Insurance, genetics and discrimination

In October 2001, the Association of British Insurers (ABI) put in place a moratorium preventing the use of genetic tests results by insurance companies. The ban was recommended by the House of Commons Science and Technology Committee and the Human Genetics Commission (HGC), and came after a MORI poll revealed that 80 per cent of the public opposed the use of genetic information by the insurance industry. It prevents the use of genetic tests for life insurance worth under £500,000 and other insurance, such as critical illness insurance or income protection, worth under £300,000.

The moratorium is due to expire in November 2006. The interested parties (the ABI, the HGC and the Genetics and Insurance Committee (GAIC)) must come to a decision as to whether a ban should be continued or made law, or whether the insurers should be allowed to use genetic test results. The issue was discussed recently at 'Insurance, Genetics and Fairness II', a joint public meeting  of the HGC and the GAIC, at which research and opinion was submitted as evidence on which to base the decision. Much of the debate is hypothetical given that few genetic tests exist that would give insurers a more accurate risk assessment than existing sources of information.

There may be good practical grounds for allowing insurers to use genetic information: if they are not allowed, insurers claim that 'anti-selection' could cause significant damage to the insurance industry. Take life insurance as an example. Not all of the population buys life insurance and any genetic test that informs an individual of their susceptibility to a genetic disease will affect their decision to buy: those found to have increased susceptibility are more likely to buy and vice versa. As a result, the average susceptibility of the subset of the population that buys insurance will increase leading to a growth in the number of claims. In order to cope with the additional claims, the insurance industry must put up premiums. The higher the premiums, the less insurance is bought by those found not to be susceptible, and so the greater the average susceptibility of the insured population. This vicious circle could continue until the life insurance industry becomes unsustainable and collapses, having unfortunate consequences for those insured and for the investment market, which receives capital from the insurers.

As well as this unlikely scenario, it could be argued that insurers should be allowed to use genetic test information for the sake of consistency. When making a decision on whether to offer insurance what premium to offer, insurers already use information on age, gender, lifestyle, occupation, postcode, weight, height and, most relevantly, family history. By discriminating by family history or gender, insurers are already discriminating on genetic grounds, so why not genetic tests? And is there any difference between genetic and other sorts of information?

It could be argued that is unfair to discriminate on factors that cannot be changed by the individual or are not the individual's fault. Genes fulfil both of these, but then so do other factors: we cannot change our age, nor can we consider when we are born our fault; many environmentally influenced health factors, such as asthma and diabetes, are determined by conditions before the age of 18, when we are not legally responsible. It would be impossible to draw a clear cut line between what we can change and what is our fault, so this is not an appropriate distinction.

If genetic test results are a factor like any other, then any objection to their use by insurers can only be an objection to discrimination of any type. It boils down to whether we believe insurance is a product, like buying a car, or whether it is should be available to all, like health and education. It is an opinion on the extent of the welfare state. That is, unless the use of genetic tests by insurers will have another effect on society. And it does.

It is already the case, despite the moratorium, that people decide not to get a genetic test fearing the effect on insurance premium or their ability to be insured at all. A survey by Swiss Re found that this fear accounted for 10 per cent of the reasons given by those not prepared to have a test. Yet testing can benefit the health of a patient, giving them enough warning to modify any lifestyle factors compounding any genetic variation. If fear of what insurance companies might do is putting people off tests, putting their health at greater risk, this is surely something we want to avoid, whatever opinion we have on the welfare state. One way to achieve this is to make this moratorium a law.

Simon Cox is a freelance science writer, currently based at the University of Nottingham