This paper discusses the macroeconomic and environmental conditions for the spread of insurance in three non-Western world regions (China, Middle East and sub-Sahara Africa). Focusing on the nineteenth and twentieth centuries, it examines the patterns of economic development relevant for the growth of insurance in these regions, and compares these against standard economic models of insurance diffusion. The paper argues that the growth of insurance must be explained by more than a simple linear relationship with the growth of per capita incomes. As well as income levels, other factors affecting insurance development include urbanization, taxation, savings rates, legal compulsion to insure, state provision of social security, state-owned insurance bodies and the presence of large infrastructural projects. The second part of the paper focuses on environmental conditions in these regions that drove insurance growth, including climate and geography, demography, drought and disease, building materials and risk-reduction technologies.