Global experts warn that today's decisions across health, finance, climate, defense and security sectors will determine how many years of good health future generations gain - or lose - to preventable illness and early death by 2100.
The health of the next generation 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, finds a new Commission published in The Lancet and launched at the World Health Summit 2026 in Berlin. For the first time, it provides decision-makers with a common framework to understand these threats and target action.
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, the authors identified 17 that pose the greatest danger to human health and survival between 2025 and 2100 - and that governments, funders and industry have a realistic route to act on through policy change, funding decisions and innovation.
The Commission identifies two threats as having extinction-potential:
The malicious use of artificial intelligence (AI)
Nuclear 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
Unhealthy ageing
These threats extend far beyond health alone, jeopardizing global prosperity, security and stability. The Commission's forward-looking assessment provides three recommendations for leaders across the health, finance, defense, climate and security sectors and beyond to address these risks 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 is 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 wellbeing of the next generation. But delaying action will only serve to shift and increase the costs into the future.”
Co-Chaired by Dr. 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. Within each country, the health harms will also be distributed unequally, with people in resource-limited settings and marginalized communities bearing the greatest burden, compounded by existing inequalities.
Dr. Murray adds : “ The estimates highlight how much health loss could be avoided in each area. Some are already imposing substantial health burdens today, while others carry a real danger if they materialize. Crucially, all 17 threats are interconnected, which is why they must be addressed together, not in isolation.”
Key findings include:
Dr. Richard Horton, Editor-in-Chief of The Lancet adds: “This Lancet Commission offers a radical conceptual shift in the way 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 coordinated action. The jeopardies that face us are multiple. Our solutions need to match that reality.”
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.
For the first time, the Commission gives decision-makers a common framework to inform action before harm becomes embedded, with a clear three-part agenda:
Without action, each of the 17 catastrophic threats presents significant risks requiring timely attention. Many of the threats are also interconnected and should not be viewed in isolation. The Commission's framework is meant to help decision-makers identify opportunities for collaborative, cross-sectoral action that can build stronger societies that are resilient to global threats.
Commission Co-Chair Dr. Kanem notes : “Recent global events show us just how quickly stability can give way to crisis, and how costly it is to respond only after disaster strikes. And the global threats to health risk amplifying existing inequalities, with the greatest burden falling on the most vulnerable communities. Yet the future is not inevitable. The Commission makes a compelling case for reshaping the future by embedding foresight into decision-making. Governments and communities must act decisively starting today, to protect health and build a fairer, more peaceful and more secure future for the coming generations.”
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.”
Post-embargo link to the report and all related content (live once the embargo lifts at 00.01 on Sunday 11 October): www.thelancet.com/commissions-do/global-threats-to-health
The Lancet
Computational simulation/modeling
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The Lancet Commission on 21st century global threats to health
10-Oct-2026