Category Archives: Life & Health

NHS Funding and the Hope of Living Longer

On March 13, 2019, the U.K. Chancellor of the Exchequer, Philip Hammond, warned in the House of Commons during his Spring Statement, that a “… cloud of uncertainty was hanging over the U.K. economy.” Reminiscing of a sunnier time for the U.K. economy, in the Budget speech in March 2000, Gordon Brown announced a substantial increase in government spending on healthcare. The Chancellor’s ambitious plan was that health spending would rise by more than a third in real terms over a five-year period, by 6.1 percent per year over and above inflation.

To inform and support this program, he commissioned a review of the long-term trends affecting the U.K. National Health Service (NHS). Based on wide-ranging academic research, this review, which was published in April 2002, had a long-term time horizon of twenty years, extending to 2022. The author of this review was Sir Derek Wanless, a professional banker, who was also a highly gifted mathematician – an important attribute for reaching robust quantitative conclusions on long-term NHS funding.

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Brain Fitness as a Driver of Longevity

Around 100 million people watched this year’s Super Bowl on February 3, which was a low-scoring game where the much faster play of the Patriots’ quarterback, Tom Brady, compared with his opposite number LA Rams’ Jared Goff, was a decisive factor. Few in the television audience would have known that the veteran quarterback had special cognitive training to enable him to perform so well according to the mantra: think slow, play slow.

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Civil War Drives the Spread of Ebola

The worst outbreak of Ebola in the DRC (Democratic Republic of Congo), Africa’s second largest country by area, with a population of over 77 million, has already claimed several hundred lives, and there have been more than three hundred and fifty cases.

Many of the Ebola cases have been in Beni (pop. ~230,000), a major city in North Kivu province, close to the Ugandan border. DRC is a failing state, where the government regime is weak, and cannot prevent militias from pillaging DRC’s abundant mineral resources. One such militia is the ADF (Allied Democratic Forces), which was formed in neighboring Uganda in the 1990s, and operates in the mineral-rich border area in North Kivu province.

The geography of the disease spread is intriguing for epidemiologists. Officially declared on August 1, 2018, this is the tenth outbreak of Ebola in DRC since 1976, but this is the first time that Ebola has affected the far northeast of this vast Central African nation. A crucial risk factor hampering the control of Ebola in this region is the conflict over mineral resources. This has limited the number of inhabitants who can be vaccinated, and restricted the access of health response teams, who are exposed to personal danger such as physical assault and kidnapping. Indeed, insecurity was a factor delaying the alert to the actual start of the outbreak, which was several months before the official declaration.

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Mapping 500 Trillion Dollars of Insured Exposure

RMS has just completed a two-year exercise documenting all the different types of insurance that are available in the market and a classification system for all the assets that they protect. This is published as a data definitions document v1.0 as a standardized schema for insurance companies to have a consistent method of evaluating their exposure.

This project, in collaboration with research partners Centre for Risk Studies at University of Cambridge, and a steering committee of RMS clients, involved extensive interviews with 130 industry specialists and consultation with 38 insurance, analyst, and modeling organizations.

The project will enable insurance companies to monitor and report their exposure across many different classes of insurance, which globally today covers an estimated US$554 trillion of total insured value. The data standard will improve interchanges of data between market players to refine risk transfer to reinsurers and other risk partners, reporting to regulators, and exchanging information for risk co-share, delegated authority, and bordereau activities.

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Reimagining the 1918 Pandemic

Ask any child, a world without Walt Disney would be unimaginable. Born in December 1901, Walt was sixteen years old when he caught the 1918 pandemic influenza — and survived. A century has passed since the great 1918 pandemic, in which tens of millions died, the deadliest in history. When an anniversary of a major event comes round, we can ask what if the event were to occur today.

Catastrophe modelers can also reimagine the event being different from what it actually was. This counterfactual perspective leads to important insights into pandemic risk, which have only recently emerged from virological research.

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Lassa Fever Outbreak in Nigeria

A few years ago, West Africa was struck by an epidemic of Ebola, which killed more than ten thousand people in Liberia, Sierra Leone, and Guinea. The first case of Ebola was a child who had been playing in a bat-infested tree. From him, the disease rapidly spread from person to person in a chain reaction of contagion. A quite different type of hemorrhagic disease is Lassa fever, which was first identified in 1969, and named after the town in Nigeria where the first cases were observed.

