2023-06-21-sri-sigma-restoring-resilience

No 2 /2023
Restoring resilience:
02 Executive summary
03 Key takeaways
06 Macroeconomic
the need to reload resilience
12 Insurance resilience
shock-absorbing 28 Resilience dividend I:
the economic
capacity benefits of loss
prevention
34 Resilience dividend II:
extending risk
protection
37 Appendix: Index
methodologies
2 Swiss Re Institute sigma No 2/2023
Executive summary
The world has faced significant shocks From the COVID-19 pandemic to war in Ukraine and 40-year high inflation in major
since we launched our resilience research economies, the world has faced extraordinary shocks in the five years since we launched
five years ago. our annual resilience and protection gap research. We measure resilience as how well an
economy, business or household can withstand an unexpected financial shock such as a
natural catastrophe or the death of a breadwinner. Our macroeconomic resilience index
captures the extent to which an economy can withstand a shock such as a recession; our
insurance resilience indices measure how insurance contributes to maintaining
households’ and businesses’ financial stability by transferring or absorbing risks to life,
health and property. The protection gap is the uninsured or unprotected portion of the
resources needed to fully mitigate risk. Given the vast economic policy shifts in response
to events of the past five years, it is vital we understand what drives risk absorption, the
contribution of insurance, and the actions we can take to restore resilience.
The global protection gap reached a new We see the world economy today as in need of a sustained reload in resilience. The value
high of USD 1.8 trillion in 2022. of unprotected risk exposure has risen steadily in the past five years. We estimate the
global protection gap at USD 1.8 trillion in premium equivalent terms for 2022, up by a
cumulative 20% from a comparable USD 1.5 trillion in 2018. We have expanded the
insurance resilience indices with a new crop protection index, and add the severe
convective storm peril to our natural catastrophe index. We estimate about 43% of risk
globally was unprotected by insurance and other assets in 2022, improved from 46% a
decade ago. Macroeconomic resilience strengthened globally in 2022 as central banks
increased interest rates, and our macroeconomic resilience measure returned to its pre-
pandemic level. However, it remains 15% weaker than in 2007, prior to the Global
Financial Crisis (GFC). Risk is elevated: the inflation-taming monetary tightening process
has laid bare financial stability and recession risks, while persistent inflation increases
the need for fiscal support to offset the erosion of households’ purchasing power. We
expect little improvement in resilience in 2023 or 2024.
About 60% of global insurable crop Our insurance research also demonstrates a need for resilience in four key perils. The
exposure is unprotected against natural agrifood system supports almost half the world’s population and food security has been
hazards, as is 75% of property exposures. a key concern since the outbreak of war in Ukraine. Yet our new crop index finds about
60% of global insurable crop production was unprotected against natural disasters and
accidents (eg, fire, disease and insect swarms) in 2022. We estimate the global crop
protection gap at USD 113 billion (premium equivalent), up by 28% in nominal terms
from 2016, emphasising the importance of agricultural insurance to smooth farmers’
income fluctuations. Our natural catastrophe insurance resilience index estimates that
about 76% of global risk was unprotected in 2022, with protection gaps largest in
emerging markets. Health resilience shows encouraging strength at 78% in 2022, as
living and health standards improved alongside economic growth, particularly in
emerging Asia. However, mortality resilience is low at 43%, implying that many
households are vulnerable to the loss of a breadwinner. We estimate the global mortality
protection gap widened to a record USD 406 billion in 2022, driven by cost of living
rises and weaker financial markets. Life insurance has helped to improve protection in
most countries, particularly those with higher resilience, but more still needs to be done.
To reload resilience requires two strategies: To reload resilience requires consideration of two strategies: reducing expected losses
reducing expected losses and expanding and increasing insurance cover. For example, investment can lower the risk of damage to
insurance coverage. crops, property and infrastructure from natural catastrophes, to structurally narrow
protection gaps while boosting economic growth. Such investment can generate
economic dividends that outweigh the cost by multiples ranging from 2:1 to 10:1. Each
USD 1 invested in loss prevention in lower income countries creates a relatively larger
resilience dividend than in wealthier economies. By reducing risk, loss prevention also
fosters insurability. At the limit of loss prevention, risk transfer comes into play. For
example, the European Insurance and Occupational Pensions Authority (EIOPA)
estimates that a large-scale disaster causing direct losses of more than 0.1% of GDP, can
reduce GDP growth by around 0.5 percentage points (ppts) in the quarter of impact if
the share of insured losses is low, but where sufficiently insured, foregone output is
inconsequential. The insurance industry can incentivise loss mitigation behaviours and
support risk transfer at the household and corporate levels.
sigma No 2/2023 Swiss Re Institute 3
Key takeaways
Economic resilience returned to pre-pandemic levels in 2022 as monetary policy tightened
SRI Macroeconomic Resilience Index (E-RI) and its sub-components, 2007–2023E
0.7
Pre-GFC: 0.62
0.6
Pre-pandemic: 0.53
0.5
0.4
0.3
0.2
0.1
0.0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023E
Structural factors Fiscal resilience Monetary resilience E-RI

Source: Swiss Re Institute
The global protection gap hit a new high of USD 1.8 trillion premium equivalent in 2022
SRI Insurance Resilience Index (I-RI) and protection gaps by region
Resilience index, % Resilience index change Protection gap, USD bn Protection gap change
2012 2017 2021 2022 1 year 5 year 10 year 2012 2017 2021 2022 1 year 5 year 10 year
Global composite
I-RI
55.3 57.1 56.7 57.2    1 291 1 451 1 707 1 775   
North America 64.5 66.1 65.8 66.0    247 255 289 319   
Latin America 42.8 47.4 52.6 52.6    151 135 99 106   
Advanced EMEA 69.5 69.8 69.3 68.5    156 170 204 215   
Emerging EMEA 31.1 31.0 28.8 28.2    225 248 240 248   
Advanced Asia Pacific 48.7 50.4 50.7 49.8    171 153 167 171   
Emerging Asia Pacific 23.7 28.1 28.2 29.5    339 489 708 715   
Advanced markets 66.5 68.5 68.6 68.7    575 579 660 705   
Emerging markets 34.0 35.9 34.4 34.6    716 872 1 047 1 070   
Note: the global I-RI is weighted based on the share of protection gap for each peril in total protection gap. The value of I-RI ranges from 0–100%. The greater the value,
the greater the protection relative to the needs and the higher the resilience. Protection gaps are measured in premium equivalent terms, which indicate the uninsured or
unprotected portion of total protection needs. Crop insurance RI starts from 2016 due to data availability. Some historical values changed due to data revision or revised
estimates.
Icons for resilience index changes:  improved;  almost unchanged;  deteriorated. Icons for protection gap change:  widened;  almost unchanged;
 narrowed.
4 Swiss Re Institute sigma No 2/2023 Key takeaways
Resilience is typically improving as protection available grows faster than protection needs
Trend of average annual values of protection gap and protection available, and growth rates, by peril
100% 9%
90% 8%
80% 7%
70%
6%
60%
5%
50%
4%
40%
3%
30%
20% 2%
10% 1%
0% 0%
22 r
2)
22 r
22 r
2)
22 r
22 r
2)
22 r
22 r
2)
20 5y
20 5y
20 10y
20 5y
20 10y
20 5y
20 10y
02
02
02
02
)
)
)
)
(2
(2
(2
(2
r
r
1y
1y
1y
1y
3–
8–
8–
3–
8–
3–
8–
01
01
01
01
01
01
01
(2
(2
(2
(2
(2
(2
(2
Crop NatCat Health Mortality
Protection available Protection gap Protection gap growth (right axis)
Crop Natural catastrophe Health Mortality

Growth 5 year 1 year 10 year 5 year 1 year 10 year 5 year 1 year 10 year 5 year 1 year
rates 2017–2022 2021–2022 2012–2022 2017–2022 2021–2022 2012–2022 2017–2022 2021–2022 2012–2022 2017–2022 2021–2022
Prot. gap 2.6% 5.7% 4.0% 6.1% 8.3% 2.6% 3.9% 3.2% 1.3% 3.4% 1.5%
Prot. avail. 12.3% 16.2% 4.5% 6.9% 12.8% 3.5% 3.7% 4.2% 0.9% 0.4% –2.1%
Prot. need 6.0% 5.8% 4.1% 6.3% 9.3% 3.3% 3.7% 3.9% 1.1% 2.0% –0.1%
GDP 4.4% 3.9% 3.0% 4.4% 3.9% 3.0% 4.4% 3.9% 3.0% 4.4% 3.9%
Our resilience index measures the contribution of insurance to maintain the financial stability of
households and businesses. The protection gap is the uninsured portion of resources needed
Insurance resilience index and protection gap methodology
Protection gap (PG=N–A) Protection gap

Uninsured/unprotected portion PG = (1 – I-RI) * N
Protection needs (N)
Resources needed to maintain households & businesses' stability
against four shocks: natural catastrophe, crop, health and mortality
Protection available (A) Insurance resilience index
A
Insured/protected portion I-RI =
N
Note: methodologies differ for each peril, but the indices are comparable, and protection gaps are additive as they are converted into premium equivalent terms for the
calculation of the global aggregate. Letters in the formulas: N= protection needs; A=protection available; PG (protection gap) = protection needs-protection available;
Insurance resilience index (I-RI) = protection available/protection need.
Key takeaways sigma No 2/2023 Swiss Re Institute 5
The global protection gap grows at roughly the rate of global GDP, at 3–5% annually on average
Average growth of global protection gap and global GDP in nominal terms over 1, 5 and 10 years
4.5% 4.4%
4.1% 4.0%
4.0% 3.9%
3.5%
3.2%
3.0% 3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
10yr (2012–2022) 5yr (2017–2022) 1yr (2021–2022)
Protection gap growth GDP growth

Resilience dividend I: investment to make infrastructure, buildings and crops more resilient can
create benefits in excess of costs; lower income countries benefit most
Selected benefit-to-cost ratios (left) and countries’ median adaptation finance needs vs their income levels (right)
Sector Intervention Benefit-to-cost ratio 80 USD 4%

Retrofitting utilities and transportation infrastructure 4:1
Infrastructure Making new infrastructure in emerging markets more resilient 4:1 60 3%
Making new infrastructure resilient 4:1 (2:1 to 10:1)
Retrofitting existing private-sector buildings 4:1 40 2%
New build meeting 2018 I-Codes 11:1
Real estate
New build exceeding select 2015 I-Codes 4:1 20 1%
New build adopting Florida building codes 3:1
Improving dryland crop production 5:1 (2:1 to 10:1) 0 0%
Crop Agricultural R&D 2:1 to 17:1 Low-income Lower-middle Upper-middle
Climate services investments 10:1 income income
Source: US National Institute of Building Sciences, World Bank, Global Commission on Adaptation, Per capita (left) Share of GDP (right)
Wharton Risk Center, World Meteorological Organization, UNFCCC, Swiss Re Institute
Resilience dividend II: risk transfer is key to securing resilience by protecting household assets
and income from adverse shocks; this consequently also supports macroeconomic resilience
The channels through which insurance supports resilience on a household and societal level
Micro/household level Macro/societal level
Supports reconstruction and recovery, and protects Enhances the efficiency of risk management
household income after financial loss Insurance resilience
Stabilises long-term financial planning  Natcat insurance RI Promotes financial stability by providing
(eg, education, retirement)  Crop insurance RI long-term capital
 Mortality insurance RI
Incentivises loss mitigation behaviours  Health insurance RI Complements or substitutes government programmes
Facilitates access to credit Positive network effects for communities

Macroeconomic resilience: boosted by higher

interest rates, but fragilities abound
Global macroeconomic resilience has improved since the pandemic but remains weak. Economic resilience globally
increased in 2022, principally from monetary policy normalisation. Our economic resilience measure has returned to pre-
pandemic levels but is still 15% below its pre-GFC level in 2007. The rapid withdrawal of liquidity from the financial system
is a double-edged sword, creating elevated risk alongside the nominally higher resilience. Financial stability is weaker and
central banks have already had to enact emergency liquidity provisions to shore up the banking system. As these lagged
impacts of the rapid monetary tightening play out, we forecast negligible further gains to global macroeconomic resilience
in 2023 or 2024. High economic and financial market reliance on public policy liquidity is a vulnerability for the future.
Meanwhile, the cost-of-living crisis induced by high inflation is eroding households’ purchasing power. Further fiscal
support is likely to be needed in the coming years, which could weigh on fiscal policy space and so on resilience.
Monetary resilience: illusions of grandeur

Global macroeconomic resilience is Global macroeconomic resilience has improved post-pandemic, reflecting the rapid
improving post-pandemic due to the rapid monetary policy normalisation in 2022. For many advanced economies, this has been
monetary policy normalisation. the fastest interest rate hiking cycle for more than 40 years (see Figure 1). However,
higher interest rates per se do not necessarily mean stronger monetary resilience,
because this environment has the potential to destabilise macroeconomic and inflation
conditions, as often witnessed in emerging markets. We take such circumstances in our
SRI Macroeconomic Resilience Index into account, by measuring deviations of interest
rates from their longer-term equilibrium.
Figure 1 15.0 Policy rate increase (percentage points)

Monetary policy tightening in 1976–80
2022 in historical context 12.5
1980–81
10.0
1972–73
7.5
2004–06
5.0 1961–66
1974 1986–89
1993–95 Current cycle
2.5 1971
Grey lines indicate rate hikes

