More than a dozen interconnected catastrophic threats could place global health and wellbeing at significant risk through the remainder of the 21st century, researchers warn. Some could even lead to extinction, although targeted action by world leaders may still prevent the worst scenarios.

A commission of 35 leaders from various industries used data from the Institute for Health Metrics and Evaluation’s Global Burden of Disease study. They forecast how many years of good health the global population could lose through sickness, disability or premature mortality.

Published in The Lancet, the findings identify 17 threats that present the greatest danger while also offering realistic opportunities for intervention. The list spans health conditions, behaviors, economic pressures, environmental change, technology and conflict.

Obesity, high blood pressure, smoking and mental health are among the health related concerns. If current trends continue, the commission found that the combined threats could account for tens of billions of years of lost health.

“The striking finding is not only the scale of these threats, but that humanity still has the agency to act,” said Dr. Christopher Murray, commission co-chair and director of the University of Washington’s Institute for Health Metrics and Evaluation.

“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,” Murray said in a statement.

Two of the threats carry the risk of extinction, according to the commission. Those are nuclear conflict and the malicious use of artificial intelligence.

Last month, an initial public offering for the AI company Anthropic said its models could pose a “catastrophic or existential risk to humanity,” while people who worked in the industry have warned that AI could kill the entire human species, perhaps within the decade.

Forecasters working with the new Lancet commission showed “wide divergence” when estimating the danger of a catastrophe involving AI. The report therefore presents substantial uncertainty around how such a threat might unfold.

The commissioners pointed to powerful AI systems as an example of how rapidly assumptions about stability can be overturned. They also cited recent global shocks, including the Covid-19 pandemic, the Ebola outbreak ongoing in Africa and accelerating climate impacts.

Malicious AI could cost the world about 10.4 billion healthy years of life by 2100, roughly matching estimates for some other dangers, including naturally occurring pandemics and obesity. However, no malicious AI event of a truly global magnitude has occurred, making those estimates theoretical.

The evidence surrounding obesity rests on more empirical data. Overweight and obesity are increasing in every country, and estimates suggest the global rate could reach 60% of adults and one third of children by 2050.

Obesity is connected with dozens of poor health outcomes, particularly those associated with increased caloric intake and reduced physical activity. The commission forecasts a “major global impact of this cluster of behavioral risks.”

The commission’s objective is not to rank the threats. Instead, it aims to “catalyse international, regional, and national actions to protect and strengthen the future of health and humanity,” according to a related editorial in The Lancet.

Dr. Natalia Kanem, former executive director of the United Nations Population Fund and commission co-chair, warned that global health threats risk deepening existing inequalities, with vulnerable communities carrying the greatest burden. She also stressed that the future is not inevitable.

“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,” Kanem said in a statement.

Trust will be essential to any meaningful intervention, the report found. Commissioners described it as a “stabilising force, enabling societies to anticipate, mitigate, and adapt,” while warning that distrust can worsen potential harm.

Seven other factors will shape how societies confront future threats. They include collaborative global leadership, resilient food systems and efforts to build more equitable societies.

“Public health is full of examples in which potential threats were known, and protection plans were in place, yet effective action failed,” the report says. “Achieving meaningful progress will require not only technical solutions but also robust societal and institutional foundations that foster collaboration and accountability.”