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The first quarter of the 21st century has already brought two pandemics, repeated outbreaks of infectious diseases, worsening climate change, rising antimicrobial resistance and the rapid expansion of artificial intelligence in medicine and other fields. Obesity has also emerged as a major global health challenge.

These developments raise an urgent question: what threats could shape the health of the world’s population over the next 75 years?

A new study published in the medical journal The Lancet identifies 17 potentially devastating threats to global health by 2100. The findings were presented at the 2026 World Health Summit in Berlin, held October 11-13, and are intended not simply to outline possible dangers but to identify areas where action could change the future.

The study was conducted by the Lancet Commission on 21st Century Global Threats to Health, a panel of 35 prominent figures from different fields, including academics and policymakers. Among them was Mario Monti, the former Italian prime minister and economist.

The commission relied primarily on data from the Institute for Health Metrics and Evaluation (IHME), based at the University of Washington School of Medicine in Seattle. The institute conducts the Global Burden of Disease study, which assesses diseases and their impact on health worldwide.

How researchers measured the threats

The commission began by examining hundreds of potential threats identified in the IHME database and scientific literature, before applying a rigorous screening process to select the 17 considered most consequential.

Christopher J.L Murray, co-chair of the commission, professor at the University of Washington and director of the IHME, explained the criteria in an interview with To BHMA-Science. The other co-chair is Natalia Kanem, former executive director of the United Nations Population Fund (UNFPA). Richard Horton, editor-in-chief of The Lancet, also played a significant role in coordinating the study.

The researchers measured the potential health impact using disability-adjusted life years, or DALYs. This metric represents healthy years of life lost because of premature death or because a person lives with illness or disability. One DALY is equivalent to one lost year of healthy life.

According to Murray, a threat qualified for inclusion among the major risks if it was projected to cost the global population at least 1 billion healthy years by 2100. To illustrate the scale, the researchers equated 1 billion DALYs to the healthy life lost during two COVID-19 pandemics. Some additional threats were included because they could directly endanger the survival of humanity.

Two threats could endanger humanity’s survival

The commission identified two threats with the potential to cause the extinction of the human species.

The first is the malicious use of artificial intelligence, which could result in the loss of up to 10.4 billion healthy life years. This category includes risks associated with the possible development of biological weapons.

The second is a potential nuclear war, which could cost up to 9.35 billion healthy life years. The consequences would include the immediate loss of life as well as famine in the aftermath of such a conflict.

The other 15 threats span health conditions, environmental pressures and socioeconomic factors. Although their projected effects are substantial, the commission emphasizes that they can be prevented or mitigated through effective action.

Obesity tops the list of preventable health threats

Among diseases and health-related behaviors, obesity is projected to have the greatest impact, costing an estimated 23.1 billion healthy life years by 2100.

The other threats in this category are:

  • Poor mental health: 9.35 billion DALYs.
  • Unhealthy aging: 8.26 billion DALYs.
  • Smoking: 7.06 billion DALYs.
  • High blood pressure: 4.79 billion DALYs.
  • Excessive alcohol consumption: 2.35 billion DALYs.

The scale of the projected burden underscores the importance of addressing not only infectious diseases and major medical emergencies but also long-term health conditions and behaviors that undermine healthy life.

Climate change, pandemics and antimicrobial resistance

Environmental threats also feature prominently in the commission’s projections. These include:

  • Antimicrobial resistance: 3.44 billion DALYs.
  • Pandemics: 2.39 billion DALYs.
  • Climate change: 1.89 billion DALYs.
  • Air pollution: 1.64 billion DALYs.

Antimicrobial resistance occurs when microorganisms develop the ability to withstand medicines designed to kill them or stop their growth, making infections more difficult to treat.

The projected toll from climate change reflects the effects of factors including extreme temperatures and air pollution. The commission argues that this burden could be reduced substantially if global warming is limited.

Education and inequality are major health risks

The study also highlights the profound influence of socioeconomic conditions on global health. Its projections include:

  • Low educational attainment: 16.1 billion DALYs.
  • Income inequality: 13.8 billion DALYs.
  • Armed conflict: 7.71 billion DALYs.
  • Collapse in international development assistance for health: 1.5 billion DALYs.
  • Child malnutrition: 1.02 billion DALYs.

Sub-Saharan Africa is expected to bear a particularly heavy burden from these threats. If international assistance for health collapses, the region is projected to account for 70% of the resulting loss of healthy life years.

The findings underline how health outcomes depend not only on medical care and individual behavior but also on access to education, economic opportunity, adequate nutrition, international support and peace.

Climate action could prevent billions of lost healthy years

The commission stresses that its findings are not intended to present an unavoidable picture of the future. For each threat, the researchers examined both more favorable and more adverse scenarios, showing how decisions made today could influence outcomes over the coming decades.

Climate change offers a clear example. The study estimates that limiting global warming to 1.8 degrees Celsius above preindustrial levels, rather than allowing temperatures to rise by an estimated 4.4 degrees by the end of the century, could prevent the loss of 1.89 billion healthy life years associated with factors such as extreme temperatures and air pollution.

The difference between these scenarios illustrates the potential impact of preventive measures and coordinated policies.

The threats are interconnected

Murray emphasized that the commission does not rank the threats according to their relative importance. Instead, it treats them as interconnected risks that form part of a broader picture of global health.

“These are interconnected risks, pieces of a mosaic that together reflect the opportunities for action over the next 75 years,” he explained. “The threats we present are not isolated, and the actions to address them cannot be fragmented either. Action in one area will bring benefits in many others.”

The commission’s aim, he added, was to identify threats whose trajectories could be substantially changed for the better through coordinated efforts by authorities at both the global and local levels.

The study’s central message is that the future of global health remains open to change. Preventing the worst outcomes will require action across public health, environmental policy, education, economic development and international security. The decisions made today will help determine how much healthy life future generations can expect to enjoy.