0.0 2015–19 associated with recession
1983–84 within 18 months.
–2.5
1 11 21 31 41 51 61 71
Months since start of tightening cycle
Source: Macrobond, Swiss Re Institute
Interest rate tightening gives monetary The interest rate tightening positions monetary authorities in many countries better to
authorities more scope to manage future deal with future shocks, and in their fight against inflation. Our index shows this: in 2022
shocks... the top 10 countries have gained on average 0.5 points from their 2021 scores. This is
driven primarily by monetary policy space, as scores for this index component soared
from less than 0.1 in 2021, to about 0.3 on average for the top 10 markets. In
Switzerland, the Swiss National Bank’s 175bps of rate hikes lifted the country’s
monetary policy resilience score to 0.25 in 2022 from 0.04 in 2021. In the US, the
Federal Reserve’s 350bps of policy interest rate rises grew monetary policy resilience in
our index to 0.44 from just 0.07 a year ago.
Macroeconomic resilience: boosted by higher interest rates, but fragilities abound sigma No 2/2023 Swiss Re Institute 7
...but tightening is a double-edged sword However, the policy decisions in the past two years have highlighted that rapid monetary
for macroeconomic resilience. tightening is a double-edged sword for macroeconomic resilience. We believe central
banks were late to begin tightening policy, which created a situation in which inflation,
and inflation expectations, were above target for too long and risked becoming
entrenched (see Figure 2).
Figure 2
Left: US long run inflation expectations. Right: US Federal Reserve balance sheet size and policy interest rate
5.5% 11 USD, trillion 7%
10
5.0% 6%
9
4.5% 8 5%
7
4.0% 4%
6
5
3.5% 3%
4
3.0% 3 2%
2
2.5% 1%
1
2.0% 0 0%
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2008 2010 2012 2014 2016 2018 2020 2022
Expected change in inflation rate, five years US Fed balance sheet (left axis) Federal Funds Target Rate (right axis)
Expected change in inflation rate, next year
Source: University of Michigan, Macrobond, Swiss Re Institute
We forecast negligible improvement in our We do not expect significant improvement in our macroeconomic resilience index in
macroeconomic resilience index in 2023 2023 or 2024, due to three key risks. First, the rapid withdrawal of liquidity from the
or 2024. financial system is exacerbating vulnerabilities in the banking sector.1 Many medium-
sized banks in the US have shown severe signs of stress in the last 12 months, while
even a global systemically important bank was forced into an emergency takeover. The
US and European banking sectors in general are signalling stress and reducing credit
supply to the real economy. There may be more credit casualties to come.
Economies and capital markets appear Second, we believe many economies and capital markets now appear overly reliant on
overly reliant on public sector liquidity. public sector liquidity measures to sectors (like the banking industry) or bond markets (as
in the UK) to limit damage. Aside from interest rate rises, central banks have made little
progress at reducing their balance sheets and offsetting past accommodative policies.
This has led to worse financial market functioning and a weaker pass-through of
monetary policy to financial conditions, both of which complicate efforts to tame
inflation.2
Inflation and the associated cost-of-living Third, inflation and the associated cost-of-living crisis have severely challenged the
crisis have severely challenged households’ purchasing power of lower and middle-income households in many countries. Inflation is
purchasing power. fundamentally a distributional outcome between firms, workers and taxpayers that must
be borne by these groups.3 Similarly, someone needs to take the risks stemming from the
banking sector. In both cases, this falls to the fiscal authorities, typically via deposit
guarantees at banks (or other guarantees), or price caps and energy subsidies to shield
1 Banking turmoil rattle markets, not central banks’ inflation-fighting resolve, Swiss Re Institute, 21 March
2023.
2 We have written extensively about both topics. See our Economic Insights on impaired financial market
functioning: Illusions of stability: when market pricing doesn’t tell the whole story, Swiss Re Institute, 26
April 2023, and on the weaker transmission link of monetary policy to financial conditions: More tightening
needed: US inflation ain’t over til it’s over, Swiss Re Institute, 19 August 2022.
3 O. Blanchard on Twitter “ (1) Olivier Blanchard on Twitter: “1/8. A point which is often lost in discussions
of inflation and central bank policy. Inflation is fundamentally the outcome of the distributional conflict,
between firms, workers, and taxpayers. It stops only when the various players are forced to accept the
outcome.” / Twitter.
8 Swiss Re Institute sigma No 2/2023 Macroeconomic resilience: boosted by higher interest rates, but fragilities abound
households from even more significant price pressures. While fiscal authorities to some
extent benefit from inflation – as higher inflation raises revenues and erodes the real
value of debt – they may also have to support societies more.
Fiscal positions may weaken in the medium Strong economic growth improved our fiscal resilience measure in 2022. However, in its
term, weighing on fiscal resilience. absence in the coming years, further fiscal support is likely to be needed to cushion the
cost-of-living crisis. As a result, fiscal deficits may not narrow soon. In regions such as
Europe, fiscal deficits may be structurally larger in the coming years than in the post-GFC
era, to fund necessary public investment related to the energy transition (see Figure 3).
This implies fiscal positions and hence fiscal resilience are unlikely to structurally
improve.
Figure 3 2%
Cyclically adjusted general government
balances (as % of potential GDP), 0%
1990 to 2028F
–2%
–4%
–6%
–8%
–10%
–12%
1990 1995 2000 2005 2010 2015 2020 2025F
Euro Area Germany France Italy Spain Five-year average

Source: IMF, Macrobond, Swiss Re Institute
Emerging markets show stagnating resilience despite earlier gains

Emerging markets’ macroeconomic Emerging markets’ macroeconomic resilience stagnated in 2022 after strengthening in
resilience strengthened earlier than 2021, well before advanced economies, which typically saw gains only last year. Many
advanced, but stagnated in 2022. emerging market central banks embarked on interest rate hiking earlier in this cycle,
arguably because they face inflationary episodes more often. If the US as we anticipate
enters recession later this year, a higher level of emerging markets resilience is welcome
and could cushion a stronger USD and potential capital outflows from these markets. But
rapidly tightening US interest rates and global financial conditions are already weighing
on emerging markets’ monetary and fiscal policy resilience. By our index, resilience in
advanced economies strengthened by 12% in 2022 (to 0.65 from 0.58 in 2021) but
only by 3% in emerging (to 0.41).
The benign growth environment generally Besides higher monetary policy space, the benign growth environment also generally
improved global fiscal resilience, but improved global fiscal policy space, even as fiscal deficits increased in some countries in
headwinds are building. regions such as Europe. That said, in light of an expected significant slowdown in most
advanced economies and a mild US recession, we expect strong headwinds for fiscal
resilience over the next 18 months. Fiscal policy space declined in emerging markets in
2022 (to 0.68 from 0.69) as current account deteriorations and exchange rate pressures
outweighed growth gains.
Recovery in the index

Macroeconomic resilience improved for Our global SRI Macroeconomic Resilience Index (E-RI) ended 2022 9% higher than a
a second year running in 2022. We see year earlier (0.53, up from 0.49, see Figure 4 and Table 1), as we predicted in our
slower uptick in 2023. resilience index update last year.4 Macroeconomic resilience in 2022 returned to pre-
pandemic levels, but remained 15% below its pre-GFC level in 2007. The main driver
was higher monetary policy space, which globally rose to a score of 0.38 in 2022 from
0.18 in the 2021 index. Our preliminary estimate for 2023, based on our monetary and
fiscal policy forecasts, points to a 2% improvement to 0.54 in our index terms.
Figure 4 0.7
SRI Macroeconomic Resilience Pre-GFC: 0.62
Index (E-RI) and sub-components, 0.6
Pre-pandemic: 0.53
2007–2023E
0.5
0.4
0.3
0.2
0.1
0.0
08
09
07
20
21
10
22
13
14
15
16
18
19
12
17
11
E
23
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
20
Structural factors Fiscal resilience Monetary resilience E-RI
Our E-RI methodology is unchanged from The methodology for the global E-RI is unchanged from last year. We cover a sample of
last year and captures policy buffers as well 31 countries made up of nine emerging and 22 advanced economies, these
as structural factors across 31 economies. accounting for about 75% of world GDP. Index values range from 0 (minimal resilience)
to 1 (maximum). The index captures the shock absorbing capacity of an economy,
which comprises macro buffers such as fiscal and monetary policy resilience. It also
captures structural factors such as the level of development and efficiency of countries’
financial and labour markets. Some of the underlying data for structural indicators are
published with a substantial lag and hence show no change vs prior years.5
4 sigma Resilience Index 2022: risks to resilience on the rise again after a year of respite, Swiss Re Institute, 30
June 2022.
5 Some measures such as financial market development or income inequality were subject to significant
dataset revisions hence not all countries show the same scores as in prior years.
10 Swiss Re Institute sigma No 2/2023 Macroeconomic resilience: boosted by higher interest rates, but fragilities abound
Table 1
SRI Macroeconomic Resilience Index (E-RI), scores and rankings
2022 2023
Labour market efficiency
Resilience Index Level

Resilience index level
Rank 2023 (prediction)

Insurance penetration
Economic complexity
(23 predicted vs 22)

2022 vs 2021 rank
(prediction 2023)
Income Inequality
Banking Industry
Financial market
Monetary policy
Fiscal resilience
Rank difference
Human capital
CO2 emissions
development
Rank 2022
difference
resilience
backdrop
Switzerland 1 = 0.81 0.98 0.25 1.00 ¬ 0.55 ¬ 1.00 ¬ 0.79 1.00 ¬ 1.00 ¬ 0.96 ¬ 1.00 ¬ 0.81 1 =
Norway 2 +1 0.77 1.00 0.36 1.00 ¬ 0.30 ¬ 0.69 ¬ 0.75 0.29 ¬ 0.81 ¬ 0.93 ¬ 1.00 ¬ 0.77 2 =
Canada 3 +4 0.75 0.88 0.43 0.23 ¬ 0.66 ¬ 0.76 ¬ 0.93 0.42 ¬ 0.88 ¬ 0.99 ¬ 0.43 ¬ 0.74 4 +1
Netherlands 4 = 0.75 0.98 0.35 0.57 ¬ 0.77 ¬ 0.60 ¬ 0.83 0.53 ¬ 0.87 ¬ 0.85 ¬ 1.00 ¬ 0.75 3 –1
Denmark 5 = 0.74 1.00 0.30 1.00 ¬ 1.00 ¬ 0.39 ¬ 0.83 0.47 ¬ 1.00 ¬ 0.77 ¬ 0.79 ¬ 0.74 5 =
Finland 6 –4 0.74 0.86 0.35 0.66 ¬ 0.91 ¬ 0.58 ¬ 0.96 0.80 ¬ 0.73 ¬ 1.00 ¬ 0.78 ¬ 0.73 6 =
Australia 7 1 0.73 0.98 0.38 0.27 ¬ 0.25 ¬ 1.00 ¬ 0.80 0.00 ¬ 0.63 ¬ 1.00 ¬ 0.60 ¬ 0.73 7 =
Sweden 8 –2 0.73 0.98 0.33 1.00 ¬ 0.61 ¬ 0.61 ¬ 0.82 0.88 ¬ 0.64 ¬ 0.68 ¬ 0.98 ¬ 0.72 8 =
US 9 +2 0.70 0.73 0.44 0.38 ¬ 1.00 ¬ 1.00 ¬ 0.77 0.83 ¬ 1.00 ¬ 0.82 ¬ 0.25 ¬ 0.69 11 +2
South Korea 10 –1 0.69 0.98 0.39 0.21 ¬ 0.98 ¬ 0.81 ¬ 1.00 ¬ 1.00 ¬ 0.37 ¬ 0.58 ¬ 0.78 ¬ 0.69 10 =
Germany 11 +1 0.68 0.88 0.35 0.53 ¬ 0.48 ¬ 0.81 ¬ 0.82 1.00 ¬ 0.78 ¬ 0.55 ¬ 0.58 ¬ 0.69 12 +1
Austria 12 +2 0.67 0.86 0.35 0.63 ¬ 0.27 ¬ 0.36 ¬ 0.76 0.82 ¬ 0.55 ¬ 0.85 ¬ 0.83 ¬ 0.67 14 +2
New Zealand 13 –3 0.67 0.80 0.44 0.59 ¬ 0.29 ¬ 0.18 ¬ 0.79 0.08 ¬ 0.95 ¬ 0.93 ¬ 0.70 ¬ 0.69 9 –4
Ireland 14 –1 0.67 1.00 0.35 1.00 ¬ 0.43 ¬ 0.54 ¬ 0.87 0.66 ¬ 0.92 ¬ 0.23 ¬ 0.69 ¬ 0.67 13 –1
UK 15 +6 0.64 0.56 0.40 0.96 ¬ 1.00 ¬ 0.96 ¬ 0.79 0.78 ¬ 0.88 ¬ 0.64 ¬ 0.70 ¬ 0.63 15 =
France 16 = 0.61 0.66 0.35 0.92 ¬ 0.82 ¬ 0.73 ¬ 0.71 0.71 ¬ 0.37 ¬ 0.72 ¬ 1.00 ¬ 0.62 16 =
Belgium 17 –2 0.56 0.68 0.35 0.51 ¬ 0.40 ¬ 0.16 ¬ 0.78 0.66 ¬ 0.41 ¬ 0.59 ¬ 0.80 ¬ 0.55 19 +2
Spain 18 +6 0.55 0.63 0.35 0.56 ¬ 0.33 ¬ 0.88 ¬ 0.72 0.34 ¬ 0.30 ¬ 0.51 ¬ 0.84 ¬ 0.58 17 –1
China 19 –1 0.51 1.00 0.41 0.04 ¬ 0.19 ¬ 0.64 ¬ 0.16 0.47 ¬ 0.22 ¬ 0.25 ¬ 0.27 ¬ 0.51 20 +1
Portugal 20 +5 0.50 0.84 0.35 0.50 ¬ 0.40 ¬ 0.39 ¬ 0.75 0.14 ¬ 0.39 ¬ 0.00 ¬ 0.72 ¬ 0.51 21 +1
Japan 21 –2 0.49 0.13 0.19 0.37 ¬ 0.68 ¬ 0.99 ¬ 1.00 ¬ 1.00 ¬ 0.73 ¬ 0.77 ¬ 0.38 ¬ 0.56 18 –3
Italy 22 +6 0.41 0.35 0.35 0.59 ¬ 0.78 ¬ 0.85 ¬ 0.65 0.67 ¬ 0.11 ¬ 0.10 ¬ 0.50 ¬ 0.42 23 +1
Russia 23 –1 0.37 0.86 0.27 0.00 ¬ 0.00 ¬ 0.09 ¬ 0.76 0.12 ¬ 0.30 ¬ 0.00 ¬ 0.26 ¬ 0.33 26 +3
India 24 –1 0.33 0.48 0.41 0.01 ¬ 0.22 ¬ 0.42 ¬ 0.00 ¬ 0.18 ¬ 0.00 ¬ 0.31 ¬ 0.12 ¬ 0.35 25 +1
Mexico 25 +2 0.30 0.00 ¬ 0.25 0.24 ¬ 0.03 ¬ 0.00 ¬ 0.06 0.56 ¬ 0.08 ¬ 0.78 ¬ 0.00 ¬ 0.31 27 +2
Chile 26 –9 0.30 0.11 0.24 0.20 ¬ 0.13 ¬ 0.00 ¬ 0.29 0.00 ¬ 0.37 ¬ 1.00 ¬ 0.00 ¬ 0.43 22 –4
Brazil 27 +2 0.26 0.00 ¬ 0.34 0.38 ¬ 0.18 ¬ 0.56 ¬ 0.00 ¬ 0.12 ¬ 0.00 ¬ 0.85 ¬ 0.00 ¬ 0.26 28 +1
Hungary 28 –2 0.24 0.00 0.20 0.23 ¬ 0.01 ¬ 0.00 ¬ 0.67 0.74 ¬ 0.20 ¬ 0.62 ¬ 0.92 ¬ 0.36 24 –4
South Africa 29 –9 0.23 0.00 0.17 0.00 ¬ 1.00 ¬ 0.24 ¬ 0.00 ¬ 0.00 ¬ 0.29 ¬ 0.79 ¬ 0.00 ¬ 0.25 29 =
Greece 30 +1 0.20 0.00 ¬ 0.35 0.31 ¬ 0.03 ¬ 0.22 ¬ 0.40 0.02 ¬ 0.00 ¬ 0.00 ¬ 0.90 ¬ 0.21 30 =
Turkey 31 –1 0.18 0.00 ¬ 0.40 0.18 ¬ 0.00 ¬ 0.39 ¬ 0.39 0.17 ¬ 0.00 ¬ 0.31 ¬ 0.20 ¬ 0.18 31 =
World 0.53 0.68 0.38 0.29 0.50 0.69 0.50 0.56 0.47 0.53 0.36 0.54
Advanced 0.65 0.68 0.38 0.50 0.80 0.88 0.81 0.77 0.77 0.72 0.50 0.65 ¬
Emerging 0.41 0.68 0.38 0.07 0.17 0.49 0.17 0.34 0.15 0.33 0.20 0.42

Note: World, advanced and emerging market indicators have changed as the GDP and FX weights have changed slightly. Otherwise they would have remained the same if
the indicator did not change since last year.
Fostering resilience-enhancing public policies

