Global experts have warned that today’s decisions involving health, finance, climate, defence and security will determine how many years of good health future generations gain – or lose – to preventable illness and early death by the year 2100.
According to a new report published in The Lancet and launched at the World Health Summit 2026 in Berlin last week, the next generation’s health will be shaped not by one defining crisis, but by a set of 17 interlinked catastrophic threats spanning disease, social and economic conditions, environmental change, technology and conflict
Drawing on historical evidence and new risk analysis covering 204 countries and territories from the Institute for Health Metrics and Evaluation (IHME), authors of The Lancet Commission on 21st Century Global Threats to Health examined hundreds of possible threats. Of those, they identified 17 that pose the greatest danger to human health and survival between 2025 and 2100.
The commission identifies two threats as having extinction-potential:
The malicious use of artificial intelligence (AI); and cuclear conflict
The catastrophic threats to health also include:
* Air pollution;
* Antimicrobial resistance;
* Childhood malnutrition;
* Climate change;
* Conventional conflict;
* Declining development assistance for health;
* High alcohol use;
* High blood pressure;
* Income inequality;
* Low educational attainment;
* Naturally occurring pandemics;
* Obesity;
* Poor mental health;
* Smoking; and
* Unhealthy ageing
These threats extend far beyond health alone, jeopardising global prosperity, security and stability, and the commission’s assessment provides three recommendations for leaders to address before they escalate into crises: build threat-ready health systems, accelerate investment in breakthrough innovation, and strengthen the monitoring of emerging risks to better protect societies and economies.
For each threat, the commission modelled a plausible best-case and worst-case future. The gap between them – measured in amenable disability-adjusted life years (DALYs), or the number of years in good health that are lost due to sickness, disability or premature mortality that could be avoided with targeted action – show decision-makers where investment and innovation can make the greatest difference.
A threat was identified as catastrophic if it met three key criteria: it could account for at least one billion DALYs by 2100, there are sufficient data to model the threat, and where there is sufficient scope for policy action.
Commission co-chair Professor Christopher JL Murray, Director of the Institute for Health Metrics and Evaluation, University of Washington, says: “The striking finding is not only the scale of these threats, but that humanity still has the agency to act. Across all 17 catastrophic threats, the decisions made by leaders today will shape the health and well-being of the next generation. But delaying action will only serve to shift and increase the costs into the future.”
Co-chaired by Murray and Dr Natalia Kanem, former executive director of the United Nations Population Fund (UNFPA), the commission was informed by the expertise of 35 leaders spanning health, economics, security, governance, and technology, offering a globally relevant perspective.
If current trends continue, the 17 catastrophic threats collectively could account for tens of billions of years of lost health. While the scale varies by threat and region, every country faces significant risks. The health harms will also be distributed unequally, with people in resource-limited settings and marginalised communities bearing the greatest burden, compounded by existing inequalities.
“The estimates highlight how much health loss could be avoided in each area,” said Murray. “Some are already imposing substantial health burdens, while others carry a real danger if they materialise. Crucially, all 17 threats are interconnected, which is why they must be addressed together, not in isolation.”
Key findings include:
• While the likelihood of nuclear conflict and the malicious use of AI remain low, they present consequential threats because of their potential for extinction. Accounting for both their potential impact and probability, the Commission’s assessment finds action to prevent nuclear conflict could avert an estimated 133m deaths and 9.35bn DALYs by 2100, while action to reduce the risk of malicious AI could avert an estimated 10.4bn DALYs.
• Climate change is already a catastrophic and urgent threat to health and human survival. The Commission finds that limiting global warming to around 1.8°C (rather than letting it reach 4.4°C) could prevent 1.89bn years of healthy life from being lost to causes like extreme heat and air pollution. The true burden is likely even greater, as this estimate only captures direct harms we can measure today, excluding harder-to-quantify effects such as displacement, drought and mental health impacts. Without sharp cuts to emissions, these losses will continue to compound beyond 2100 and increasingly intensify other threats, such as migration, in ways not yet reflected in these numbers.
• 16.1bn DALYs are amenable to improvements in educational attainment, with women and children in sub-Saharan Africa facing the greatest potential burden of associated health loss. Faster progress on education will substantially improve health outcomes and reduce mortality rates among educated mothers’ children, while indirectly contributing to slower population growth over the longer term.
• Income inequality could impose an amenable health burden equivalent to 25 Covid-19 pandemics by 2100, accounting for an estimated 13.8bn DALYs.
• Obesity is a significant and growing health burden that is forecast to compound over time, contributing to 23.1bn potential DALYs by 2100 that could be avoided through policies to reduce obesity risk.
• Sub-Saharan Africa is forecast to bear around 70% of the amenable health burden linked to a collapse in development assistance for health.
“This latest Lancet Commission offers a radical conceptual shift in how we think about future threats to human survival. It invites us to expand the array of dangers facing humanity, moving from single issues to a broader and more complex landscape of threats, which demands a much more extensive framework for co-ordinated action. The jeopardies that face us are multiple. Our solutions need to match that reality,” said Dr Richard Horton, Editor-in-Chief of The Lancet.
Build, back, track: a global call to action
Proven and emerging solutions for most of the threats to health already exist and are ready to be scaled up and implemented – from medicines and health technologies to proven public policies – while others require targeted investment and innovation to reach their full potential.
The commission gives decision-makers a common framework to inform action before harm becomes embedded, with a clear three-part agenda:
Build readiness – create and fund threat-ready health systems with dedicated teams for foresight, prevention, preparedness and protection across a wide range of risks. These capabilities should be embedded in how health systems are funded and delivered, supported by durable financing rather than ad hoc crisis responses, and designed to reach lower-resource settings and marginalised communities, not just wealthier populations.
Back breakthroughs – increase investment in innovation where existing tools are insufficient including new vaccines, antibiotics, obesity treatments and climate technologies, alongside appropriate governance and equitable access.
Track threats – reassess threats regularly and independently so that evidence keeps pace with emerging and changing risks and reaches decision-makers in finance and security as well as health, including the creation of the Lancet Monitor of 21st Century Global Threats to Health to provide an institutionalised mechanism for tracking emerging risks.
Without action, each of the 17 catastrophic threats presents significant risks requiring timely attention. Many are also interconnected and should not be viewed in isolation
An accompanying Lancet editorial says: “It is important to be clear about what this Commission is and what it is not. The Commission does not present a fixed ranking of threats or policy priorities. On the contrary, the report emphasises that its analysis should be seen as a dynamic process – its findings will probably change as new evidence and data are accrued… We believe this Commission can catalyse international, regional, and national actions to protect and strengthen the future of health and humanity. Doing so will require all of us to think much more broadly about where the biggest threats lie.”
See more from MedicalBrief archives:
Well-being and health of world’s teens in peril – Lancet global experts
Influenza pandemic one of 10 global threats in WHO’s 5-year plan
Poor diet a factor in 20% of deaths — Global Burden of Disease study
Drastic action urged as child obesity set to soar to 220m by 2040