In presenting a paper on underwriting to this Institute, I realize how difficult it is to say anything new on the subject. There have been excellent papers presented to the Institute since the Second World War, the first by W. Perks, ‘The Treatment of Substandard Lives in Practice’ (J.I.A. 78, 205), and the second by R. D. Clarke, ‘An Investigation into the Mortality of Impaired Lives’ (J.I.A. 87, 196). Moreover, there have been several papers presented to the Faculty of Actuaries. I believe, however, that this is a subject which the actuaries of life offices should discuss periodically. The terms on which risks, both standard and substandard, are admitted to a life fund are clearly of prime importance to the actuary responsible for the management of the fund. Underwriting is fundamental to life assurance and will remain fundamental as long as life assurance is voluntary and underwritten by separate and competing institutions.

Previous investigation

A previous investigation into the mortality of diabetics was made by A. J. Steeds following the analysis of data based upon a large London clinic. The present paper is based on data derived more recently from the experience of the patients attending a large Birmingham clinic.

Diabetes mellitus

2. Diabetes mellitus is a very ancient disease which may be described as a disturbance of the normal insulin mechanism of the body. The pancreas is a gland which secretes insulin for the purpose of converting sugar and starches into the energy forms required by the body (the metabolism of carbohydrates) and disturbance in this metabolism is accompanied by an abnormality in the breakdown of fats. Apart from physical damage to the pancreas the causes of diabetes are various and obscure (although they are thought to include heredity, overweight and, in females, a high level of childbearing). It is generally accepted that diabetes in young lives is a more severe form associated with insulin deficiency, whereas in older lives the disease is of a milder type, but there are many exceptions to this broad division.

Many assurance offices are in the early stages of changing to a computer for the mechanization of their business. Each office has its own problems which frequently arise from its historical record of amalgamations, changes in management policy, etc.

2. Probably the biggest problem for the office is the standardization of its data into a form which can be read by the computer. When this has been accomplished the small-size computer can readily take over practically all the work which has already been mechanized, usually giving a better product in a shorter time and with reduction in manual work. There is also a simplification of diverse mechanical systems into a single medium.

In an earlier paper the author traced the development to 1949 of public service superannuation schemes (other than for the Armed Forces) which are provided wholly or partly out of Exchequer or rate funds, i.e. for the benefit of civil servants, teachers, national health and local government employees, police and firemen. It was shown that those schemes, other than for (principally) police and firemen, tended to follow a common pattern although not all had reached the same stage of development and there were numerous variations of detail.

Population trends in Great Britain have been discussed at the Institute on three occasions since the Second World War. The first occasion was in 1949 following the publication in that year of the Report of the Royal Commission on Population. The second was in 1956 on a two-part paper submitted by Benjamin, Cox and Menzler which dealt not only with the situation in Great Britain but also with the wider—and fundamentally more important—problems of world population and resources. More recently, the changing age distribution of the population of England and Wales was discussed in Benjamin's paper on Ageing.