Working to reduce structural economic Public policy decisions can support the slower-moving structural components of an
vulnerability is also key. economy. For example, investments in infrastructure, human capital, the green transition
and mitigating inequality can foster macroeconomic resilience and lift trend growth (see
Chapter 3). The human capital indicator by and large declined across countries in 2022,
highlighting the importance of increasing labour force participation, for example by
facilitating flexible retirement ages. The lesson of 2022 and 2023 so far is that continuous
public policy intervention can inhibit risk signals and create an illusion of stability despite
underlying fragility. For example, although post-GFC regulatory frameworks strengthened

global systemically important banks, these institutions can still require emergency support.
Risks have also moved: to smaller banks, or to opaque and illiquid balance sheets.
Action points include taking a holistic view Our research offers several action points for consideration:
of resilience and the effects of public policy
interventions, as well as resilience bonds. 1. Tackling one area of resilience can have positive spillovers in others. For example,
deeper financial markets are associated with higher insurance penetration and more
efficient labour markets. Likewise, higher insurance penetration rates reduce the
impact of a shock on public finances, and so support fiscal space. Targeted measures
to improve one aspect can uplift other dimensions of resilience at the same time,
initiating positive feedback loops.
2. Evaluation of the full effects of public policies is needed. Less public policy
intervention in private markets ensures risk signals can more adequately reflect reality.
While strong interventions are valuable in crises, a clear timeframe to exit such
policies can support economies to rebuild strength themselves.
3. Governments could proactively evaluate their vulnerabilities and invest in resilience,

taking a long-term approach. For example, the war in Ukraine was a signal of Europe’s
reliance on natural gas. Energy independence, environmental and societal
sustainability go hand in hand and should be urgently addressed.
4. Resilience bonds could be more widely used. Similar to catastrophe bonds, these
connect insurance premiums to resilience-building projects (see An introduction to
resilience bonds). Hence, they help fund risk reduction projects via resilience rebates
that translate avoided losses into a revenue stream.
We believe resilience should be viewed We believe resilience should be viewed holistically. Measures to strengthen
holistically. macroeconomic resilience can be complemented by household (micro) resilience, for
example by providing adequate and affordable insurance coverage. In addition,
resilience is also about not needing it in the first place: loss prevention is a key
component of resilience. We look at these aspects in the next two chapters.
An introduction to resilience bonds

Resilience bonds, like green bonds and Resilience bonds are related to green bonds and catastrophe bonds. Their purpose is to
catastrophe bonds, channel capital into channel the raised capital into climate-resilient infrastructure investments that help
climate-resilient infrastructure investments. reduce expected losses from disasters through climate adaptation. Hence, the aim of
resilience bonds is to prevent not only financial but also physical disasters, which is
why they entail embedded insurance. Resilience bonds use a rebate structure to value
the reduction in disaster related expected losses: essentially, investors agree in
advance on a discount of the bond coupons they receive when targeted risk-reducing
projects are completed during the term of the bond. The Coalition for Private
Investment in Conservation (CPIC) states that “the bond issuer uses financial
catastrophe models to validate whether a resilience project will reduce expected
losses. This sets the reduction in coupon payments to investors. The cost savings from
this reduction are distributed back to the sponsor in the form of a resilience rebate,
which can be used to finance risk reduction investments.”6
Resilience bonds are a nascent investment As is the case for green bonds, resilience bonds are a nascent investment instrument.
instrument. The EBRD was the first issuers of a climate resilient bond in 2019 which raised USD
700 million.7 Multinational balance sheets can be leveraged for climate resilient
investment, ensuring that the private sector can provide capital for such risks whilst
enabling a very high credit rating of bonds, thereby making them accessible for a large
range of institutional investors. As our research in Chapter 3 highlights, the benefits of
proactive economic adaptation are very high. We believe resilience bonds will be on
investors’ radars in the future because they make economic sense.
6 More details around the financial structure of resilience bonds can be found here: Resilience Bond for risk
reduction – CPIC (cpicfinance.com).
7 More information on the EBRD issuance can be found here: World’s first dedicated climate resilience bond,
for US$ 700m, is issued by EBRD.
Insurance resilience: more of the world is better

protected, but still further to go
The global protection gap reached a new record high of USD 1.8 trillion in premium equivalent in 2022, 4.0% higher in
nominal terms than in 2021, similar to global nominal GDP growth. The gap has risen by a cumulative 20% in the past five
years, as protection needs have been pushed up by economic growth, and inflation increased insured exposures. The SRI
Insurance Resilience Indices (I-RI) have improved over the past five years as a growing proportion of households’ risk
protection for four key perils is protected, mainly by insurance. Advanced market resilience is stronger, with almost 70% of
their protection needs covered as of 2022, up from 68.5% five years ago and 66.5% in 2012. In emerging regions,
healthcare resilience has particularly improved as health insurance premiums have grown at rates far higher than GDP. Our
new crop I-RI recognises the importance of the agrifood system in supporting an estimated 50% of the world’s population.
We find great strides being made to better absorb food security risks, particularly in emerging markets. The progress
made in insurance resilience alongside the widening protection gap highlight the value proposition of insurance in
supporting financial security for households and businesses. It also signals huge development potential for the industry:
USD 1.8 trillion equates to 26% global insurance premiums written in 2022.
Gradual gains in resilience, but challenges remain

The insurance industry has kept pace with SRI insurance resilience research assesses the contribution of insurance in helping
growing loss potential over the long term. households and businesses to better withstand financial shock scenarios. The global
composite I-RI (see The SRI Insurance Resilience Index approach) indicates that in
relative terms, the insurance industry has kept pace with growing loss potential over the
past five and 10 years, in both advanced and emerging regions (see Table 2). However,
on a global level, the protection gap is still widening.
We have expanded the scope of our We expand the scope of our research this year to include a new component, a crop I-RI.
research to include a new crop insurance This captures the protection needed for insurable crop production in case of natural
resilience index. disaster events or other accidents (e.g., fire, disease and insect swarms), and the
protection available (sum insured for the insured crop output value). It reflects how far
insurance, and related public sector support, offer financial resilience to farming
households to support security of food supply. We also expanded the range of modelled
perils for the natural catastrophe I-RI to include severe convective storms for 12
countries, and extended our overall country coverage from 34 to 39.
The SRI composite insurance resilience With these new inclusions, the composite I-RI stood at 57.2% in 2022, up by 0.5ppt
index has seen gradual improvement over from 56.7% (restated) in 2021,8 with improvements in both advanced and emerging
the short and long term. regions. This implies that more than 40% of global risks remain unprotected or uninsured
across the four perils. The most significant driver of the increase in global resilience was
rising healthcare resilience, with protection available rising 4.2%, faster than total
protection needs (3.9%). Emerging regions are still much less resilient than advanced,
and there have been slight declines or slow progress in several areas. The key to
improving global resilience lies in unlocking emerging economies’ potential to catch up
in the development of their public welfare systems and private insurance markets.
8 The 2021 SRI composite insurance resilience index and aggregate protection gap in this sigma are updated
and changed from last year (sigma Resilience Index 2022, Swiss Re Institute, 30 June 2022) due to the
addition of the crop I-RI and adjustments to the measurement of other three perils. These changes improved
the 2021 global I-RI to 56.7% (from 54.3% as published), and widened the protection gap to USD 1.7 trillion
in 2021 from USD 1.4 trillion as previously published (for details, please see Appendix: Index Methodologies).
Insurance resilience: more of the world is better protected, but still further to go sigma No 2/2023 Swiss Re Institute 13
Table 2
SRI Insurance Resilience Index and protection gaps by region
Resilience index, % Resilience index change Protection gap, USD bn Protection gap change
2012 2017 2021 2022 1 year 5 year 10 year 2012 2017 2021 2022 1 year 5 year 10 year
Global composite
I-RI
55.3 57.1 56.7 57.2    1 291 1 451 1 707 1 775   
North America 64.5 66.1 65.8 66.0    247 255 289 319   
Latin America 42.8 47.4 52.6 52.6    151 135 99 106   
Advanced EMEA 69.5 69.8 69.3 68.5    156 170 204 215   
Emerging EMEA 31.1 31.0 28.8 28.2    225 248 240 248   
Advanced Asia Pacific 48.7 50.4 50.7 49.8    171 153 167 171   
Emerging Asia Pacific 23.7 28.1 28.2 29.5    339 489 708 715   
Advanced markets 66.5 68.5 68.6 68.7    575 579 660 705   
Emerging markets 34.0 35.9 34.4 34.6    716 872 1 047 1 070   
Note: The global I-RI is weighted based on the share of protection gap for each peril in total protection gap. I-RI values range from 0–100%. The greater the value, the
greater the protection relative to the needs and the higher the resilience. Protection gaps are measured in premium equivalent terms, which indicate the uninsured or
unprotected portion of total protection needs. Crop insurance RI starts from 2016 due to data availability. Some historical values changed due to data revision or revised
estimates.
Icons for resilience index changes:  improved;  almost unchanged;  deteriorated. Icons for protection gap changes:  widened;  almost unchanged;
 narrowed.
Protection gaps: new record highs, but real terms decline

The global protection gap widened to With crop exposures added, we estimate the global protection gap reached a new high
USD 1.8 trillion in nominal terms in 2022. of USD 1.8 trillion in 2022. This is up by 4.0% in nominal terms year-on-year from our
revised estimate of USD 1.7 trillion for 2021, and a cumulative 20% increase from five
years ago. Since 2012, the global protection gap has grown at 3–5% annually in nominal
terms, roughly matching that of global nominal GDP growth trends. This implies that the
protection gap rises and widens alongside economic growth despite gradually
improving resilience (see Figure 5). Adjusted for USD inflation, the protection gap
declined by 3.7% in real terms in 2022.
Figure 5 5.0%
Growth rates per annum of the global 4.5% 4.4%
protection gap and global GDP, 4.1% 4.0% 3.9%
4.0%
in nominal terms
3.5%
3.2%
3.0% 3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
10yr (2012–2022) 5yr (2017–2022) 1yr (2021–2022)
Protection gap growth GDP growth

Source: Swiss Re institute
14 Swiss Re Institute sigma No 2/2023 Insurance resilience: more of the world is better protected, but still further to go
Advanced and emerging markets The advanced markets protection gap jumped by 6.9% in nominal terms in 2022, with
protection gap growth rates are diverging. strong growth rates in health and natural catastrophe gaps. The mortality protection gap
declined marginally in advanced markets. For emerging markets, accounting for 60% of
the global protection gap, their unmet protection need grew by 2.2% nominally in 2022,
with a significant improvement in health resilience helping to close the gap.
Resilience is increasing in the crop, natcat Figure 6 shows that protection available is increasing at a faster rate than protection
and health perils. needed in the crop, natural catastrophe and health perils, resulting in increasing
resilience. The figure also illustrates that the protection gap is growing in USD terms, but
at a slower pace than protection needs in this case, because coverage provided by
insurance and other available resources remains relatively low despite the progress
made. The I-RI is highest for health, followed by mortality, crop and natural catastrophe.
Figure 6
Trend of average annual values of protection gap and protection available, and growth rates, by peril
100% 9%
90% 8%
80% 7%
70%
6%
60%
5%
50%
4%
40%
3%
30%
20% 2%
10% 1%
0% 0%
22 r
)
22 r
22 r
22 r
22 r
22 r
22 r
22
22
22
22
20 5y
20 5y
20 10y
20 5y
20 10y
20 5y
20 10y
)
)
)
20
20
20
20
r(
r(
r(
r(
1y
1y
1y
1y
8–
3–
8–
3–
8–
3–
8–
01
01
01
01
01
01
01
(2
(2
(2
(2
(2
(2
(2
Crop NatCat Health Mortality
Protection available Protection gap Protection gap growth (right axis)
Crop Natural Catastrophe Health Mortality

5 year 1 year 10 year 5 year 1 year 10 year 5 year 1 year 10 year 5 year 1 year
2017–2022 2021–2022 2012–2022 2017–2022 2021–2022 2012–2022 2017–2022 2021–2022 2012–2022 2017–2022 2021–2022
Prot. gap 2.6% 5.7% 4.0% 6.1% 8.3% 2.6% 3.9% 3.2% 1.3% 3.4% 1.5%
Prot. avail. 12.3% 16.2% 4.5% 6.9% 12.8% 3.5% 3.7% 4.2% 0.9% 0.4% –2.1%
Prot. need 6.0% 5.8% 4.1% 6.3% 9.3% 3.3% 3.7% 3.9% 1.1% 2.0% –0.1%
GDP 4.4% 3.9% 3.0% 4.4% 3.9% 3.0% 4.4% 3.9% 3.0% 4.4% 3.9%
Source: Swiss Re institute
Crop resilience has grown in most Crop resilience has improved strongly in most regions since 2017. Protection available
regions…. through private and public agricultural insurance programmes achieved the strongest
growth of the perils we cover, and exceeded that of protection needs both in 2022 and
over the last five years (see Figure 6). However, crop insurance penetration remains very
low comparing to growing crop output, especially in emerging markets, and despite a
large and fast-expanding agriculture insurance sector (such as in China and Brazil),
resulting in widening protection gaps between needs and available resources.
…while natcat resilience has improved in The natural catastrophe I-RI improved marginally to 24.3% in 2022 from 23.5% in 2012,
advanced markets. reflecting increases in insurance coverage, most strongly in advanced markets, despite
the growth of protection need systematically exceeding GDP growth. Emerging
economies’ natural catastrophe resilience improved in emerging Asia Pacific, especially
in China, while declining in emerging EMEA and Latin America. Globally, the protection
gap is rising slightly slower than protection available, but for emerging markets, where
95% of risk exposures are uninsured on average, protection need and protection gaps
have outgrown available protection over the last decade. Property insurance growth has
lagged rapid economic growth and asset accumulation.
Improvement in health resilience is largely Health resilience has shown encouraging improvements, in advanced economies
attributed to Asia, particularly China. especially, with global growth in available protection slightly outpacing protection needs
and gaps. However, the health I-RI for advanced economies widened in 2022, reflecting
the winding-down of COVID-19-related extraordinary government support programmes,
and pressures from the reopening of healthcare systems post-COVID-19 with resumption
of many elective medical treatments. This 2022 decline is mostly driven by advanced
EMEA. A marginal long-term decrease in overall emerging markets’ health I-RI obscures
solid resilience gains in Latin America and emerging Asia Pacific, particularly China,
whose growing weight and low starting base drags down the aggregate index.
Mortality resilience is weak, reflecting a In contrast with the other three perils, mortality resilience declined in 2022 and over the
decline in protection available, including life past 10 years. Recent unfavourable economic conditions of high inflation have eroded
insurance. household purchasing power while volatile financial markets depleted household assets.
In advanced economies, the mortality I-RI declined due to slow life premium growth,
rising debt, and relatively stagnating social security benefits post-GFC. In advanced
economies, the prolonged period of low interest rates penalised life insurers’ investment
returns and forced them to make products less attractive and led to some major life
insurers exiting the market. Emerging markets’ mortality resilience has risen marginally
over the last decade, as mortality-related insurance premiums have growth faster than
GDP earlier on, especially in China, but the growth in insurance premiums and available
protection slowed strongly over the past five years and protection gaps are expanding.
High inflation pushed up the protection gap Higher inflation tends to negatively impact the (real) value of household financial assets
globally. including insurance coverage, particularly for maturity mortality policies in which
benefits are defined at the inception of the policy. Soaring prices also increase household
burden to replace or reconstruct the building if disasters occurred, and decrease
households’ financial resources, which hinders families from purchasing more insurance
or leveraging other tools to improve the protection gap. Per peril, the natural catastrophe
protection gap growth rate is well above that of the composite, especially for 2022,
driven up by rising construction costs, mostly in North America and western Europe. The
crop protection gap also surged in 2022 as the Ukraine war triggered higher food prices.
The SRI Insurance Resilience Index (I-RI) approach

