume, and insurers will need to underwrite these risks.
To meet this need, RGA has released its 2020 Foreign Risk Study, a comprehensive assessment of the relative mortality risk of 205 countries drawing on data from 2019, prior to the outbreak of COVID-19, and based on weighted rankings across 25 indicators grouped into six broad categories:
Each indicator is assigned a score of 1 through 10, where 1 is the best and 10 is the worst, based on the data for each variable relative to other countries. RGA’s data scientists and underwriters developed a model to produce an ordered ranking of each country, based on the data and the relative importance of each variable. To further understand the interaction of the variables, predictive modeling experts developed a model that clustered nations into five groups based on data similarities and categorized countries A through E. Countries receiving an A ranking were considered safest, whereas E nations were viewed as the most dangerous.
Among the study’s more surprising findings? The more things change, the more they stay the same. Overall the U.S. slid three spots to 42 in overall mortality risk, yet most rankings remained very stable between the 2020 study, drawing on data from 2019, and the 2018 study from data in 2017. In both reports, the lowest risk nation to visit was the ultra-wealthy principality of Monaco.
To more accurately assess the real, and sometimes subtle, factors that contribute to mortality risk in different geographies, insurers should carefully weigh a variety of factors, but some focus areas did emerge:
Life expectancy at birth can be an excellent indicator of a country’s overall living conditions that impact mortality expectations. The United Nations estimates that the global average life expectancy was 72.6 years in 2019 – higher than in any country in 1950.1 For comparison, life expectancy at birth in the United States is 80.30 years, 36th among the 205 countries in RGA’s analysis. Life expectancy varies considerably among countries in the study. Those in the top 10% have a life expectancy above 80 while the bottom 10% have a life expectancy below 60.
Even pre-pandemic, much of this disparity in health and longevity was related to high rates of communicable diseases, including HIV/AIDS, tuberculosis, malaria, and other infectious diseases. The United States has an age-adjusted communicable disease death rate of 29.2, ranking the nation at 48 of the 184 countries with data. By contrast, the country with the lowest rate of communicable disease in the study was Finland with a rate of just 8.7.
Additionally, obesity rates contribute to chronic conditions that have a considerable role in expected mortality, as did maternal and infant mortality rates. At 0.5%, the United States has the least amount of underweight children among the nations studied; at the same time, the country has one of the highest rates of obesity, with only 10 nations surpassing U.S. citizens’ waistlines. The U.S. also suffered higher rates of maternal and infant mortality than many other advanced, industrialized countries, ranking 61 and 47, respectively.
Another contributor to mortality differences is the quality of a country’s health system, a reality that has been thrown into stark relief by COVID-19. Long before the pandemic made available hospital bed counts and physician staffing levels global news, these numbers were factored into RGA’s comparative evaluation of medical care. Cuba had the strongest physician density, with more than eight medical doctors for every 1,000 citizens, and Monaco, Japan, and Korea led the world in available hospital beds, with more than 13 per 1,000 citizens.
Nations with high homicide rates pose additional mortality risks. The highest homicide rates were experienced in Central and South America. In contrast, five countries – Andorra, Liechtenstein, Monaco, San Marino, and Israel – experienced zero homicides in 2019. The United States has a homicide rate of 5.3 per 100,000 people, ranking 113 of the 170 countries with data. The U.S. rate also represents a slight uptick from the rate reported in 2018.
Perhaps the more prevalent source of safety risk may be the rate of motor vehicle accident deaths. The WHO reports that worldwide approximately 1.35 million people die each year as a result of motor vehicle accidents.2 Poor road infrastructure and lax traffic safety enforcement can strongly contribute to morality risk. The safest place to drive? Monaco, the same as in 2018. The most dangerous? The Dominican Republic.
From 2003 to 2019 according to the U.S. State Department, more Americans died abroad in vehicle accidents (29%) than any other non-natural cause, outstripping homicide (19%), suicide (14%), and accidents. However, mortality experience differed dramatically by country. For example, in 2015, nearly 29,000 U.S. citizens travelled to Mexico and around 12,000 travelled to Canada. Yet, in that same year, 324 Americans died from non-natural causes in Mexico and only 21 died in Canada. Notably, terrorist actions accounted for only 3% of deaths during this lengthy period.
Poor air and water quality also can have severe and lasting impacts on human longevity, a fact reflected in RGA’s Foreign Risk Study. The research relies on two variables related to the air quality: carbon dioxide emissions tied to climate change and particulate matter concentrations, or exposure levels to particulates less than 10 microns in diameter (PM10) that can penetrate deep into the respiratory tract.
RGA discovered that while high carbon dioxide and particulate matter concentrations were more common in less developed economies, the state of a country's pollution controls is a more important determinant of particulate matter concentrations. The United States has a carbon dioxide emission rate per capita of 16.49, which gives the U.S. a rank of 186 out of the 196 countries with data. Only 10 other countries have a higher emission rate, while the country’s particulate matter concentration level was comparatively low. What country does best across both metrics? Trinidad and Tobago.
View Occupational Risk through a Broader Lens
The journal Safety Science estimates fatal occupational accident rates per 100,000 workers for 165 countries in our study. Many of these occupational accidents are under reported, especially in developing countries. Countries with the best occupational safety records? Malta, the United Kingdom, Antigua and Barbuda, the Netherlands, and Iceland. The country with the worst record? Morocco.
Underwriters, and all travelers, would be well advised to overlook public perceptions and focus on data when assessing of international travel and residence risks. RGA’s recently updated Worldwide Mortality Risk Study and U.S. Underwriting International Guidelines can help guide this assessment. These guidelines draw from U.S. State Department reports, World Health Organization (WHO) data, as well as a range of other international reference sources.
https://ourworldindata.org/life-expectancy#:~:text=The%20United%20Nations%20estimate%20a,any%20country%20back%20in%201950.
https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