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Purpose before Profit: The Rise of Impact Investing

I had the privilege of following Ben Brookes onto the Exceedance main stage in 2015. I can’t remember a word of my talk, but something Ben said while I was watching him from the green room has stayed with me ever since:

“Some, like Aubrey de Grey, believe that the first person to live to 1,000 has already been born.”

If that sounds to you like the claim of an oddball biogerontologist, you’re not alone. I for one remember scratching my head quizzically at the time.

All the same, it certainly got me thinking. If we’re going to live that long, we’re going to need something worthwhile to keep us busy. We’re all going to need to find a purpose; a focus for our energies.

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Why We’re Getting Better at Changing the World

Photo by Blue Origin

Let’s start by celebrating goal achievement.  Last week, Jeff Bezos’ Blue Origin rocket successfully took off—and then returned back to Earth.  Mission accomplished. But, from 100 kilometers above the Earth’s surface, looking back at our planet, what’s the state of our global goal achievement?  Do we even have goals?

I ask this as over 50,000 delegates descend on Paris this week for the 21st Conference of the Parties to the United Nations Framework Convention on Climate Change. Or more simply, COP21.

COP21 offers the unique prospect of 196 countries achieving a (sort of) legally binding agreement on climate change: to keep global warming below 2°C by reducing greenhouse gases. But what would a “good goal” for COP21 look like and would it ever be achieved?

Set your goal. Measure it. Achieve it.

It’s easy to get cynical about achieving BHAGs (Big Hairy Audacious Goals), but maybe a template for success has emerged. In 2000, the United Nations agreed to eight BHAGs through its global Millennium Development Goals. Goal number four was to reduce child mortality by two-thirds within 15 years across 138 developing countries.

A 50% reduction in child mortality in 15 years

In 2010, Hans Rosling’s celebrated TED talk outlined a two million annual reduction in child deaths under the age of five within a decade, down to 8.1 million per year. By the end of 2015, we will be below six million deaths per year, almost halving in 15 years.  That’s still too high, and many countries will miss the two-thirds reduction target, but nonetheless it is a huge improvement.


Source: IHME

As Rosling points out, the Millennium Goals were strong due to measurable targets. Clear targets, at individual country level, have driven the ability to lobby for increases in financial resources for clean water, immunization and antibiotics, motivated by strong partnerships and innovations in service delivery.

A goal for climate change

Rio in 1992 is remembered for establishing climate change as being caused by humans, and more specifically, primarily the responsibility of the industrialized countries.

Source: Wikipedia/EU Edgar Database

France, as host, wants to build on the momentum of Rio, but also learn lessons from past summit failures.  So, much of the COP21 framework has been defined and negotiated in advance. Francois Hollande has already agreed with top-polluter China on a mechanism to monitor cuts every five years.

The squabbling that characterized Copenhagen in 1999 will be minimized, and high expectations set for those attending, such as encouraging heads of state to arrive at the start, rather than jetting in at the end.

Frequent communication with every country participating has been critical. As conference chair, Laurent Fabius, French Foreign Minister told the FT last week “Negotiators sometimes hold firm positions that only ministers can unlock, I know their bosses – I see them all the time. We talk often, it helps”.


Infographic: Who has pledged an INDC so far, and what percentage of the world’s emissions are covered. Credit: Rosamund Pearce, Carbon Brief, based on EU data

Paris will pull out all the stops to get an agreement, but will we be willing to accept the short-term costs and constraints to slow down climate change?  The answer is probably yes.

So what are the lessons for COP21?

As Jeff Bezos’ Blue Origin extreme rocket recycling shows, individual changes in our daily behavior such as recycling and energy conservation can affect climate change, but ultimately, changes need to be government led, especially around energy generation and emission control. Whether world leaders are ready to be held legally accountable for missing their climate goals is an ongoing issue.

Nonetheless, as the Millennium Goals show, clear and well-defined targets, annually measured (“are we there yet?”) create momentum to drive change forward. The success of COP21 will be defined by whether emerging sub-goals are specific, measurable, achievable, realistic, and time bounded. Now that would be smart.