Our resilience indices measure the Five years ago, our resilience indices started to measure the contribution of insurance
contribution of insurance to support in helping households and companies to better withstand catastrophic shocks such as
households and businesses to withstand natural disasters, acute health costs or the death of a family’s breadwinner.9 The
catastrophic shocks. methodologies differ for each peril but the indices are comparable.
There are two metrics by which to assess The index measures how insurance contributes to maintaining households’ and
insurance resilience: the index and the businesses’ financial stability by transferring or absorbing risk. The protection gap is the
protection gap. uninsured or unprotected portion of the resources needed to fully mitigate risk. Figure 7
shows the relationship between the two metrics. We update the indices annually to
measure changes to risk exposures, protection levels and untapped insurance
provision. In this fifth year of publishing we have revisited data sources, markets
covered and methodologies to improve the results (see Appendix for details).
9 sigma 5/2019 – Indexing resilience: a primer for insurance markets and economies, op. cit.
The more protection a household or The more coverage that insurance (or other resources)10 provides relative to protection
business has, the higher its resilience. needs, the higher a household or business’s resilience, and the smaller the protection
gap in proportionate terms (rather than absolute value). This is because from a dynamic
perspective, protection needs and protection available typically grow alongside the
economy and the development of resilience metrics depends on the relative growth
between the underlying variables. If protection available grows faster than protection
need, the resilience index improves, and the protection gap grows more slowly than
protection needs, even as the absolute value expands (as protection coverage provided
is typically relatively low). In a few cases, when the growth difference is large or where
the growth of protection needs is very low (or negative), protection gaps decline.
Figure 7 Protection gap

The building blocks of the (PG=N–A) Protection gap
SRI Insurance Resilience Index and Protection needs (N) Uninsured/unprotected PG = (1 – I-RI) * N
protection gap Resources needed to maintain portion
households & businesses' stability
against four shocks: natural
catastrophe, crop, health and
Protection available (A) Insurance resilience index
mortality
A
Insured/protected portion I-RI =
N
Crop resilience: substantial progress, but more needed

A resilient crop production system is key for Our new I-RI focuses on crops, which account for 65% of global agricultural output and
global food security. so offer a good proxy for the agriculture sector.11 Crop yields have a direct and significant
impact on various aspects of food security, including the prevalence of hunger and the
livelihoods of farmers. The vulnerability of agricultural production to shock events that
may adversely affect crop yields and overall agricultural output is a key risk in producing
countries worldwide.12
Agriculture insurance can directly or Agricultural insurance plays a key role in covering the losses farmers incur when, among
indirectly support the SDGs and alleviate others, extreme weather conditions, fire and pests lead to poor crop harvests. Coverage
food supply pressures… also helps farmers manage transitions between crops imposed by climate change
effects, evolving demographics and biodiversity on the most optimal type of crop.13 By
stabilising farm income, insurance can reduce poverty (SDG 1) and offer a safety net for
food producers against climate risks (SDG 13). Better food security could also help
strengthen social wellbeing and reduce the risk of unrest. The positive welfare effects
from insurance pay-outs can also lead to multiple spill-over effects over the medium-to-
long term, not least hunger reduction (SDG 2).14
…hence we develop a new index that A low crop insurance protection gap in key producing countries implies that farmers can
measures crop insurance resilience and quickly relaunch production after a shock and export to dependent economies to
protection gaps. alleviate food shortages. Emerging Asia (including India and China) produces nearly two-
thirds of global crop production by value, with China alone accounting for about 38%
(see Figure 8).
10 Mortality resilience considers also social security benefits and financial assets. Health resilience looks at the
risk of catastrophic OOP expenses after health insurance and government funding. For more details, see the
Appendix.
11 Computations based on data from FAO. For full index and protection gap methodology, see Appendix.
12 The crop and natural catastrophe I-RI cover different types of exposure, though the perils may be similar (e.g. a
damaging hailstorm). See Appendix for details.
13 This is illustrated by the desired transition away from rice for climate and health reasons. How to fix the global
rice crisis, The Economist, 30 March 2023.
14 S. Vyas, T. Dalhaus, M. Kropff et. al., “Mapping global research on agricultural insurance”, Environmental
Research Letters, vol 16, no 10 2021.
Figure 8
Gross value of crop output by market, 2021 4%
6%
7%
9% 38% China
Emerging EMEA
India
9% Other Americas
Other emerging Asia Pacific
United States
11%
17% Advanced EMEA
Advanced Asia Pacific
Source: FAO, Swiss Re Institute
We estimate a global crop protection gap of about USD 113 billion

Advanced Asia
Crop insurance resilience has risen by The global crop protection gap stands at an estimated USD 113 billion in USD premium
13ppts since 2016. equivalent terms in 2022.
Advanced EMEAThis corresponds to about 59% of the insurable value of crop
production left unprotected:
United States in other words, a resilience index value of around 41%. The
protection gap last year was up from USD 88 billion in 2016, with the index 13 ppts
Other emerging Asia
higher as of 2022.
Other Americas
The global protection gap increased by The global crop protection gap increased by 4.2% on average per year, partly from
India
4.2% on average per year. inflation. Indeed, increasing prices for commodities and other farming inputs
mechanicallyEmerging EMEA
moves protection needed, and therefore the gap, higher. The second way
through which protection needed changes is the fast growth of crop production and
China
increasing market sophistication in some large emerging economies such as China, on
the back of supportive policies and advances in agro-related technology. Improving
regulation in areas such as fertilizers and phytosanitary controls is also supporting
growth in farming.15 Overall, protection needed and protection available both rose
strongly since 2016, with the latter doing so at a faster clip owing to rising insurance
penetration. While there is more to protect, an increasing share of that amount is insured.
Table 3
SRI Crop Insurance Resilience Index and protection gaps
Resilience index, % Protection gap, USD bn

2016 2021 2022 Change (1yr) 2016 2021 2022 Change (1yr)
Global crop I-RI 27.7 38.6 40.8  88 107 113 
North America 85.8 86.3 87.3  2 2 3 
Latin America 16.3 28.7 34.1  6 6 6 
Advanced EMEA 26.2 23.8 23.6  10 18 21 
Emerging EMEA 5.0 3.8 4.3  40 34 36 
Advanced Asia Pacific 51.2 60.3 60.8  1 1 1 
Emerging Asia Pacific 26.6 43.8 46.8  29 46 45 
Advanced markets 57.3 58.9 59.3  13 22 25 
Emerging markets 20.9 34.2 36.9  75 85 88 
Note: index starts from 2016 due to data availability. North America includes the US only, as Canada is not part of the sample. This makes the implicit assumption that both
countries have the same resilience index.
 narrowed. Source: FAO, World Bank, Swiss Re Institute
15 Enabling the business of agriculture, World Bank, October 2019.

The gain in resilience is encouraging, but is The gain in resilience is particularly large compared with the other perils we cover. The
not shared by all markets considered, and improvement can largely be attributed to rising agroinsurance penetration, spurred by
absolute resilience is only moderate. public schemes and subsidies in different countries (see Divergence in crop insurance
resilience in emerging Asia). With global gains in resilience being caused by a limited
number of economies, a more widespread and inclusive push for better crop protection
is needed.
Emerging Asia is driving the overall Crop resilience has improved in most regions since 2016. Emerging Asia has contributed
improvement in crop resilience since 2016. strongly to growing global resilience due to a large and fast-expanding agriculture
insurance sector (see Divergence in crop insurance resilience in emerging Asia). North
America, where the crop insurance system is mature, has not seen a significant change
in resilience in the past seven years. Emerging EMEA continued to see limited resilience,
while resilience in advanced EMEA declined, as sums insured rose less than the value of
crops in some markets (eg, Spain, Italy) and France saw several years of poor crop yields.
Figure 9 70%
SRI Crop Insurance Resilience Index,
advanced and emerging markets 60%
62%
60% 60% 59% 59% 59%
50% 57%
41%
40% 39%
36% 36%
34%
31% 37%
30% 28% 34%
31% 32%
20% 27%
23%
21%
10%
0%
2016 2017 2018 2019 2020 2021 2022
Global Emerging markets Advanced markets

Source: FAO, World Bank, Swiss Re Institute
Crop resilience improved in China, Global gains in resilience are caused by a limited number of economies, suggesting a
Argentina, Brazil, and South Korea but more widespread and inclusive push for better crop protection is needed. China was by
declined in India and others. far the main contributor to the improvements, with its I-RI rising by 24ppts from 2016 to
2022l, primarily from strong gains in insurance penetration. Countries such as Argentina,
Brazil and South Korea also saw robust increases in crop resilience. However, not all
countries saw gains: resilience declined in India (see Divergence in crop insurance
resilience in Emerging Asia), France and Japan, among others. Japan’s I-RI fell by 11ppts
due to declining insurance premiums, although we stress that this market has historically
been perceived as highly protected.16 In 2022, we find the largest share of unprotected
insurable crop output in Indonesia and several small EMEA countries, while protection
gaps appear limited in markets such as the US and France.17
16 C. M. Reyes et. al., “Agricultural insurance program: Lessons from different country experiences”, PIDS
Discussion Paper Series, Philippine Institute for Development Studies (PIDS), 2017.
17 While information on agroinsurance premiums, an important part of our methodology, is not widely available,
some limited data points were published in collaboration with Munich Re and AIAG.
Table 4
SRI Crop Insurance Resilience Index, protection gaps and shares for the five largest markets
Gross crop output Share of global crop

Resilience index, % Protection gap, USD bn share of GDP, % output (2021), % Rank by crop output
United States 87.3 3 1.0 6.9 3
China 61.6 7 6.3 38.1 1
Brazil 31.7 3 5.5 3.1 4
India 11.5 31 10.4 10.5 2
Indonesia 0.6 1 6.4 2.6 5
Source: FAO, World Bank, Swiss Re Institute
Divergence in crop insurance resilience in emerging Asia

China and India together contribute 49% China and India are the two largest agricultural economies and most populous
of global crop production and are highly countries in the world, accounting for almost 49% of global crop production (38% in
dependent on the primary sector. China and 11% in India).18 In terms of labour force, 25% of China’s population work in
agriculture. In India, the share is 42%.19 With such high dependency on the sector and
importance of food security for the country, a stable and robust crop insurance system
is imperative, to make both individual farming households and businesses, and the
national economy more resilient.
India’s current subsidised crop insurance In India, the government launched the crop insurance scheme “Pradhan Mantri Fasal
programme was launched in 2016. Bima Yojana (PMFBY)” in 2016. The aim was to provide farmers across the country
with a simplified and affordable risk protection solution through a minimum premium
structure and early settlement of crop insurance claims.20 To make it affordable for the
farmers, premium rates are extremely low depending on crop (2% for Kharif crops,
1.5% for Rabi crops and 5% for commercial crops).21 The balance of the outstanding
actuarial premiums is borne by central and state governments in 50:50 proportions.
Some recent amendments to the scheme in However, it is believed that some recent amendments to the scheme have made
India have resulted in lower coverage. PMFBY less attractive for states to implement and for farmers to purchase.22 Firstly, the
central government subsidy on premium rates has been capped at 30% for non-
irrigated crops and 25% for irrigated crops.23 In cases where premium rates are higher,
the burden is to be borne by state governments. Second, the states have been given
flexibility to implement the scheme. As a result, the governments of some of the major
agriculture-producing states have opted out, resulting in low coverage area (only
around 30% of the crop area is insured in the states that implemented the scheme).24
Third, many surveys show that most farmers are not well-informed about the scheme.25
Due to lack of awareness, and because the scheme is non-mandatory for farmers, sums
insured fell by nearly 3% on average each year between 2016 and 2022.26 This reflects
in the decline of India’s crop I-RI to 11.5% in 2022 from 17% in 2016.
18 Calculations based on data from FAO.

19 World Development Indicators, World Bank.
20 Report on Crop feasibility study to recommend appropriate mechanisms for providing farmers with rational
compensation on occurrence of crop losses and identifying vulnerable districts for risk coverage under
Pradhan Mantri Fasal Bima Yojna (PMFBY), Ministry of Agriculture & Farmers Welfare, Government of India,
September 2022.
21 Kharif crops are sown in the rainy season, i.e., April-May; Rabi crops are sown at the end of monsoon or start
of winter, i.e., September-October.

22 Farmers opt out of PM Fasal Bima Yojana; these 2 reasons likely made centre’s crop insurance less
attractive, Financial Express, 11 August 2020. Crop Cover: Centre looks for new ways as states opt out of
PMFBY, Financial Express, 17 August 2021.
23 Cabinet approves Revamping of “Pradhan Mantri Fasal Bima Yojana (PMFBY)” and “Restructured Weather
Based Crop Insurance Scheme (RWBCIS)” to address the existing challenges in implementation of Crop
Insurance Schemes, Government of India (PIB Delhi), 19 February 2020.
24 States opting out from Pradhan Mantri Fasal Bima Yojana, Ministry of Agriculture, Government of India, 14
March 2023.
25 Farmers still unaware of details of PMFBY: Survey, The Economic Times, 20 August 2018.
26 Computations based on data from Ministry of Agriculture, Government of India.

China is making significant efforts to China has sought to improve agricultural stability and food security for many years.
enhance agriculture risk protection. After the launch of a policy agriculture insurance programme in 2007, the government
has set milestones to cover farmers’ losses on their main crops: rice, wheat, maize, etc,
in important crop-producing provinces, using insurance. Since 2022, the Ministry of
Finance, relevant departments and local governments have issued a number of policies
to expand the full cost of insurance and income insurance coverage of the three major
grain crops, as well as sugar cane and soybean. These joint efforts led to fast progress.
In our crop I-RI, China’s index rose to 62% in 2022 from 34% in 2016, with the rise of
agricultural premiums to almost USD 19 billion in 2022 from approximately USD 6.3
billion in 2016 the key driver.
China government’s promotion, subsidies China also faces some of the challenges described for India, such as low awareness
and unified data platform contributed to among farmers and data constraints, that can limit insurance coverage. Despite these
improved insurance coverage. difficulties, the following arrangements have driven progress. Firstly, promotion of
agriculture insurance by regulators and stakeholders including insurers and producers
of crop, raises farmers’ risk awareness and the willingness to purchase coverage.
Secondly, the heavy fiscal subsidies from central and local governments (~80% of
premiums are subsidised) allow the insurers to keep expanding their coverage with
affordable prices, further raising farmers’ willingness to purchase agriculture risk
protection. In addition, China is establishing a unified data platform specifically for
agriculture insurance, to address data issues in underwriting and claims.
Natural catastrophe resilience: still under-protected

Large-scale natural catastrophes can result Floods, earthquakes and severe storms are major threats to societal and economic
in significant economic and financial strains development, households and businesses. In addition to loss of life and bodily injury,
for households and businesses alike. natural catastrophes can inflict damage to property, resulting in potentially significant
financial losses on both macro and micro levels. By providing compensation for those
losses, insurance can enable faster reconstruction and recovery. In addition, insurance
contributes to the understanding and impact of the natural hazards through disaster risk
assessment.27 We calculate the natural catastrophe I-RI as the ratio between protection
available from the private insurance sector and protection needed, based on modelled
annual expected natural catastrophe losses. In other words, it measures the aggregate
amount of insurance against major natural hazards in a country or region.28
The natural catastrophe protection gap The natural catastrophe protection gap is the difference between protection available
reflects expected losses rather than past and protection needs. We measure protection available as the amount of annual written
actual losses. insurance premiums to cover for natural catastrophe risks, based on the annual expected
insured losses. Similarly, we measure protection needs as the amount of annual
premiums that would be needed to cover for all natural catastrophe risks, based on
annual expected economic losses. Both the expected economic losses and expected
insured losses are based on our modelled estimate of the risk of natural catastrophes in
each country in a given year. Modelled losses must not be mistaken for the actual
economic and insured losses as reported in SRI’s annual sigma study,29 which are based
on actual events, whereas modelled numbers are based on exposures. The protection
gap in premium equivalent terms is higher than that based on loss estimates alone, since
premiums also cover insurers’ costs, reserving and other requirements.
This year we also include modelled This year we also include modelled exposure to severe convective storms (SCS). These
exposure to severe convective storms. represent globally the peril with the biggest loss potential, followed by tropical cyclones.
They occur to different degrees of frequency and severity in many countries, but it is in
the US that they typically cause the most damage. In the US and Canada, the wide
geographic extent and high number of SCS has created a steadily increasing insurance
loss trend. SCS risk is also high in Australia and is rising in Europe.
27 UNDRR, Financing prevention and de-risking investment”, 2021 download (undrr.org)

