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Durham University

Department of Geography

Departmental Research Projects

Health, Life Insurance and Financial Inclusion

A research project of the Department of Geography.


This project arises from:

  1. A growing concern about uneven access to key financial services, especially those offering protection to individuals and families at a time when state safety nets are thinning out. The existing literature on market-based risk-mitigation has concentrated on low incomes and unemployment (especially following shocks to the economy) and to a lesser extent relationship breakdown. Market-led measures to manage the financial uncertainties associated with accidents and ill health are less well explored
  2. Evidence (from our own earlier work) of the extent to which health inequalities, like many other kinds of social divide, are an outcome of discrimination as well as a product of the uneven distribution of risks
  3. Concern that new developments in bioinformation - especially around human molecular genetics - have the potential to increase the social and financial divide between people whose health is known to be at risk and people with no history or prognosis of illness. There may be a fine line between what the UK's Scretary of State for Health (2003) calls the ‘more personalised prediction of risk...’ driving those services aimed at ‘realising the potential of genetics’, and the prospect of unjustifiable discrimination even against the ‘healthy ill’
  4. A move in the life insurance industry towards greater transparency in underwriting, together with concern amongst policy makers with how to regulate insurance provision as the moratorium on the use of genetic tests results comes to an end

The PIs on this project are Paul Bennett, Donna Easterlow and Susan J. Smith; other researchers include Niamh O'Connor, Carol Riddington and Andrew Tibbs.


  1. To complete a systematic review of the ways in which health conditions and health risks are defined and assessed by life insurers
  2. To consider the compatibility between the commercial, social and ethical demands facing life insurers
  3. To explore the ways in which people whose health is at risk can more effectively access the financial benefits and social security associated with life insurance
  4. To investigate the advantages and disadvantages, for both the industry and consumers, of using new genetic tests to determine the health risk posed by an individual


The research utilised a multi-method approach, incorporating:

  1. An annotated bibliography/comprehensive review of research literature on health, insurance genetic testing
  2. A quantitative overview of insurance industry practices, including a wide-ranging (38 page) survey of Life Insurance Chief Underwriters in the UK, in which 78% of UK Life Insurers participated (by number), representing 95% of the UK market. A database of life insurance and related protection products (their characteristics, access rules, health-sensitivity and exclusions) was also constructed
  3. A set of qualitative interviews with policy makers, members of heath interest groups and financial advisors to evaluate current policies and practices, and explore possible future trends
  4. A participatory methods approach, using citizens’ jury and focus group techniques designed to enable informed public evaluation of key ethical and policy debates


The most significant achievements include:

  1. Raising the profile of the life insurance industry as a focus for research on financial inclusion. Our work points to the increasing importance of this market-based service both as a security supporting home ownership, and as a gateway to the suite of other private safety nets designed to protect households against risks which are no longer underwritten by the state
  2. Completing the first comprehensive survey in the UK of the way health risks are defined and assessed in the life insurance industry. This has industry relevance as part of a move towards greater transparency in underwriting; for the academic community it significantly expands the evidence base for understanding financial consumerism and social protection
  3. Implementation, critique and development of a suite of participatory methods anchored on the Edinburgh Citizens’ Jury. The Jury was convened to feed into the key public debate about options for policies on the use of genetic test results in life insurance underwriting once the current moratorium has ended. The findings challenge the scepticism some policy makers have towards public understanding and involvement in complex decision making. It shows that the lay public can be sufficiently motivated, knowledgeable and capable of making ‘expert’ input into policy evaluation and design
  4. Theoretically the work has informed the development of a discrimination model of health inequalities and, in particular, has contrasted a risk-based model of health-assessment used in the private insurance industry with a needs-based model used in the welfare state. The work has also evaluated different ethical views of ‘discrimination’ in insurance, ranging from those emphasising ‘actuarial fairness’ to those prioritising the social justice of outcomes. While there has been an underlying assumption that as science and knowledge accumulates, controversies will disappear (especially in the field of genetic tests and insurance), the research suggests that it is conflicting long-term ethical views, rather than temporary inadequate knowledge, which are fuelling current controversies
  5. Practically the research contains recommendations on the appropriate balance of state and market in providing safety net services for households whose homes and livelihoods are at risk. The research solicited the views of vested interests, including policymakers, insurers and health interest groups, and then put competing policy models to citizens for evaluation. The results include a Citizens’ recommendation for post-moratorium policy


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