Getty ImagesThe decisions New Zealanders make at this year’s general election will help shape health and wellbeing for decades to come.Yet political debate is dominated by immediate concerns such as rising living costs, access to health services, and economic management.These all matter enormously, but an equally important question is receiving far less attention: are we making the decisions needed to protect our long-term future?A major new report from the Lancet Commission on 21st Century Global Threats to Health – from a group of 37 experts in health, economics, security and technology – provides compelling evidence that many of the greatest dangers facing our future are preventable.It also highlights why governments must look beyond short electoral cycles and national borders.The greatest threats are not necessarily what we expectThe Commission examined hundreds of potential threats to human health through to 2100, identifying 17 major catastrophic threats, including two with potential to cause human extinction.Among the largest potentially preventable sources of future health loss are obesity and unhealthy diets, low educational attainment, income inequality, poor mental health, smoking and unhealthy ageing.Other major threats include pandemics, antimicrobial resistance which makes infections harder to treat, climate change, air pollution and armed conflict.Most alarming are the potentially “existential” dangers from nuclear conflict and malicious uses of artificial intelligence, including biological weapons.Importantly, these findings are not a simple ranking of policy priorities based on existing health burdens. The Commission estimates potentially avoidable health losses under different scenarios of societal response, rather than the otherwise expected consequences.As The Lancet’s accompanying editorial emphasises, these threats are interconnected, uncertain and require coordinated action.Climate change, for example, threatens food and water security, worsens existing diseases and disproportionately harms vulnerable populations. Its consequences extend far beyond 2100.Responsibilities to our children and grandchildrenMany children born today will live into the next century. Their children and grandchildren will inherit the consequences of decisions we make now.This perspective aligns with Māori concepts of intergenerational responsibility, including kaitiakitanga or guardianship of the environment for both the present and future.Yet governments face incentives to deliver visible benefits within three-year election cycles, while the costs of inaction on climate change, environmental degradation and preventable disease accumulate over decades.These findings have direct implications for Aotearoa New Zealand. They point to five priorities for the next government that would help protect our children and grandchildren, while strengthening our ability to respond to threats that cross national borders.Five priorities for NZ’s next governmentFirst, there is a need to invest in prevention and reducing inequality. Better housing, education, income security, nutrition and healthcare deliver benefits across generations.The Commission reinforces the importance of addressing social and commercial determinants of health. New Zealand could achieve substantial gains through healthier food environments, stronger tobacco and alcohol controls, and fairer taxation. It must also curb undue commercial influence that puts private profits ahead of public health and wellbeing.Second, it should protect the environment that sustains life. New Zealand needs credible policies to reduce greenhouse gas emissions, restore biodiversity, protect freshwater and accelerate renewable energy and sustainable transport.Recent analysis of political parties’ climate policies highlights differences in their approaches. The Conversation’s 2026 election policy tracker also compares commitments.A third priority is to prepare for catastrophic threats. COVID-19 demonstrated the importance of preparedness, scientific capability and effective government action.New Zealand’s Royal Commission of Inquiry into Covid-19 identified opportunities to strengthen pandemic preparedness, coordination and accountability. We need to implement these recommendations.Sustained investment is also needed in protection against emerging biological threats including through improved infectious disease surveillance, vaccination programmes, antimicrobial resistance prevention and controls for AI and biorisk.Fourth, there is a need to strengthen international cooperation. Climate change, pandemics, conflict and technological risks cannot be managed by countries acting alone.New Zealand should return to fully supporting the World Health Organisation, international pandemic agreements, revised International Health Regulations, climate treaties, development assistance and nuclear disarmament. Protecting global health is essential to our own shared security.Fifth, governments should be held accountable for the future wellbeing of our children and grandchildren. This may be the most important reform for ensuring that long-term wellbeing remains a government priority.Read more: Election Policy Tracker: your guide to what the parties are promising during the 2026 election campaignNew Zealand should consider legislation requiring governments to assess, publicly report and respond to the long-term health, social, economic and environmental consequences of major policies.Wales provides a useful precedent. Its Well-being of Future Generations Act requires public bodies to consider long-term wellbeing and established an independent Commissioner to safeguard the interests of future generations.The Public Health Communication Centre has proposed mandatory health impact assessments across government. These assessments should explicitly consider consequences that span decades into the future.An independent commissioner or agency could also monitor long-term catastrophic threats, evaluate progress and report regularly to parliament and the public.Such arrangements would strengthen transparency and accountability beyond electoral cycles.The election is a choice about our collective futureThe Lancet Commission delivers an important message of hope: our future is not predetermined and can be made safer. Many of the greatest threats to human health and survival are preventable, provided governments act now on the evidence.This election is an opportunity to look beyond the next three years and ask what kind of future we want to live in over coming decades and to leave to our children and grandchildren.Ultimately, governments should be judged not only by what they achieve during their term in office, but by the long-term future they help create.From the cost of living to how best to tackle climate change, the coming election involves some big choices.This article is part of The Conversation’s Election 2026 series: expert analysis of the major policy debates and the big challenges New Zealand’s next government will face.Michael Baker's employer, the University of Otago, has received funding from the Health Research Council of New Zealand and the Ministry of Health for research he has carried out on COVID-19 epidemiology, prevention and control.Nick Wilson is a Co-Director of the Public Health Communication Centre, based at the University of Otago. He is also affiliated with the NZ charity "Islands for the Future of Humanity".