28 See Appendix for detailed methodology.
29 sigma 1/2023, Natural catastrophes and inflation in 2022: a perfect storm, Swiss Re Institute, 22 March 2023.
24% of global catastrophe exposures are insurance protected

Natural catastrophe resilience remains low, Global resilience against disaster events is still low, with approximately 76% of global
with 76% of global exposures unprotected. exposures not protected by insurance. The global natural catastrophe protection gap
stood at USD 368 billion in premium equivalent in 2022. Our re-assessment of exposure
estimates, taking into account economic growth and migration of people to areas more
exposed to natural hazards, combined with updated views of the natural hazard risks
themselves, drove up expected losses and the resulting protection gap. High inflation
has also upped exposure values and associated claims in the past two years.
Table 5
SRI Natural Catastrophe Insurance Resilience Index and protection gaps

Global natural catastrophe I-RI 23.5 23.5 24.3  248 340 368 
North America 37.5 37.4 38.0  66 105 120 
Latin America 18.0 7.6 7.8  24 23 27 
Advanced EMEA 39.1 44.4 45.0  19 21 24 
Emerging EMEA 6.5 5.9 5.9  36 42 48 
Advanced Asia Pacific 21.7 24.5 26.3  50 46 40 
Emerging Asia Pacific 3.9 4.6 4.6  52 102 109 
Advanced markets 32.7 35.5 36.9  135 173 184 
Emerging markets 8.1 5.4 5.4  112 167 184 
 narrowed. Source: Swiss Re Institute
Natural catastrophe resilience globally has The Global I-RI for natural catastrophes has improved from 23.5% in 2012 to 24.3% in
improved over the last 10 years. 2022, with a strong rise in advanced markets partially offset by a reduction in emerging
markets. Since 2012, the I-RI for advanced markets increased from around 33% to above
37% in 2022. The emerging markets index dropped from 8.1% in 2012 to 5.4%, but this
primarily reflects the rapidly growing index weight of China, which has low, though still
rising, resilience. Lower Latin America resilience is likely to be attributable to a very low
frequency of events during the period.
The natural catastrophe protection gap is The protection gap of emerging markets in total is now the same as that of the aggregate
now about the same for the advanced and advanced markets. In the emerging Asia Pacific region, the gap has doubled since 2012,
the emerging regions in aggregate. as countries are heavily exposed to events such as tropical cyclones, floods and seismic
hazards (earthquake and tsunami). They are also undergoing rapid economic growth and
urbanisation, leading to accumulating asset exposure to natural catastrophes. Still,
resilience improved, albeit marginally, to 4.6%.
There are significant differences in By country, the populations of Denmark, Norway and France were most protected
resilience across countries. against natural catastrophe risks in 2022. By region, resilience is highest in advanced
EMEA, followed by advanced Asia Pacific and North America, reflecting the existence of
robust private insurance and/or national disaster protection sectors, which help
businesses and homeowners to manage the financial fallout from natural catastrophes.
In these regions the index was slightly higher last year than in 2021. This was primarily
due to a higher frequency of storms, which are typically highly insured, relative to other
perils. Though the I-RI for advanced Asia Pacific improved to 26.3% from 21.7%, about
74% of potential natural catastrophe losses in the region are uninsured.
Table 6
SRI Natural Catastrophe Resilience Index: scores, rankings and protection gaps by country
Natural Catastrophe I-RI Protection gap, USD bn Natural Catastrophe I-RI Protection gap, USD bn
Index (%) Rank Index (%) Rank
Denmark 80 1 0.1 Turkey 30 21 1.1
Norway 77 2 0.0 Chile 29 22 2.1
France 75 3 1.2 Japan 24 23 30.0
United Kingdom 73 4 0.9 Portugal 20 24 1.6
Australia 70 5 1.4 Colombia 19 25 0.7
Luxembourg 69 6 0.0 South Africa 18 26 0.5
Sweden 64 7 0.0 Mexico 16 27 3.9
Ireland 62 8 0.0 Ecuador 15 28 0.5
Hong Kong 60 9 0.0 Italy 16 29 7.2
Switzerland 60 10 1.1 Taiwan 12 30 7.9
Belgium 57 11 0.7 Thailand 12 31 0.0
New Zealand 53 12 0.4 Brazil 10 32 0.8
Israel 52 13 0.5 Peru 10 33 0.8
Czech Republic 50 14 0.1 Uruguay 10 34 0.3
Poland 50 15 0.3 India 7 35 8.0
Germany 46 16 4.4 Philippines 7 36 17.7
Canada 45 17 2.2 Indonesia 6 37 5.1
Austria 44 18 1.3 China 5 38 58.1
United States 38 19 118.1 Greece 5 39 1.0
Netherlands 35 20 1.3
Resilience index score (%)

<25 25–50 50–75 >75
Healthcare resilience: emerging markets gaining

Our health resilience indices quantify Health shocks can be a painful reminder that access to quality healthcare is not a given.
the financial capacity of a household to For those without adequate coverage, and limited financial and physical access to care,
withstand stressful OOP spending on the cost of hospitalisation and treatments can be substantial and can stress individual
health. finances. To assess this risk, we define the health protection gap as the share of
individual out-of-pocket (OOP) expenditure on health that may cause stress to the
financial position of a household (see Appendix for methodology). Health protection
gaps are measured in US dollars for comparison purposes, and in premium equivalent
terms for the current level and availability of healthcare service usage. Our health I-RI
represents the private protection available as a share of the total private protection
needed, with health protection gap as the missing coverage.30 A rising health I-RI can be
interpreted as a net health resilience improvement.
The world is more health resilient today The world is more health resilient today, with emerging Asia as the driving force for
despite widening protection gaps, with progress. Our global health I-RI stood at 78.3% in 2022, implying untapped global
greatest gains in emerging Asia. coverage of c.22% to be met by additional health insurance. In premium equivalent, this
represents a USD 889 billion market potential, the global health protection gap. This gap
grew 3.2% in 2022 (see Table 7).31 Since 2012, emerging markets have contributed
82% to the protection gap widening, against 18% for advanced markets. The gap more
than doubled in emerging Asia to USD 412 billion, or 46% of the global total.
Large protection gaps hide mixed resilience In emerging markets, and particularly in Asia, the large resilience gains came as living
improvements, driven by economic and health standards, and thus protection available, rose faster than their protection
development and pandemic exit policies.
30 Protection available includes, for instance, the prevalence of an established social security and public health
system relying on a network of hospitals and care centre accessible to all.
31 In real terms, the health protection gap narrowed 4.5% in 2022 amidst elevated inflation. This compares to a
20-year average 4.8% real growth.
gaps.32 In advanced markets, where the protection available is initially more elevated,
health resilience decreased in 2022 amidst the cost-of-living crisis weighing on
household expenses, winding-down of public health programs, and resumption of health
treatments post-pandemic. Over the longer term, resilience improvements in the US are
offset by stagnation in advanced Asia-Pacific and Europe, where public sectors play a
bigger role in healthcare provision.
Table 7
SRI Health Insurance Resilience Index and protection gaps, by region

Global health I-RI 76.2 77.5 78.3  686.8 860.6 888.5 
Advanced markets 86.1 89.1 88.8  316.8 320.5 353.7 
North America 92.2 94.7 94.6  120.2 113.8 124.6 
Western Europe 79.5 79.9 79.0  105.0 117.8 126.5 
Advanced Asia-Pacific 58.5 61.3 58.4  88.5 85.7 99.0 
Emerging markets 46.9 45.7 46.0  370.1 540.1 534.8 
Emerging EMEA 56.6 54.3 53.8  75.3 74.1 75.7 
Latin America 58.4 74.1 74.0  90.8 46.9 47.2 
Emerging Asia 29.8 33.4 35.4  203.9 419.1 411.9 
Note: Health I-RI methodology is updated to reflect the level of protection needed and available provisioned by the private sector. Current and historical estimates were
also updated with new incoming data.
Icons for resilience index changes:  improved;  almost unchanged;  deteriorated. Icons for protection gap changes:  widened;  almost unchanged; 
narrowed. Source: Swiss Re Institute
Macro-structural and policy factors impact The factors contributing to health resilience include the reach and effectiveness of total
the health protection needed, that available health spending, driven by health policy choices, health shocks and the available
and the protection gap. healthcare infrastructure in place. Demographics, inflation and technology also drive
healthcare costs and thus protection gaps expressed in nominal terms.
Ageing and medical technology advances contribute to higher protection needs

Ageing societies and medical technology Ageing demographics and medical technology are structural drivers of higher healthcare
drive structural changes in health costs... costs. With older demographics come a rising utilisation of healthcare resources and
treatments tend to become more expensive. In our sample, the average median age of
the population rose by close to six years over the past two decades. Medical technology
is also advancing, for example in cancer diagnostics.33 In some cases, research finds that
the diffusion of new healthcare technologies in the US has also fueled healthcare
spending, with high-cost, often limited-effectiveness, treatments driving the
momentum.34
…and widen protection gaps. Altogether, these factors drive structural changes in healthcare costs, protection needed
and available, and eventually protection gaps. We estimate that global healthcare costs
grow by a structural 6.4% per year (2.1% in real terms), proxied by the 20-year growth
average of total health expenditures, including both public and private spending on health.
This compares to a 20-year average growth rate of 6.6% for the health protection gap
(2.2% in real terms) and of 5% for the protection available (0.8% in real terms). Exchange
rate swings also influence (nominal) US dollar protection gaps (see Appendix for details).
32 The growing weight of China, where resilience gains were strong but below the emerging markets total,
statistically slowed aggregate gains. Health resilience declined in EMEA but increased in Latin America.
33 The future of life expectancy: forecasting long-term mortality improvement trends for insurance, Swiss Re
Institute, 22 March 2023.

34 A. Chandra et. al, “Technology Growth and Expenditure Growth in Health Care”, NBER, April 2011. New
Technologies and Costs in Healthcare, Oxford Research Encyclopedia of Economics and Finance.
Health policy: boosts and pain-points for resilience

Public policy stances on health can improve Policy choices, from legislation to strengthen the health sector to unplanned expenditure
resilience when effectively designed and during the pandemic, strongly influence health resilience. The impact hinges on whether
targeted. the policy is effectively designed and targeted. We find that as public health expenditure
grows, the burden of individual healthcare spend tends to be structurally lower and
narrow the health protection gap. This effect is stronger at constant rate of health
services utilisation and when health spending is effectively targeted.
Global health expenditure rose in 2020 as In 2020, we estimate that global public and compulsory health expenditure rose by
health systems responded to the crisis. 10.1%, above the pre-pandemic 10-year average of 7.2%, as public health systems
responded to the COVID-19 crisis. Simultaneously, OOP expenses fell by 1.6%, below the
pre-pandemic average of 3.8%, reflecting delays to any non-COVID-19 related treatment
during the crisis. This mechanically boosted resilience by 10bps and the health
protection gap narrowed by 2% (see Figure 10), but the effect has reversed as delayed
health treatment has resumed.
Figure 10
Healthcare expenses and health protection 25%
gap (% growth)
20%
15%
10%
5%
0%
–5%
–10%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Out-of-pocket Out-of-pocket (pre-pandemic average) Public & compulsory

Public & compulsory (pre-pandemic average) Health protection gap
Note: weighted averages across data sample covering 160 countries. Weights are USD-denominated GDP.
Government expenses on health in this chart include compulsory contributory insurance schemes. The jump
in 2014 is driven by a USD 1 trillion expense in the US when Obamacare was enacted.
Source: Swiss Re Institute, WHO data
As Medicaid eligibility redeterminations In the US, the scope of public and compulsory healthcare expenses was widened with the
were suspended in the US during enactment of the Affordable Care Act (“Obamacare”). In 2014, public policy-driven health
COVID-19, health resilience improved. expenditures (including compulsory contributory insurance schemes) grew 76% (above
the long-term trend of 7%), while OOP expenses grew 2.2%, below the long-term trend. In
2015, the health protection gap contracted 8% for instance. A more recent example relates
to the pandemic years. Medicaid eligibility re-determinations were suspended in 2020 as
the COVID-19 public health emergency was declared. This policy broadened government-
sponsored healthcare coverage targeting vulnerable groups and remained in place
throughout 2022. In its first year, we estimate that the health protection gap narrowed 5%
to USD 109 billion as public-policy driven expenditures on health grew 13% and individual
OOP expenses declined close to 4%. Medicaid eligibility re-determinations should resume
this year, estimated to leave about 400 000 people without cover.35 We expect this will
increase the US health protection gap from USD 118 bn in 2022.
The evolution of protection available and In emerging markets, where public entities tend to closely govern healthcare provisions
health protection gaps both matter for due to the prevalence of large low-to-middle income groups and less established
resilience. healthcare frameworks, the protection available should be viewed in conjunction with
the health protection gap. This is notably the case in China. Despite improved health
insurance coverage and access to care for its huge population, the gap remains the
35 Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy
Approaches, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and
Human Services, Issue Brief August 2022.
highest globally. It accounted for 63% of the emerging markets gap in 2022, up from
41% in 2012. Meanwhile, the health resilience index improved by 115bps as the
protection available rose faster than the protection need. Healthcare system
development, including the swift take-up of affordable online private medical insurance
and government-endorsed inclusive medical products, played a role.
Mortality resilience: protection gap likely to stay large

Many households are vulnerable to Mortality protection is the core of life insurance. When a primary breadwinner dies,
financial distress in the case of death of a those left behind often face financial hardship. We define the mortality protection gap as
breadwinner. the difference between the resources (or protection) needed to sustain a household’s
living standards (including repayment of debts such as mortgages) in the event of the
death of a breadwinner, and the resources available. The latter include financial assets,
proceeds from life insurance policies and social security benefits. This year we have
refined our estimation of some indicators (eg, income), revised assumptions and
changed some data sources (see Appendix).
The mortality protection gap reached Global mortality resilience deteriorated in 2022 from 2021 and the protection gap
USD 406 billion in premium equivalent widened to an all-time high. This is in line with our expectations, given unfavourable
terms in 2022. economic conditions, in which high inflation has eroded household purchasing power,
surging wages have increased protection needs and volatile financial markets have
depleted household assets. The mortality protection gap rose to USD 406 billion in
premium equivalent terms globally in 2022, up by 1.5% from 2021, and USD 49 billion
more than in 2012. The global mortality I-RI stands at 43.4%, below the 44.3% score in
2012, implying a household asset shortfall of around 57%.
Table 8
SRI Mortality Resilience Index and protection gaps

