A new Lancet Commission has identified 17 catastrophic threats to global health and human survival, warning that decisions taken today across health, finance, climate, defence and technology will determine how many years of healthy life future generations gain — or lose — by 2100. For India, the findings underscore the need to strengthen long-term health planning and play a more prominent role in global negotiations on pandemic preparedness, artificial intelligence (AI) safety and other emerging risks.Launched at the World Health Summit in Berlin, which opened on October 11, the Lancet Commission on 21st Century Global Threats to Health examines risks across 204 countries and territories. It assesses how investments in prevention, preparedness, health systems and innovation could avert enormous losses of healthy life over the next 75 years.Obesity emerges as one of the largest projected health burdens, accounting for an estimated 23.1 billion disability-adjusted life years (DALYs) that could potentially be avoided by 2100 through effective interventions. DALYs measure years of healthy life lost because of illness, disability or premature death.Other threats include antimicrobial resistance (AMR), poor mental health, high blood pressure, childhood malnutrition, smoking, unhealthy ageing, income inequality and low educational attainment. Climate change, pandemics, conventional conflict, nuclear conflict and the malicious use of AI also feature in the Commission’s assessment.A threat was classified as catastrophic if it could account for at least one billion DALYs by 2100, sufficient data existed to model its potential impact, and there was scope for policy action. For each threat, the Commission modelled plausible best-case and worst-case scenarios, highlighting the health losses that targeted interventions could prevent.Professor Christopher JL Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington and co-chair of the Commission, said the estimates demonstrated the scale of avoidable health losses. While some threats already impose substantial burdens, others carry significant risks if they materialise.“Crucially, all 17 threats are interconnected, which is why they must be addressed together, not in isolation,” he said.Story continues below this adWhy India needs to take the leadDr Soumya Swaminathan, the World Health Organization’s inaugural chief scientist and a member of the Commission, told The Indian Express that policymakers must move beyond short-term priorities and national-level considerations to address long-term risks proactively.She said many major threats — including childhood malnutrition, air pollution, AMR, high blood pressure, obesity, poor mental health, income inequality, pandemics and unhealthy ageing — are exacerbated by climate change. Conversely, well-designed climate mitigation measures can also help tackle several of these challenges.“We have to find a way to manage them all in parallel and in an integrated manner — we do not have the luxury of choosing one over the other,” she said.For India, this means incorporating foresight into health planning, drawing on local data across sectors, using AI to integrate and analyse information, modelling future scenarios and directing investments towards vulnerable populations.Story continues below this ad“India should play a leading role in global health discussions and negotiations on important topics like AI safety, pandemic threats, commercial determinants of health and global health architecture,” Dr Swaminathan stressed.She also called for people’s lived experiences and ethical considerations to inform policymaking, alongside greater interdisciplinary research to develop solutions suited to local contexts.Climate change, inequality and emerging risksThe Commission highlights the far-reaching consequences of climate change. Limiting global warming to around 1.8°C, rather than allowing it to reach 4.4°C, could prevent an estimated 1.89 billion years of healthy life from being lost to causes including extreme heat and air pollution. Unchecked warming could also intensify other threats, including migration.Income inequality could account for an estimated 13.8 billion DALYs by 2100, a burden the Commission equates to 25 COVID-19 pandemics.Story continues below this adAlthough nuclear conflict and the malicious use of AI are considered less likely than many other threats, their potential consequences are exceptionally severe. Preventing nuclear conflict could avert an estimated 133 million deaths and 9.35 billion DALYs by 2100, while measures to reduce the risk of malicious AI could avert an estimated 10.4 billion DALYs.The report also notes that, although moderate pandemics have become less frequent, naturally occurring pandemics remain a major long-term threat.Build readiness, back breakthroughs, track threatsThe Commission recommends a three-pronged approach: build readiness through health systems equipped for prevention and preparedness; back breakthroughs by investing in vaccines, antibiotics, obesity treatments and climate technologies; and track threats through regular, independent assessments.Dr Richard Horton, editor-in-chief of The Lancet, said the report calls for a broader framework for coordinated action, reflecting the increasingly interconnected dangers facing humanity.