A major international assessment has identified a range of emerging and persistent risks that could reshape global health outcomes, while highlighting why decisions taken today may carry consequences for generations.
A major global health assessment has identified 17 significant threats that could affect humanity over the next 75 years, with experts warning that some low-probability risks carry consequences severe enough to threaten human survival itself.
The findings come from The Lancet Commission on 21st Century Global Threats to Health, whose researchers evaluated dangers ranging from climate change and pandemics to inequality, pollution and conflicts. The report concluded that malicious use of artificial intelligence and nuclear conflict represent the most extreme scenarios because of their potential to cause human extinction before the end of the century.
Researchers examined how each threat could affect global health by estimating future losses in healthy years of life, known as disability-adjusted life years (DALYs). The assessment focused not only on the scale of the risks but also on whether practical solutions exist to address them.
According to the commission, the possibility of AI being used to develop biological weapons and the threat of nuclear war resulting in widespread famine remain relatively unlikely. However, experts argued that both scenarios could have catastrophic consequences. A large-scale nuclear conflict could inject enough particles into the atmosphere to block sunlight and disrupt food production, while AI-enabled biological threats could create unprecedented global health crises.
The commission stressed that many of the identified dangers are interconnected and should not be treated in isolation. Researchers argued that action remains possible across all areas, making prevention and preparedness crucial priorities for governments and international institutions.
Commission co-chair Professor Christopher Murray, who leads the Institute for Health Metrics and Evaluation at the University of Washington, said decisions taken by current leaders will directly influence the wellbeing of future generations.
Climate, inequality and disease remain major long-term risks
Beyond extinction-level threats, the report identified a range of challenges capable of causing more than one billion cumulative DALYs by 2100. These were classified as major catastrophic threats because of their potential impact on global health.
Among them were air pollution, antimicrobial resistance, childhood malnutrition, climate change, conventional warfare, declining international aid, high alcohol consumption, high blood pressure, income inequality, low educational attainment, naturally occurring pandemics, obesity, poor mental health, smoking and unhealthy ageing.
Researchers noted that inclusion on the list required both a substantial health burden and the existence of measures capable of reducing that burden.
Professor Ibrahim Abubakar, a commission member and infectious disease epidemiologist at University College London, said the project was intended to help policymakers understand where interventions could deliver meaningful benefits rather than simply highlighting alarming scenarios.
The report also modelled best- and worst-case outcomes for several threats. According to the analysis, limiting global warming to around 1.8°C instead of allowing temperatures to rise to 4.4°C could prevent approximately 1.89 billion healthy years of life from being lost.
Health risks varied across regions. Wealthier parts of the world were projected to be more heavily affected by non-communicable conditions such as obesity and mental health challenges. In lower-income regions, factors including limited educational attainment were identified as major drivers of health loss.
The commission also highlighted concerns about declining overseas aid. Recent reductions in international assistance by major donor countries could lead to as many as 1.5 billion DALYs before 2100, with nearly 70 per cent of those losses occurring in sub-Saharan Africa. The same region is expected to continue carrying a significant burden from childhood malnutrition.
The assessment was prepared by 35 experts and will be presented at the World Health Summit in Berlin. Researchers plan to update the analysis annually to reflect new evidence and emerging threats.
While the report outlines a broad spectrum of risks, its central message is that prevention remains possible. The authors urged governments to invest in stronger health systems, technological innovation and long-term planning to address threats before they develop into larger crises.