Global mortality I-RI 44.3 44.3 43.4  357 400 406 
North America 53.4 54.5 54.7  61 67 71 
Latin America 37.4 51.3 50.5  36 23 26 
Advanced EMEA 70.2 65.5 64.1  29 43 40 
Emerging EMEA 31.4 27.8 26.4  114 90 89 
Advanced Asia Pacific 60.0 57.9 58.8  33 34 31 
Emerging Asia Pacific 20.6 25.6 25.4  84 142 149 
Advanced markets 60.5 59.2 58.7  123 145 142 
Emerging markets 29.0 29.7 29.2  234 255 263 
Note: 2022 figures are preliminary results. For EMEA region, our estimates in this report are not directly comparable to our previous research, due to modelling revision
and data changes. To extrapolate our estimates for the Middle East, Africa and Central Asia as part of the EMEA region, we run a regression model.
 narrowed. Source: Swiss Re Institute
Mortality resilience has flattened or Mortality resilience has flattened or declined in some advanced EMEA and APAC
declined in advanced markets over the last economies as household debt has grown rapidly. For example, since 2012, household
decade. debt as a percentage of GDP has increased in Korea by more than 28ppts to 106%, and
in France by 11ppts to 67%.36 Stagnant or declining social security benefits in advanced
EMEA also contributed to higher protection gaps. In North America, mortality resilience
has barely changed as income replacement needs have grown as fast as life insurance
coverage. In the US, with a protection gap of USD 70 billion in 2022, the prolonged
period of low interest rates penalised life insurers’ investment portfolios and made
products less attractive, leading to industry consolidation with major life insurers exiting
the market. As a result, life sector growth was slow and fewer American adults have life
insurance today (52% versus 63% in 2011).37
The life insurance industry has helped to Standing at 29% in 2022, emerging markets mortality resilience was about half that of
improve mortality resilience in emerging advanced markets, with a USD 263 billion protection gap, 65% of the global total in
markets since 2012. premium equivalent terms. In emerging APAC, mortality protection gap has widened in
absolute terms since 2012, mainly due to greater economic development and income
replacement needs. China represented 55% of that (USD 82 billion). In relative terms i.e.,
the mortality resilience index, has improved in emerging APAC as the life insurance
industry has made good progress in narrowing the gap in many countries in the region,
as well as advances in social security systems. In Latin America, with a protection gap of
USD 26 billion, higher growth in life insurance, of about 5% annually on average since
2012, relative to stagnant income need resulted in an increase in the resilience index.
Brazil, for example, the mortality I-RI, estimated at 57% in 2022, has increased by more
than 20 ppt since 2012.
Life insurance makes up the lion’s share of Life insurance plays an important role in providing protection in most countries,
protection available in many countries. particularly those with higher resilience (see Figure 12). In some cases, half or more of
the protection need is covered by insurance (Canada: 53%; France 51%). However, in
other countries the opposite happens. For example, in India, where the life insurance
market is still underdeveloped, only around 3% of mortality protection need is covered by
insurance. In China, too, the ratio of life insurance to protection need is only 12% due to
its low life penetration rate (2.1%), even relative to other emerging Asian markets
(Malaysia: 3.8%; Thailand: 3.4%).
Figure 11 100%
Ratio of life insurance coverage to 90%
protection need and mortality resilience index,
80%
selected countries
70%
60%
50%
40%
30%
20%
10%
0%
US Canada Germany France Japan Australia China India Brazil
Life insurance coverage Mortality resilience index

36 Data from IMF.

37 Life insurance is profitable again, but too late for many insurers, The Wall Street Journal, 17 April 2023.
Has COVID-19 impacted mortality protection?

The pandemic increased demand for pure The world has gone through a pandemic since we launched our global mortality
life insurance products, but we expect the resilience index in 2019. The economic fallout left millions unemployed, particularly
volume of new policies to plateau as risk during the first months, exposing and increasing households’ financial vulnerabilities.
awareness moderates. The health crisis itself also reinforced the value placed on life insurance (or mortality)
protection. Surveys by Swiss Re show that the pandemic prompted consumers,
including in emerging markets, to consider purchasing new or additional life
insurance.38 While savings products are a major component of overall life premiums,
pandemic-driven rise in risk awareness has translated into an increase in the share of
risk protection-related premiums, i.e. mortality coverage (see Figure 12, left). As risk
awareness moderates post-COVID-19, demand for risk protection products is too. We
expect the volume of new policies to plateau and the share of risk premiums in total life
premiums to stay at around 23% by 2025.
We expect a deterioration in mortality Despite higher life insurance coverage, mortality resilience is worse than pre-pandemic
resilience in the near-term. levels in most regions (Figure 12, right). Unfavourable economic conditions are unlikely
to change in the near term, as we expect global GDP growth to slow significantly this
year (2.1%) and CPI inflation to stay elevated (almost 6% on average). A potential severe
recession or entrenched inflation for the next 12–18 months implies downside risks to
insurance purchases and financial assets and so a likely deterioration in the mortality
resilience index. With government finances stretched in many economies, social
security benefits will likely lag protection needs. The silver lining is that strong job
markets, above-trend wage growth and higher interest rates could lift demand for
savings products, but the net effect may be small.
Figure 12
Left: Global share of risk and savings premiums. Right: Mortality resilience index in 2022 versus 2019
100% 80
90%
70
80%
60
70%
50
60% 77% 77%
81%
50% 40
40%
30
30%
20
20%
10
10% 23% 23%
19%
0% 0
2015 2020 2025F
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38 Swiss Re global COVID-19 consumer survey 2022, Swiss Re Institute, 31 May 2022.
Resilience dividend I: loss prevention

Loss prevention offers a route to structurally boost both insurance and macro resilience. Reducing expected losses is one
side of narrowing insurance protection gaps; it also protects economies’ growth capacity, fiscal resources and brings
additional economic benefits. For example, the net economic benefits of adapting infrastructure, buildings and crops to
reduce natural catastrophe losses before they occur can outweigh the cost between 2:1 and 10:1, and in some cases
even higher. Loss prevention also fosters insurability through risk reduction. The relative resilience dividend of USD 1
invested in loss prevention as a share of GDP is greater in lower income countries, where insurance penetration is also
lower. Yet large investment gaps remain given inadequate finance as well as complexities and limitations to risk-reduction.
Where there are limits to loss prevention, risk transfer comes into play. Insurance, loss prevention and boosting economic
growth are complementary and need to all be strengthened to boost financial resilience.
Loss prevention benefits households, businesses,

governments and economies
Investing in loss prevention is one way to A key route to increase both micro (household) and macro resilience is to prevent or
structurally narrow protection gaps. reduce the size of the loss from a shock event such as crop failure, damage to a home, ill
health, or death of a breadwinner. Narrowing the protection gap for any given peril
involves either increasing the insured portion of losses, or reducing expected losses, or
both. Reducing expected losses by scaling up loss prevention is, however, not costless
and for the most part requires financial resources. For example, investment in
preventative healthcare or better infrastructure can add to health resilience. Investment
in smart agricultural systems, such as switching to drought-tolerant crop types can
alleviate the impact on crop yields of natural hazards (e.g., storms, droughts) or disasters
(e.g., fire, disease). Investment in building codes, zoning, or increasing flood protection
can similarly reduce property damage.
Reducing losses can protect fiscal Efforts to reduce losses can safeguard economies’ growth capacity and fiscal space and
resources and reduces the economic so support macroeconomic resilience. Where households’ risks are underinsured, some
impact of disasters. share of the economic losses ultimately falls to the government. This link is either direct,
through disaster relief programmes, or indirect, via reduced taxes or lower economic
growth, as the tax base suffers from lost income, business interruption, unemployment
or a higher need for welfare support. Risks to public infrastructure are typically
uninsured, so for these, loss prevention efforts also reduce the potential economic and
financial burden on societies and governments. For example, increasing flood protection
can reduce both the fiscal cost of rebuilding damaged assets and the spillover economic
costs from infrastructure disruptions.
Investing in risk-reduction can boost Loss-reducing investments can also generate additional economic benefits that may
incomes and incentivise development that strengthen macroeconomic resilience. These benefits can accrue regardless of whether
can also strengthen macro resilience. risks materialise. First, by improving the productivity of resources and people, loss
reduction actions can boost incomes and trend growth. For example, growing flood-
resistant varieties of rice in Orissa, India, both reduced losses in times of floods, and
boosted farm yields in normal years.39 Second, risk-reducing actions can incentivise
developments otherwise perceived as too risky. For example, the reduction in flood risk
from the Thames Barrier in the UK helped stimulate investments in Canary Wharf,
London City Airport, and wider East London.40 Studies have also found lower-cost, more
extensive insurance coverage linked to lower risk.41
39 M.H. Dar et al., “Transforming Rice Cultivation in Flood Prone Coastal Odisha to Ensure Food and Economic
Security.” Food Security 9(4): 711–722, 2017.
40 E. Penning-Rowsell et al., “A Threatened World City: The Benefits of Protecting London from the Sea.” Natural
Hazards 66: 1383–404, 2013.

41 K. McCormick and S. Marshall, “Returns on Resilience: The Business Case”, Urban Land Institute, 2015.
Resilience dividend I: loss prevention sigma No 2/2023 Swiss Re Institute 29
Investments in solutions can drive Third, by providing solutions, such investments can drive innovation in technologies and
innovation. markets. For example, wearable medical devices translate into cost savings for
households from reduced hospital visits, more timely adjustments to treatment, higher
patient engagement, and booming market opportunities. The global wearables market
was valued at USD 21.3 billion in 2021 and is expected to grow at a 28.1% CAGR
through 2030.42 The additional economic value generated through the various
abovementioned channels, plus possible ancillary social and environmental benefits
from such investments (eg, protecting wellbeing or natural ecosystems), can potentially
exceed the value of avoided losses.43
Emerging markets’ USD 100 billion investment need

We focus on investment in adaptation to We focus on the adaptation investment needed in emerging markets to alleviate natural
reduce risks related to natural hazards. hazard risk related to infrastructure, real estate, and crops. This covers investment for
adaptation to minimise losses due to both existing climate variability and future climate
change, but only considers investment with public benefits. Resilient property and
infrastructure are vital as asset accumulation in hazardous areas is a major driver of
natural disaster-related losses.44 For crops, too, the FAO estimates that in developing
countries the agriculture sector absorbs more than a fifth of the economic impact of
medium- and large-scale natural disasters.45 Over time, climate change is anticipated to
increase the frequency and severity of extreme weather events and so also potential
losses.
Loss prevention ranges from retrofitting Reducing losses principally involves improving existing assets, such as retrofit measures
buildings to behavioural change. on existing residential property, or building new assets in resilient forms, such as
adhering to more stringent building codes. It also includes technological change such as
improved fertilizer use; systemic or behavioural initiatives such as early-warning systems
or awareness campaigns; and disaster relief and emergency response programmes that
limit knock-on economic losses when a disaster occurs.
Adaptation investment needs for Funding sources can be public or private. We estimate that emerging markets globally
infrastructure, real estate and crops may require total investment of about USD 100 billion (our estimated range is USD 89–118
amount to about USD 100bn per year. billion) per year this decade into resilient infrastructure, real estate, and agriculture to
adapt to natural catastrophes (see Table 9). This is about a third of what we estimate is
needed for emerging markets’ total adaptation investment across all sectors of the
economy. We derive these estimates from the UNFCCC’s bottom-up estimate of
adaptation finance needs in 76 developing countries, as reported in countries’ National
Determined Contributions to the Paris Agreement and National Adaptation Plans. We
extrapolate to all emerging economies using per-capita costs and population levels, and
draw on sectoral breakdowns in previous studies.46 These estimates however remain
indicative as costs vary depending on the framing and objectives set, and the methods
and assumptions used. Adaptation needs are also specific to the location and nature of
risks (hazard, vulnerability, exposure), and are influenced by socioeconomic trends and
the uncertain path of global warming.47
42 Wearable Medical Device Market Size Report, 2030 (grandviewresearch.com)

43 The Triple Dividend of Building Climate Resilience: Taking Stock, Moving Forward, World Resources Institute
(WRI), 2022.
44 sigma 1/2023 Natural catastrophes and inflation in 2022: a perfect storm, op. cit.
45 The impact of natural hazards and disasters on agriculture and food security and nutrition: A call for action to
build resilient livelihoods, Food and Agriculture Organization of the United Nations (FAO), May 2015.
46 Developing Countries Adaptation Finance Needs: Insights from Domestic Adaptation Plans, United Nations
Framework Convention on Climate Change Adaptation Committee (UNFCCC), 2022; Too Little, Too Slow:
Climate adaptation failure puts world at risk, United Nations Environment Programme (UNEP) Adaptation
Gap Report, 2022; The Economics of Adaptation to Climate Change Synthesis Report, World Bank, 2010.
47 For existing estimates see The Adaptation Finance Gap Report, UNEP, 2016; UNFCCC, op. cit.; UNEP 2022,
op. cit.; Adapt Now: A Global Call for Leadership on Climate Resilience, Global Commission on Adaptation,
2019.
30 Swiss Re Institute sigma No 2/2023 Resilience dividend I: loss prevention
Table 9
Potential adaptation finance needs in emerging countries for the 2021–2030 period, by region (USD billions)
(1) (2) (3)

Adaptation needs: aggregate Adaptation needs: infrastructure, buildings & agriculture Adaptation spending: aggregate
2021–2030 average 2021–2030 average 2019–2020 average
Latin America 36 11–14 5
EMEA 75 22–30 12
APAC 186 56–74 24
Total 297 89–118 41
Note: Both needs and actual spend only cover investment with public benefits. Amounts are in billions of constant 2020 USD. Totals may not add up due to rounding.
Also, USD 2.7 bn of adaptation finance spending in 2020 was transregional and is not allocated to any region.
Source: Climate Policy Initiative, Swiss Re Institute
Total annual spending on adaptation However, the Climate Policy Initiative estimates that the actual global adaptation
remains too low. spending in emerging economies is only around USD 41bn annually, about seven times
lower than the annual aggregate need we estimate (Table 9, column 3). And of this, only
about 10% has gone into agriculture and infrastructure.48 Almost all adaptation
investment tracked to date has come from the public sector, and more than 60% (USD
28.6bn) has been cross-border financing from developed to developing countries, with
only 2% (USD 1bn) from the private sector.49 But, as with the investment need estimate,
this accounts only for investment in projects with public benefits; spending by
households or businesses to make their own assets or business models more resilient is
not included as private investment data lacks contextual information on whether an
investment has any relevance to adaptation.50 Establishing a fit-for-purpose taxonomy
around climate finance could foster more accurate tracking and scale up financing.
Adaptation investment: benefits and constraints

Investment and adaptation gaps persist Adapting to reduce natural catastrophe losses before they occur is typically in our
despite offering economic benefits. economic self-interest. The amount of investment needed in emerging markets is a
relatively small share (about 0.1%) of global GDP (roughly USD 96 trillion in 2021).
Yet despite this, investment shortfalls and corresponding adaptation gaps persist.
This is partly a function of the complex reality of delivering ambitious transformation.
Each of the three sectors we study faces specific challenges that constrain adaptation
investment. These range from demand- and supply-side constraints (such as risk
perception and knowledge, affordability and adequate financing, bankability and time
scale of projects, or efficiency and diminishing returns), to technical constraints (such
as the feasibility or scalability of loss prevention); institutional, policy and capacity
constraints (including information and “know-how”); and coordination failures (eg, loss
prevention as a common good that individuals cannot solve).
The financial need falls disproportionately The financial need also falls disproportionately on the countries least able to fund it.
on poorer countries. Among the low-income countries in our sample, the median estimate of adaptation
needs is 3.3% of GDP, compared to 0.9% of GDP for upper-middle income countries. The
IMF estimates that in about 50 low-income and developing economies, financial needs
for adaptation exceed 1% of GDP per year, rising to 20% of GDP for small island nations
exposed to tropical cyclones and rising seas.51
Overcoming constraints has the potential to Overcoming the constraints has the potential to deliver benefits that are multiple times
deliver benefits multiple times larger than larger than their costs, in each of the three sectors. Benefit-to-cost ratios (BCRs) for
the costs. adaptation interventions compare the present value of future net economic benefits,
after accounting for the time value of money and inflation, to the upfront cost. Ratios are
typically calculated per project and vary significantly depending on project specifics.
48 Global Landscape of Climate Finance 2021, Climate Policy Initiative, 2021.