The Paris Attack Explained: 7 Points

The suicide armed and bomb attacks in Paris on November 13, 2015 were unprecedented in size and scale. The attacks that killed more than 125 people and left 350 injured have exposed France’s vulnerability to political armed violence and alerted the rest of Europe to the threat of salafi-jihadist within their domain.

The Eiffel Tower was lit in the colors of the French flag in a tribute to the victims. Source: Reuters

Here are seven points we found noteworthy about these attacks:

1. Tragic but not surprising

Though tragic, the Paris attacks do not come as a complete surprise to the counter terrorism risk community.  The terrorism threat in France is higher compared to several other Western European countries. Apart from this recent attack, there have also been several terrorist attacks in France in the last 18 months.  These include the attack on December 20, 2014 in Tours, the armed assault at the ‘Charlie Hebdo’ offices in Paris on January 7, 2015, the shootings in Montrouge on January 8, 2015, the hostage siege at a Jewish supermarket in Paris on January 9, 2015 and an attack against three French soldiers in the city of Nice on February 3, 2015. On August 21, 2015, there was also a terrorist attack on the Amsterdam to Paris high speed Thalys (TGV) train service.

What is surprising is the magnitude and scale of these six assaults.  These attacks were very ambitious. Divided into three distinct groups, the militants were able to execute simultaneous strikes on six locations. Simultaneous attacks are very effective as they cause significant number of casualties before the security services have the time and ability to respond. The attacks were also very well coordinated and involved myriad attack devices reflecting a sophistication that can only come from having some level of military training and expertise as well as centralize control.

2. A well-coordinated attack with unprecedented magnitudes and scale  

In the first series of attacks, three bombs were detonated at locations near the Stade de France, where a soccer match between France and Germany was taking place.  These bombings killed five people. The three explosions at the Stade de France outside Paris were all suicide bombings. One of the attackers had a ticket to the game and attempted to enter the stadium when he was discovered wearing a suicide bomb vest. He blew himself up upon detection. The second suicide bomber killed himself outside the stadium few minutes later while a third suicide attacker detonated explosives at a nearby McDonalds.

Meanwhile at the same time, gunmen reportedly with AK-47 assault rifles opened fire on a tightly packed Southeast Asian restaurant in a drive-by shooting, killing more than 10 people.  Later in the evening there were two other drive by shootings in the different parts of the city that resulted in the deaths of 23 people. Another suicide bomb blast also occurred along the Boulevard Voltaire at a cafe, killing himself but also injuring 15 customers.

The worst violence occurred at the Bataclan Theater, where four militants took hostages during a concert performance by an American rock music group. Witnesses reported that the attackers launched grenades at people trapped in the theater. All the assailants were reported dead after the French police raided the building. Three of the assailants blew themselves up with suicide belts instead of getting arrested, as the police got close while the remaining one was shot and killed by the French authorities.  More than 80 people were believed to be killed at the theatre suicide siege.

3. Chosen strategy offers greatest impact

The suicide armed attacks or sieges witnessed at the Bataclan Theater involved a group opening fire on a gathering of people in order to kill as many as possible.  Similar to the Mumbai attacks in 2008, the ability to roam around and sustain the attack, while being willing to kill themselves in the onslaught, makes such terrorist attacks more difficult to combat. From the terrorist’s perspective, these assaults offer a number of advantages, such as greater target discrimination, flexibility during the operation, and the opportunity to cause large numbers of casualties and generate extensive worldwide media exposure.

It is possible that following the success of Friday’s Paris attacks, suicide-armed assaults and bomb attacks will become an even more attractive tactic for terrorist groups to replicate. Such attacks will typically target people in crowded areas that lay outside any security perimeter checks such as those of an airport or at a national stadium.  Probable targets for such attacks are landmark buildings where there is a large civilian presence.

