A new global risk assessment released by the Lancet Commission on 21st Century Global Threats to Health warns that humanity faces a possible extinction by the end of the century if artificial intelligence is weaponised or nuclear war erupts. Those two scenarios sit at the top of a catalogue of seventeen major health threats projected to affect the world over the next 75 years.
Commission members estimated the loss of healthy life years using disability-adjusted life years, a metric that aggregates years lost to illness, disability or premature death. To qualify for the list, a hazard had to both threaten large numbers of healthy years and possess at least one plausible mitigation pathway. Co-chair Professor Christopher Murray, director of the Institute for Health Metrics and Evaluation, reminded that policy choices made today will shape the wellbeing of future generations.
The analysis identified a further set of risks that could each generate more than one billion cumulative DALYs, labeling them as major catastrophic threats. These include pervasive air pollution, the spread of antimicrobial resistance, childhood malnutrition, unchecked climate breakdown, conventional armed conflict, steep declines in overseas aid, high alcohol consumption, elevated blood pressure, widening income inequality, low levels of education, naturally occurring pandemics, obesity, poor mental health, smoking and unhealthy ageing.
The commission modeled scenarios for global temperature rise, finding that limiting warming to roughly 1.8 °C instead of allowing it to climb to 4.4 °C could spare 1.89 billion years of healthy life. This projection underscores the health dividend of aggressive climate action, as each degree avoided translates into billions of DALYs saved across populations worldwide.
In wealthier regions, non-communicable conditions such as obesity and mental-health disorders dominate the projected health loss, whereas in lower-income settings the principal drivers are factors like limited educational attainment. The report highlights that the same threat can manifest differently depending on socioeconomic context, reinforcing the need for tailored interventions that address both disease burden and underlying social determinants.
The assessment warns that recent announcements by major donor nations, including the United States and the United Kingdom, to slash overseas aid could generate up to 1.5 billion DALYs of loss before 2100. Nearly 70 % of that burden would fall on sub-Saharan Africa, a region already bearing the greatest share of child malnutrition. The authors argue that preserving aid flows is essential to avert a massive health crisis.
The 35-expert commission will present its findings at the World Health Summit in Berlin, with plans to refresh the threat list each year as new data emerge. Authors stress that coordinated policy, investment in technological safeguards and reinforced health systems constitute realistic pathways to keep each identified risk from spiralling into a full-scale crisis.