49 Ibid., and Aggregate Trends of Climate Finance Provided and Mobilised by Developed Countries in
2013–2020: Insights from Disaggregated Analysis, OECD, 2022
50 Climate Policy Initiative, op. cit.
51 Poor and Vulnerable Countries Need Support to Adapt to Climate Change, IMF, 2022
Resilience dividend I: loss prevention sigma No 2/2023 Swiss Re Institute 31
The range can be very large, ranging from 2:1 to 10:1, and in some cases even higher,52
though it is not a given that the ratio will be greater than one.
Risk reduction investment in infrastructure For infrastructure investment, the primary constraint is on government spending and
faces fiscal constraints but offers a 4:1 BCR. political appetite. Governments at all levels tend to hold the primary role in planning,
building (as sponsor), financing and maintaining infrastructure. As such, investment is
vulnerable to falling tax revenues and debt limitations, together with rising costs. The
Global Commission for Adaptation estimates that making infrastructure more climate-
resilient can add about 3% to the upfront costs but has a benefit-to-cost ratio (BCR) of
about 4:1 overall (see Table 10).53 A BCR of 4:1 is confirmed by other studies. However,
infrastructure adaptation may also face other hard constraints such as unavailability of
technological options (eg, in the case of adaptation to coastal flooding and erosion).54
Table 10
Summary of benefit-to-cost ratios of selected adaptation investments
Sector Intervention Benefit-to-cost ratio Source

Retrofitting utilities and transportation infrastructure 4:1 US National Insitute of Building Sciences
Infrastructure Making new infrastructure more resilient in EMs 4:1 World Bank*
Making new infrastructure resilient 4:1 (2:1 to 10:1) Global Commission on Adaptation
Retrofitting existing private-sector buildings 4:1 US National Insitute of Building Sciences
New build meeting 2018 I-Codes** 11:1 US National Insitute of Building Sciences
Real estate
New build exceeding select 2015 I-Codes*** 4:1 US National Insitute of Building Sciences
New build adopting Florida building codes**** 3:1 Wharton Risk Center*
Improving dryland crop production 5:1 (2:1 to 10:1) Global Commission on Adaptation
Crop Agricultural R&D 2:1 to 17:1 Global Commission on Adaptation
Climate services investments 10:1 World Meterological Organization
Note: * Lifelines: The Resilient Infrastructure Opportunity, World Bank, 2019 and Building Code Economic Performance under Variable Wind Risk, Risk Management and
Decision Processes Center, The Wharton School, University of Pennsylvania, 2018; ** Versus standards from the 1990s. Total against riverine floods, hurricane winds and
earthquakes; *** Total against riverine floods, hurricane winds and surge, earthquakes, and wildland-urban interface fire; **** Against wind damage.
For private real estate, retrofitting is the key The real estate sector’s challenge is to retrofit to new resilience standards the existing
challenge, but the BCR is again 4:1. building stock that predates modern codes. This is typically difficult and costly, in
contrast to developing resilient new property, which is easier and cheaper. That said, the
US National Institute of Building Sciences (NIBS) finds that performing some of the most
common or practical retrofit measures on the existing residential building stock produces
a benefit of USD 4 for every USD 1 invested (a BCR of 4:1).55 In new-build real estate, the
US NIBS estimates that adopting newer, more environmentally stringent building codes
(the 2018 I-Codes, versus standards from the 1990s) could save up to USD 6 against
riverine floods, USD 10 against wind damage and USD 12 against earthquakes in future
for every USD 1 invested today per peril.56 Even against the cost of investing to merely
exceed some provisions in more recent 2015 I-Codes, society still enjoys a BCR of 4:1.
However, there are technical limits to how far adaptation can avert losses to buildings,
depending on the type and severity of peril to which a property is exposed.
Adaptation of dryland crop production Reducing crop losses faces capacity constraints,such as inadequate access to climate
faces capacity constraints in addition to and agro-meteorological information, or unavailability of resilient crop varieties, as well
inadequate finance. The BCR is 5:1. as governance and institutional factors (eg, ineffective agricultural policies).57 The
benefits associated with resilience investments in dryland crop production have been
found to outweigh the additional costs by more than 5:1.58 Investment in agricultural
R&D has demonstrated BCRs from 2:1 to 17:1.59 Climate services investments
52 Global Commission on Adaptation, op. cit.

53 Ibid.
54 Climate Change 2022: Impacts, Adaptation and Vulnerability, Contribution of Working Group II to the Sixth
Assessment Report of the Intergovernmental Panel on Climate Change (IPCC), 2022.

55 Natural Hazard Mitigation Saves, National Institute of Building Sciences (NIBS), 2019.
56 NIBS, op. cit.
57 IPCC, op. cit.
58 Global Commission on Adaptation, op. cit.
59 Ibid.
32 Swiss Re Institute sigma No 2/2023 Resilience dividend I: loss prevention
(such as seasonal forecasts, drought advisories and fire danger indices) can produce a
BCR of 10:1.60 Data analytics can also be used to improve disease surveillance, such as
digital soil maps for farmers to understand local soil health. Similarly to real estate, crop
losses are primarily borne privately by the producers: loss prevention and insurance are
complementary and insurance offers a key support where losses cannot be avoided.
Loss prevention and fostering resilience

High adaptation investment needs and low Emerging markets face a double strain on resilience. Their higher burden of needed
insurance penetration are likely to coexist adaptation investment makes it relatively more costly to attenuate losses. While lower
the lower a country’s income level… income countries on average face lower adaptation finance needs in absolute USD terms
due to lower costs, these finance needs comprise a much larger share of their GDP
(Figure 13, left). At the same time, insurance penetration across countries is positively
correlated with income levels (GDP per capita), so their lower level of income is
associated with lower insurance penetration rates (Figure 13, right). Emerging
economies have consistently higher protection gaps as a share of GDP.
…but the relative resilience dividend of However, this also means that the relative resilience dividend as a share of GDP is greater
every USD 1 spent is greater. in lower income countries. Every USD 1 invested has the potential to yield benefits
comprising a much larger share of GDP than the same USD 1 spent in an upper-middle
income country, and less is needed.
Figure 13
Annual adaptation finance needs (left), and non-life insurance penetration (right) relative to income levels among emerging countries
80 USD 4% 4 % of GDP
60 3% 3
40 2% 2
y = 0.0788x + 0.683
20 1% 1
0 0% 0
Low-income Lower-middle income Upper-middle income 0 5 10 15 20
Per capita (left) Share of GDP (right) GDP per capita (2020 USD, thousands)
Note: The figure on the left shows median adaptation finance needs. In both figures, dollar amounts are in 2020 USD.
Source: UNFCCC, Swiss Re Institute
Loss prevention and risk transfer are Insurance, loss prevention and boosting economic growth need to all be strengthened to
complementary. boost financial resilience. Adaptation does not prevent all losses and damages, even
with effective adaptation and in the absence of constraints. Where there are limits to loss
prevention, risk transfer comes into play. At the same time, loss prevention fosters
insurability through risk reduction. Similarly, loss prevention boosts macro resilience, but
investing in loss prevention requires fiscal resources. Here greater mobilisation of private
capital, for example through resilience bonds, could form part of the solution (An
introduction to resilience bonds). While not explicitly covered in this chapter, investment
to improve health systems and mortality risks is also essential.
60 2019 State of Climate Services: Agriculture and Food Security, World Meteorological Organization, 2019.
sigma No 2/2023 Swiss Re Institute 33
Resilience dividend II: extending risk protection

Beyond the benefits offered at the micro level, risk transfer to insurance markets boosts macroeconomic resilience by
facilitating stronger recovery after a shock event, and through secondary network effects. EIOPA estimates that a large-
scale disaster, causing direct losses of more than 0.1% of GDP, can reduce GDP growth by around 0.5ppts in the quarter of
impact if the share of insured losses is low. Yet where sufficiently insured, events are inconsequential in terms of foregone
output. To reload insurance resilience will require realising the full potential of insurance in risk transfer, with governments,
regulators, insurers and businesses working together to expand the uptake of insurance. For example, innovation in data
and analytics can expand insurance to new and under-served risk pools, from holistic covers that combine multiple risks,
to embedded insurance bundled with a related purchase, or parametric solutions. Public authorities can use tax and
regulatory systems to incentivise greater insurance coverage of their citizens, while microinsurance and new distribution
channels can widen access to coverage, and public-private partnerships can facilitate insurability of hard-to-insure risks.
Insurance supports both micro and macro resilience

Household-level financial resilience from Our analysis of micro insurance resilience focuses on the impact of the major perils with
major perils accumulates to influence potential for catastrophic financial impact on the welfare of households. The relevance of
national economic welfare. these perils for the welfare of a country is so significant that in many countries, state
programmes cover mortality and particularly health risks, at least to some degree. With
respect to natural catastrophe risks, most governments focus on mitigation and
adaptation, while risk transfer is predominantly covered by private (property) insurance
markets. We show in Chapter 2 above that the insurance cover for property cat risks is
the lowest in emerging economies, with only 5% of exposures insured, and therefore
policy efforts to strengthen property insurance warrant particular attention.
Insurance protects assets and income from Insurance protects assets and income from adverse shocks; and encourages long-term
adverse shocks. financial planning and investment in homeownership, small business, education and
health. By providing financial relief when households incur catastrophic expenses, lose
assets or the ability to earn income, insurance can be particularly relevant to protect the
welfare of low-income segments of society and influence inequality. Insurance also
offers economic incentives for loss mitigation behaviour.
Figure 14
The channels through which insurance supports resilience on a household and societal level
Micro/household level Macro/societal level
Supports reconstruction and recovery, and protects Enhances the efficiency of risk management
household income after financial loss Insurance resilience
Stabilises long-term financial planning  Natcat insurance RI Promotes financial stability by providing
(eg, education, retirement)  Crop insurance RI long-term capital
 Mortality insurance RI
Incentivises loss mitigation behaviours  Health insurance RI Complements or substitutes government programmes
Facilitates access to credit Positive network effects for communities

34 Swiss Re Institute sigma No 2/2023 Resilience dividend II: extending risk protection
The benefits of insurance extend to the In addition to these benefits at household level, there are benefits from insurance for the
resilience of an entire economy. resilience of an economy as a whole. The degree of insurance cover is important for the
speed and magnitude of recovery after natural catastrophes, for example. Rebuilding
homes and restoring businesses is dependent on funding. Insurance provides a
permanent transfer of resources into a recovering region, thereby reducing disruption to
economic activity and the financial stress on households and businesses. Without
insurance claims payments, rebuilding would need to be financed through other means
such as loans or divestment of assets. This, in turn, would reduce funds available for
consumption and investment to the effect of curbing GDP growth in the future. Lack of
funding can have a drastic negative impact on the ability to rebuild.
Insurance can also have positive second- An expectation of forthcoming insurance payouts for rebuilding can also have a positive
order network effects on the local second-order impact on economic activity, through network effects. For example, if local
economy. business owners in other sectors reasonably foresee their customers rebuilding and
returning, they may be more willing themselves to invest after a disaster. Such micro-
level decisions add to positive overall macro-level impact.
Our models confirm the positive effect of Prior econometric analysis confirmed the positive effect of insurance on growth and
insurance on recovery through the funding recovery through the funding of rebuild activities. The positive effect is strongest in the
of rebuilding. year of the event and still strong and significant in the following year (dynamic
resilience).61 EIOPA estimates that a large-scale disaster causing over 0.1% of GDP worth
of direct losses can reduce GDP growth by around 0.5ppts in the quarter of impact if the
share of insured losses is low (less than 35%), with the adverse effect on GDP growth
also persisting over the subsequent three quarters.62 These findings are also
complemented by a study by the Bank of International Settlements, which found that
major natural catastrophes have a large and significant negative impact on economic
activity, driven by uninsured losses. Where sufficiently insured, however, events are
inconsequential in terms of foregone output.63 This impact is particularly evident in low-
to middle-income countries, which suffer more when uninsured but recover faster when
insured. Our own analysis supports this finding; the positive growth effect from insured
losses is stronger for emerging than advanced economies.
Private insurance can substitute for Another way insurance contributes to reducing the economic disruption from disasters is
government spending, relieving fiscal by reducing the impact on public finances and lessening the need for private borrowing.
stress. Governments often provide financial assistance to households and businesses without
sufficient insurance coverage, increasing deficits and constraining fiscal spending in
other areas. From our prior data analysis, we conclude that for advanced economies, a
higher level of insurance penetration coincides with lower government expenditures
post disaster. That is, in countries with high insurance penetration, disasters have smaller
real consequences and do not result in deficit expansion. Similarly, advanced economies
with higher insurance coverage have lower levels of debt to the private sector in the year
after an event. Fiscal resources and access to credit are more limited in many emerging
economies, which is why insurance plays a more important role as a shock absorber. 64
Increasing insurance of crop, property, life, and health

To strengthen insurance resilience and address large protection gaps, we see the
following points as crucial:
Innovate in insurance product design to With advanced modelling, insurers can analyse and better understand key risk drivers.
improve efficiency of risk transfer. Product developments and innovation around data and analytics are needed to expand
the scope of insurance to access new and under-served risk pools. For example, holistic
covers, which combine multiple risks and/or interdependent triggers, can facilitate
better alignment to the specific risk transfer needs of an insurance buyer. Embedded
insurance bundles insurance cover with a related purchase (eg, crop insurance and
seed). Parametric solutions are based on indices rather than actual losses and can
especially facilitate crop and property cat insurance. These concepts are useful to
61 sigma 5/2019 - Indexing resilience: a primer for insurance markets and economies, op. cit.
62 “Policy options to reduce the climate insurance protection gap”, EIOPA discussion paper, April 2023.
63 G. von Peter, S. von Dahlen and S. Saxena, “Unmitigated Disasters? New Evidence on the Macroeconomic
Cost of Natural Catastrophes,” Bank for International Settlements Working Paper, No 394, 2012.
64 Emerging economies score lower, on average, for the “fiscal resilience” category in our macroeconomic
resilience index.
Resilience dividend II: extending risk protection sigma No 2/2023 Swiss Re Institute 35
improve the efficiency of risk transfer and to enhance insurability of difficult-to-insure