4. Use of TATP explosives indicates high levels of experience

Also of interest is the terrorist’s use of triacetone triperoxide (TATP) explosives for the suicide bomb vests used in the attacks at the Stadium as well as the Bataclan Theater. TATP is basically a mixture of hydrogen peroxide and acetone with sulfuric, nitric, or hydrochloric acids. These are chemicals relatively available in neighborhood stores.  However, TATP is highly unstable and is very sensitive to heat as well as shock. More often than not TATP will detonate prior to the desired time.  Given the high level of precision and coordination needed to orchestrate these attacks, an experienced bomb maker had to be involved in creating the suicide bomb vest stable enough to be used in these operations.

5. Longstanding ethnic tensions fueled

The Islamic State (IS) has claimed responsibility for the catastrophic attacks in the French capital. While these claims have not been officially authenticated, the suicide operations and the synchronous nature of these attacks are consistent with the modus operandi of salafi-jihadi militant groups such as the IS and al-Qaida.

France’s military incursion in the Middle East such as the country’s recent bombing campaigns against IS positions in Syria and Iraq, justifies its targeting in the eyes of the Salafi-jihadi community. Both IS and al-Qaida linked groups have in the past have threaten reprisal attacks against France for their military intervention in the region.    On the domestic side, the fact the one of the suicide bombers was a Syrian refugee will also further fuel longstanding ethnic tensions in the country. France continues to struggle to deal with the problems of poor integration and perceived marginalization of its large Muslim population. Domestic policies such as the deeply unpopular headscarf ban have contributed to the feelings of victimization claimed by some sections of the French Muslim community.

6. Homegrown terrorists pose a threat

Compounding the threat landscape are indications that many French individuals have traveled to countries such as Syria and Libya to receive paramilitary training. The experience of other Western European countries, which face their own home-grown terrorist threat, has shown that individuals benefiting from foreign training and combat experience can act as lightning rods for local radicalized individuals and provide an addition impetus to orchestrate attacks in their homeland. So far, according to the French authorities it is believe that there is around 400 French citizens in Syria fighting with extremists, making the French among the largest western contingents of foreign fighters in Syria.

7. Potential for subsequent attacks

The November 13, 2015 attacks in Paris, France are the deadliest attacks in Europe since the 2004 train bombings in Madrid, Spain, where 191 people were killed and over 1,800 people were injured.

In regards to the terrorism risk landscape in France, while the suicide bombers have been all killed, the drive-by shooters remain at large. Moreover, despite several arrests in Belgium of individuals allegedly link to the attacks in Paris, it is still unclear whether these detentions have broken up the terrorist network that supported these attacks. Thus, in the short term, subsequent attacks in France or even neighboring countries cannot be discounted.

 

 

Learning More About Catastrophe Risk From History

In my invited presentation on October 22, 2015 at the UK Institute and Faculty of Actuaries GIRO conference in Liverpool, I discussed how modeling of extreme events can be smarter, from a counterfactual perspective.

A counterfactual perspective enables you to consider what has not yet happened, but could, would, or might have under differing circumstances. By adopting this approach, the risk community can reassess historical catastrophe events to glean insights into previously unanticipated future catastrophes, and so reduce catastrophe “surprises.”

The statistical foundation of typical disaster risk analysis is actual loss experience. The past cannot be changed and is therefore traditionally treated by insurers as fixed. The general consensus is why consider varying what happened in the past? From a scientific perspective, however, actual history is just one realization of what might have happened, given the randomness and chaotic dynamics of nature. The stochastic analysis of the past, used by catastrophe models, is an exploratory exercise in counterfactual history, considering alternative possible scenarios.

Using a stochastic approach to modeling can reveal major surprises that may be lurking in alternative realizations of historical experience. To quote Philip Roth, the eminent American writer: “History, harmless history, where everything unexpected in its own time is chronicled on the page as inevitable. The terror of the unforeseen is what the science of history hides.”  All manner of unforeseen surprising catastrophes have been close to occurring, but ultimately did not materialize, and hence are completely absent from the historical record.

Examples can be drawn from all natural and man-made hazards, covering insurance risks on land, sea, and air. A new domain of application is cyber risk: new surprise cyber attack scenarios can be envisaged with previous accidental causes of instrumentation failure being substituted by control system hacking.

The past cannot be changed—but I firmly believe that counterfactual disaster analysis can change the future and be a very useful analytical tool for underwriting management. I’d be interested to hear your thoughts on the subject.