Lancet commission proposes unified framework to compare 21st-century global health threats

A new Lancet Commission is proposing a single long-range framework to compare very different threats to global health — from pandemics and climate impacts to conflict, antimicrobial resistance and the malicious use of artificial intelligence — and says governments need more systematic preparedness planning after a series of global shocks upended assumptions about stability.

The findings are due to be publicly launched Sunday at the World Health Summit in Berlin in a session co-hosted by the Institute for Health Metrics and Evaluation, or IHME, and The Lancet. The event, “Launch of the Findings from the Lancet Commission on 21st Century Global Threats to Health,” is scheduled for 2 p.m. to 3:30 p.m. CEST at the summit’s Center Stage.

The report, titled “The Lancet Commission on 21st Century Global Threats to Health,” lays out what organizers describe as a foresight-driven, health-focused approach to identifying and prioritizing major threats through 2100. It comes after several years in which COVID-19, major geopolitical conflict, accelerating climate impacts, abrupt changes in development assistance and the emergence of powerful AI systems have all tested public institutions’ ability to prepare for cascading risks.

“The Lancet Commission on 21st Century Global Threats to Health stands as an independent voice bringing together diverse experts to examine the broad set of threats facing the world over the rest of the century,” according to the World Health Summit session description.

The launch materials say the commission examines threats including “the malicious use of artificial intelligence (AI),” “naturally occurring pandemics with the potential to exceed the impact of COVID-19,” “conventional conflict destabilizing entire regions” and “antimicrobial resistance threatening modern medicine's safety net.” They also say noncommunicable diseases and poor mental health can make populations more vulnerable to those shocks.

What makes the effort unusual is its attempt to place those very different dangers on a common health scale. Rather than treating each as a separate policy silo, the commission compares them through what it calls cumulative expected amenable disability-adjusted life-years, or DALYs, from 2025 to 2100. DALYs are a common global health measure that combines years of life lost and years lived with illness or disability.

“Central to the Commission's approach is an inclusive definition of a threat: the largest causes of future health loss that are amenable to policy action… To compare this wide array of threats, the Commission measures cumulative expected amenable disability-adjusted life-years (DALYs) from 2025 to 2100 - the difference between a plausible best and a plausible worst scenario for each threat,” the session description says.

In plain terms, the commission is asking how much health damage could be avoided if governments act well versus poorly over the rest of the century. It then groups risks into a “pyramid of threats,” including threats with the potential to cause human extinction by 2100, catastrophic threats projected to cause at least 1 billion cumulative DALYs by 2100, and a broader set of other risks affecting health across the century.

The commission is co-chaired by Natalia Kanem, executive director of the U.N. Population Fund, and Christopher J.L. Murray, who leads IHME at the University of Washington. Murray’s involvement is notable because IHME runs the Global Burden of Disease project and is known for large-scale health forecasting, helping explain the commission’s use of DALY-based comparisons and long-range scenarios.

The project also carries weight because Lancet commissions have often helped shape global health debates, including around climate and planetary health. This commission is broader than many earlier efforts, aiming not at one disease or one hazard but at a cross-cutting framework for comparing multiple long-term risks.

Richard Horton, editor-in-chief of The Lancet, is set to join the Berlin launch alongside Kanem, Murray and other commissioners including Julio Frenk and Dame Sally Davies. The larger message of the report, however, is less about any one threat than about changing how institutions plan: away from short-term crisis response and toward repeatable health-risk assessment and preparedness over decades.