exposures. It is important that insurance regulation is flexible and accommodates the use
of new data sources for underwriting and modelling, as well as the application of new
insurance products and risk-linked derivatives. Predictive modeling, streamlining and/or
automating underwriting, AI-powered virtual assistants, electronic health records,
lifestyle data and wearables can all play a significant role in making life and health
insurance products more efficient and accessible for new customer groups.
Alternative channels are being activated Alongside new technologies, insurers can consider bringing into use a wide range of
to distribute insurance to under-served other new distribution channels to widen access to coverage. These alternatives to
consumer groups. traditional agency or salesperson-led sales interactions can include utility and remittance
companies, cellphone networks, cooperatives, financial institutions and insurance
aggregators, to reach new consumers who have not bought insurance before. More
digital technologies not only change insurance distribution channels but contribute to a
more seamless insurance value chain experience. After more consumers purchased
insurance online during COVID-19 lockdowns, our 2022 consumer survey found this
increased their openness to buying coverage over digital channels and engaging with
health and wellness apps. Digital touchpoints usage adoption is higher in emerging
markets with younger and more tech-savvy populations.65
Microinsurance can make affordable and Microinsurance can make affordable and efficient insurance products available to
efficient insurance products available to households through unconventional product design, distribution and claims
households. management processes. The use of microinsurance has increased in recent years,
particularly for life, property and agricultural exposures. The Microinsurance Network
reports that up to 223 million people were recorded as covered by microinsurance in the
34 countries covered in 2022. Life microinsurance became the most important product
covering the highest number of people in both Asia and Latin America, including other
mortality products such as credit life and funeral expense covers. In Latin America, life
insurance continued to be the dominant product line, with health microinsurance
reaching a relatively low number of customers.66 For the emerging middle class, we see
elevated financial vulnerability due to inflation. Affordable life and health insurance
covers are even more important now, to prevent households from falling back into
poverty in the event of a mortality or sickness event.
The insurance industry relies upon Governments and regulators set rules that enable insurance markets to expand the
governments and public institutions for availability of risk transfer solutions. A reliable legal structure is key for this. Many
reliable legal and regulatory frameworks. economies mandate insurance coverage for health and workers’ compensation, which
reduces the risk of catastrophic health expenditure. In many perils, especially in crop
where standalone insurance is rarely profitable, public-private partnerships could be
encouraged, either through subsidies or other support from public entities. The crop
resilience gains outlined above can partially be attributed to the rising role of public
insurance schemes and subsidies. Many governments also offer tax benefits to promote
life and health insurance. Meanwhile, property insurance premiums are taxed in many
countries instead of promoting natural catastrophe insurance through the tax code.
Complementary to insurance, governments could promote risk mitigation, for example
by providing tax relief for retrofitting of buildings against seismic risk.
Public-private partnerships can facilitate Public-private partnerships can facilitate insurability of hard-to-insure risks. These types
insurability of hard-to-insure risks. of partnerships work both ways: on the one hand, there is a need for government
backstops as insurer of last resort for risks that exceed the capacity for insurability in the
private markets. This could be cyber catastrophe risks from large coordinated attacks,
future pandemics, or solutions for affordable natural catastrophe insurance in peak risk
zones. On the other hand, there is a need for insurance of public (infrastructure) assets
for countries or public entities under fiscal stress, where risk transfer through the global
re/insurance market comes at a lower cost of capital. There is also a strong case for
transforming international disaster assistance from post-event grants to ex ante solutions
via insurance or cat bonds.
65 Swiss Re global COVID-19 consumer survey 20222, Swiss Re Institute, 1 June 2022.
66 The Landscape of Microinsurance 2022, Micro Insurance Network, 2022.
Appendix: Index methodologies

SRI Composite Insurance Resilience Index and protection gap
The SRI Composite I-RI is a weighted The SRI Composite I-RI aggregates the four I-RI for crop, natural catastrophe, health and
average of I-RIs of the four perils. mortality for any country or region. It is a weighted average of the I-RIs of the four perils
with the average respective protection gaps used as weights. In the years prior to 2016,
for which crop I-RI is not available, the 2016–2022 numbers are back-casted assuming
that it evolved proportionally to the average of the other three indices.
The composite protection gap sums the Similarly, the composite protection gap is the aggregation of protection gaps for the four
protection gaps for the four perils, in perils, in premium equivalent terms. To create this we sum the protection gaps of all four
premium equivalent terms. perils from 2016 till 2022. For years prior to 2016, the composite protection gap is the
summation of protection gaps of the three perils, excluding crop, because the numbers
are only available from 2016.
SRI Crop Insurance Resilience Index (new)

The crop insurance protection gap is the We calculate the crop insurance protection gap as the difference between the insurable
difference between protection needed and market value of the gross crop production (the “protection needed”) and maximal losses
available. covered by the crop insurance, that is sums insured (the “protection available”). Although
the agroinsurance market structures vary widely across markets, sums insured include
both private and public covers, as long as premiums are collected and protection
allocated through insurers.
Insurable production value and insurance In this model, a higher production value could increase the gap because farmers would
penetration are among the main moving face increased potential risks. This would be caused by higher input costs, rather than
pieces of the model. higher value added, as this is not insurable. Lower penetration of insurance among
farmers, and lower insurance coverage limits or indemnity levels, all mean that sums
insured are lower and possibly inadequate and thus increase the gap. Losses impacting
other assets of farmers, such as buildings, would fall under property natural catastrophe
policies and are therefore excluded from this index.
The gap shows how much of crop From the point of view of farmers, the gap therefore indicates how much of the overall
production may not be recovered from insurable gross market value of the production would not be recovered from insurance
insurance. following an event.67 Perils may include natural hazards which also impact property, but
the availability of insurance for property is covered in the natural catastrophe I-RI.
.
Figure 15
The building blocks of the Protection needed
SRI Crop Insurance Resilience Index
Insurable gross values Protection available (crops sum insured)
of crop production
Moving averages are used.
The share of the insurable 1. Premium based (15 markets) Protection gap
production is estimated Premiums written are multiplied
using a 70% rule-of-thumb by exposure rate
Protection needed less
Source: FAO Source: Swiss Re protection available
2. Imputed through claims
and yield shortfall (13 markets)
The yield shortfall is the gap between
a target yield and the actual yield,
with the target proxied by the maximum
yield reached in recent years
Source: FAO, Swiss Re
Note: as two different approaches are combined, there may be inconsistencies in results and what drives them.
In particular, premiums are determined before an event, while claims and yields are known ex-post, so the time
element differs. Limited overlap meant it was not possible to cross-check conclusions.
67 Typically, insurance covers only the input costs of farmers, rather than their profit margin. We apply a 70%
factor to gross crop output value to broadly capture this nuance, based on internal and external experience. In
practice, the share of output that is insurable depends on insurance market structures and the prices of inputs
such as commodities.
Appendix: Index methodologies sigma No 2/2023 Swiss Re Institute 37
Two different approaches are used to Sums insured are estimated by combining two approaches for two different groups of
estimate sums insured, based on the data markets. In some markets, sums insured are obtained by combining agro insurance
availability. premiums written with premium rates. For other countries, we combine claims paid with
crop yield performance. An excess of yield directly implies there was no protection gap,
while a shortfall of yield combined with the attainable yield and claims paid gives an
estimate of sums insured.
The 28 countries in the sample account for The 28 countries in our sample cover around 75% of global crop production. Estimates
75% of global crop production. only measure the resilience available through private and public crop insurance
programmes. Other sources of protection, such as non-insurance disaster assistance
from government programmes or charity organisations are not included, even though
they may be significant in some markets. To afford comparability with other perils,
regional and global protection gaps estimated from the sample are scaled up to an
artificial total using the share of the sample in aggregate crop production. Protection
gaps are shown in so-called premium equivalents, to make them comparable with other
perils and the size of existing insurance markets. These are derived by applying average
premium rates from the insured exposures to the estimated uninsured values.
SRI Natural Catastrophe Insurance Resilience Index (updated)

Our natural catastrophe risk assessment Swiss Re’s proprietary global natural catastrophe risk assessment model generates
model generates expected loss expected loss distributions for the major perils: earthquakes, tropical cyclones,
distributions for the major perils. extratropical cyclones (winter storms in Europe), severe convective storms and floods.
We have re-run the calculations with the latest updated model versions for the existing
list of 34 countries and newly added modeled exposures to severe convective storms for
the 12 countries (out of the existing 34) with the largest exposures. These probabilities,
along with estimated market portfolios of economic and insured values, are used to
estimate the current annual expected economic and insured loss caused by each peril in
a particular country. Based on these simulations, expected losses in 39 selected
countries were calculated, extending the list in this edition from 34.
Data inputs include country output, Data inputs are GDP by country (or GDP by province for countries where provincial data
insurance cover and risk exposures. is used), insurance cover by country and peril, and risk exposure and property
concentration by locality. Insurance take-up rate by country and peril are our best
approximations given knowledge of each country’s insurance markets and regulatory
frameworks. Property concentration and risk exposure by locality are based on data
collected on insured asset portfolios and natural science-based risk factors, which are
proprietary data to Swiss Re.
We use expected loss estimates for more Availability of exposure data is limited, mostly to advanced markets. Hence, we
than 76 countries. supplement the probabilistic model-based losses with expected loss estimates for
another 76 countries from the United Nations Office for Disaster Risk Reduction’s
(UNDDR) Global Assessment Report (GAR), scaled up to current level using econometric
models (refer GAR report 2015).
Regional index values back until year 2000 Regional index values back until year 2000 are derived by back-casting the current loss
are derived by back-casting the current loss estimates for 2022, based on changes in the share of average historic insured vs
estimates for 2022. economic losses for a region, as per Swiss Re Institute’s sigma disaster loss data. We do
this at regional level for better historical data density, to result in good estimates for loss
shares.
38 Swiss Re Institute sigma No 2/2023 Appendix: Index methodologies
Figure 16
Global & regional indices
The building blocks of the SRI Natural
Catastrophe Insurance Resilience Index Additional data and modeling for 2022 estimates
SR nat cat risk models  Probabilistic estimates  Time series for

of expected losses resilience index and
 Earthquake  39 countries and insurance cover protection gaps on
 Tropical with key  GAR data for additional global and regional
cyclone exposure 76 countries level
 Extra-tropical scenarios  Back-casting
 Exposure data from
cyclone of current
 Severe  Exposure data Perils AG (new)
probailistic data
convective from Perils AG  Economic variables
 Use of SRI historic
storm (new) (new for some  Expert opinion and
 Flood perils/countries) data on economic
historic data for and insured losses
insurancetake-up
SRI Health Insurance Resilience Index

Our model is centred on the share of Our health resilience and protection gap computations are based on World Health
population exposed to catastrophic out-of- Organization (WHO) estimates for the share of population exposed to catastrophic out-
pocket healthcare spending. of-pocket healthcare spending for a wide set of countries. We compute the level of
stressful health spending based on the share of the population exposed to catastrophic
out-of-pocket (OOP) healthcare expenditure, and the level of OOP health expenditure.
We consider expenditure on health “catastrophic” for a household when it exceeds 10%
of total household expenditure or income.
We supplement missing data with a multi- We developed a multi-variable econometric model to predict the share of population
variable econometric model. exposed to catastrophic OOP healthcare spending for countries and years when the
original data was missing. The values were then linearly transformed to estimate the
share of OOP healthcare expenses based on findings from Swiss Re’s consumer survey
covering 12 Asian economies.
Figure 17
The building blocks of the health insurance protection gap
Protection gap Protection gap in USD
Share of stressful out-of

Protection needed Total out-of pocket HCE
pocket HCE
Multi-variable economeric
model based on historic SRI survey results on health WHO healthcare data WHO data
Model and data
WHO survey results on risks and insurance Misc macro variables SRI estimates
stressful HCE

Published by:
Swiss Re Management Ltd
Swiss Re Institute
P.O. Box
8022 Zurich
Switzerland
Telephone +41 43 285 2551

Email institute@swissre.com
Authors
Roopali Aggarwal
Dr Chandan Banerjee
Lucia Bevere
Caroline De Souza Rodrigues Cabral
Hendre Garbers
Loïc Lanci
Patrick Saner
Dr Thomas Holzheu
Arnaud Vanolli
Dr Li Xing
Contributors
Ayush Uchil; Xin Dai; Yaxin Chen; Sunnie Wang,
Jessie Guo
Editor
Alison Browning
Managing editor
Dr Jerome Jean Haegeli
Group Chief Economist
Explore and visualise sigma data on natural catastrophes and the world
insurance markets at www.sigma-explorer.com
The editorial deadline for this study was 25 May 2023.
sigma is available on Swiss Re’ s website: www.swissre.com/sigma
The internet version may contain slightly updated information.
Graphic design and production:

Corporate Real Estate & Logistics / Media Production, Zurich
©2023
Swiss Re
All rights reserved.
The entire content of this sigma edition is subject to copyright with all rights reserved. The
information may be used for private or internal purposes, provided that any copyright or other
proprietary notices are not removed. Electronic reuse of the data published in sigma is prohibited.
Reproduction in whole or in part or use for any public purpose is permitted only with the prior
written approval of Swiss Re and if the source reference “sigma 2/2023 - Restoring resilience: the
need to reload shock-absorbing capacity” is indicated. Courtesy copies are appreciated.
Although all the information used in this study was taken from reliable sources, Swiss Re does
not accept any responsibility for the accuracy or comprehensiveness of the information given or
forward looking statements made. The information provided and forward-looking statements made
are for informational purposes only and in no way constitute or should be taken to reflect Swiss
Re’s position, in particular in relation to any ongoing or future dispute. In no event shall Swiss Re
be liable for any loss or damage arising in connection with the use of this information and readers
are cautioned not to place undue reliance on forward-looking statements. Swiss Re undertakes no
obligation to publicly revise or update any forward-looking statements, whether as a result of new
information, future events or otherwise.
Swiss Re Management Ltd.
Swiss Re Institute
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P.O. Box
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Telephone +41 43 285 3095

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No 2 /2023

Structural factors Fiscal resilience Monetary resilience E-RI

Crop NatCat Health Mortality

Protection available Protection gap Protection gap growth (right axis)

Crop Natural catastrophe Health Mortality

Source: Swiss Re Institute

Protection gap (PG=N–A) Protection gap

Protection gap growth GDP growth

Sector Intervention Benefit-to-cost ratio 80 USD 4%

Micro/household level Macro/societal level

Facilitates access to credit Positive network effects for communities

Source: Swiss Re Institute

Macroeconomic resilience: boosted by higher

Monetary resilience: illusions of grandeur

Figure 1 15.0 Policy rate increase (percentage points)

Grey lines indicate rate hikes

Source: University of Michigan, Macrobond, Swiss Re Institute

1990 1995 2000 2005 2010 2015 2020 2025F

Euro Area Germany France Italy Spain Five-year average

Emerging markets show stagnating resilience despite earlier gains

Recovery in the index

Labour market efficiency

Resilience Index Level

Rank 2023 (prediction)

(23 predicted vs 22)

Source: Swiss Re Institute

Fostering resilience-enhancing public policies

underlying fragility. For example, although post-GFC regulatory frameworks strengthened

3. Governments could proactively evaluate their vulnerabilities and invest in resilience,

An introduction to resilience bonds

Insurance resilience: more of the world is better

Gradual gains in resilience, but challenges remain

Protection gaps: new record highs, but real terms decline

Protection gap growth GDP growth

Crop NatCat Health Mortality

Protection available Protection gap Protection gap growth (right axis)

Crop Natural Catastrophe Health Mortality

Source: Swiss Re institute

The SRI Insurance Resilience Index (I-RI) approach

Figure 7 Protection gap

Source: Swiss Re Institute

Crop resilience: substantial progress, but more needed

We estimate a global crop protection gap of about USD 113 billion

Resilience index, % Protection gap, USD bn

15 Enabling the business of agriculture, World Bank, October 2019.

2016 2017 2018 2019 2020 2021 2022

Global Emerging markets Advanced markets

Gross crop output Share of global crop

Source: FAO, World Bank, Swiss Re Institute

Divergence in crop insurance resilience in emerging Asia

18 Calculations based on data from FAO.

of winter, i.e., September-October.

26 Computations based on data from Ministry of Agriculture, Government of India.

Natural catastrophe resilience: still under-protected

27 UNDRR, Financing prevention and de-risking investment”, 2021 download (undrr.org)

24% of global catastrophe exposures are insurance protected

Resilience index, % Protection gap, USD bn

Resilience index score (%)

Source: Swiss Re Institute

Healthcare resilience: emerging markets gaining

Resilience index, % Protection gap, USD bn

Ageing and medical technology advances contribute to higher protection needs

Institute, 22 March 2023.

Health policy: boosts and pain-points for resilience

Source: Swiss Re Institute

Telephone +41 43 285 2551