A new global risk assessment warns that humanity could face extinction by 2100 due to nuclear conflict or the malicious use of AI, including bioweapons. These two dangers top a list of 17 major threats to human health over the next 75 years, compiled by The Lancet Commission on 21st Century Global Threats to Health. Other threats include cuts to international aid spending by wealthy nations, the climate crisis, childhood malnutrition, air pollution, antimicrobial resistance, and naturally occurring pandemics.
The commission stresses that all 17 threats interact and must be addressed together, but emphasizes that a “realistic route to act” exists for each one. Prof. Christopher Murray, commission co-chair and director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, stated: “Decisions made by leaders today will shape the health and wellbeing of the next generation.”
To build the list, the commission modeled how many years of good health could be lost to sickness, disability, or early death from each threat, using a metric called disability-adjusted life years (DALYs). The report warns that the malicious use of AI—including bioweapon creation—and nuclear conflict resulting in nuclear famine carry risks of human extinction within the next 75 years. While the likelihood remains low, nuclear conflict could inject enough soot into the upper atmosphere to block sunlight and trigger global famine. An accompanying Lancet editorial warned: “The scale of harm, should they be realized, would inflict an apocalypse on humanity.”
Other risks projected to cause more than 1 billion cumulative DALYs were designated “major catastrophic threats.” These include air pollution, antimicrobial resistance, as well as childhood malnutrition. Additionally, climate breakdown, conventional conflict, declining overseas aid, as well as high alcohol use were highlighted. Further associated risks include high blood pressure, income inequality, low educational attainment and naturally occurring pandemics ( but not limited to). To be included, threats required both the potential to cause massive losses in healthy life years and viable potential solutions.
Ibrahim Abubakar, a commission member and professor of infectious disease epidemiology at UCL, emphasized that the goal was not to spread panic. “We’re starting from the premise that if you are a policymaker today, whether at the global multilateral level or at the national level, these are the potential threats that you could face, and this is the magnitude by which, if you act, you can actually make a difference,” he said.
Report scenarios forecasted best- and worst-case outcomes. For instance, limiting global warming to 1.8°C instead of 4.4°C would save approximately 1.89 billion healthy years of life. In high-income regions, the primary health risks stem from non-communicable diseases, such as obesity and mental health issues, whereas in lower-income regions, health losses are driven predominantly by factors like low educational attainment.
Meanwhile, major donor nations—including the US and UK, have announced substantial aid reductions. The commission found that a collapse or steep reduction in global health aid could result in up to 1.5 billion DALYs lost before 2100, nearly 70% of which would affect sub-Saharan Africa, a region that also bears the primary burden of child malnutrition.
Composed of 35 global experts, the commission released its findings at the World Health Summit in Berlin, Germany. The report will be updated annually to reassess the 17 threats alongside emerging dangers. Authors called on global leaders to act before these risks escalate into acute crises through increased investment in emerging technologies and resilient health systems. Murray noted that while the project began three years ago focused on three major risks; conflict, climate, and pandemics; it became clear that “there’s a much larger number of threats that we need to worry about, and governments really need to dedicate some money and staff to the task of anticipation, prevention, and preparation.”
