A major new Lancet Commission has listed 17 interlinked catastrophic threats that could shape global health through 2100. Zooming out to take a bird’s eye view of the possible threats, the Commissioners have counted amongst them — pandemics, obesity, antimicrobial resistance, nuclear conflict, and artificial intelligence.
Driven by the motive to move away from the intense focus on certain domains, the default mode that health care governance and activism has taken so far, the Commission took upon itself the task of freeing the world from being bogged down with single issues, though the benefits of that have been aplenty, the time had come to go beyond.
Launched at the recent World Health Summit in Berlin, the report urges global leaders to stop treating these issues in isolation, and start viewing them as deeply interconnected economic, environmental, and national security challenges. The Commission, “composed of 37 experts in health, economics, security, and technology, uses a foresight-driven, health-focused approach to identify 17 priority threats to human health.” Not a crystal ball gazing exercise, it reportedly assessed threats by calculating the expected cumulative disease burden — measured as amenable disability-adjusted life-years from 2025 to 2100 — that can be reasonably altered through policy intervention. It lists two of these major catastrophic threats: nuclear conflict and malicious use of AI: as having extinction potential. Additional threats include climate change, air pollution, antimicrobial resistance, childhood malnutrition, conventional conflict, declining development assistance for health, high alcohol use, high blood pressure, income inequality, low educational attainment, naturally occurring pandemics, obesity, poor mental health, smoking, and unhealthy ageing.
While the report seeks to identify the threats to human health and survival, and could been seen as doomsdayist, in principle, it is not an apocalyptic forecast of unavoidable doom. The model it uses, as described here earlier, is “amenable” Disability-Adjusted Life Years (DALYs) — meaning it measures how many years of healthy life can still be saved if take decisive policy action is launched today. It predicts that high-income nations will see dominant health losses from non communicable risks such as obesity and poor mental health. On the other hand, low-income regions will bear the brunt of childhood malnutrition and the collapse of international aid.
The Commission analysed hundreds of risks across 204 countries and territories. A threat was classified as “catastrophic” if it could account for at least 1 billion DALYs (healthy years lost to illness, disability, or premature death) by 2100. These 17 threats were then categorised into a pyramid of severity, with extinction potential right on top (nuclear conflict and malicious AI) at Category 1, and then cascading down to Category 2 (major catastrophic threats) and Category 2 (environmental, social and health risks).
Although the likelihood of Category 1 dangers remains low, the report says, the scale of harm, should they be realised, would be apocalyptical. The bulk of the threats come under category 2, and include obesity, which represents the largest single potential health loss identified in the report. Addressing high body mass index (BMI), poor diet, and physical inactivity could prevent a massive 23.1 billion DALYs, the report says.
Similarly, improving global access to education could avert 16.1 billion DALYs, it claims. The income gap between the rich and poor represents an amenable health burden equivalent to 25 COVID-19 pandemics, it avers.
The report flags poor mental health rapidly rising in the higher income countries, as also the pressures on societies from ageing populations without adequate health support systems. While smoking, high blood pressure, antimicrobial resistance, alcohol use, child malnutrition and naturally-occurring pandemics are conventionally connected with health; climate change, conventional conflict and air pollution also find a place in the list. The withdrawal of international aid has been flagged: severe cuts to health aid from wealthy nations could cause 1.5 billion DALYs, with sub-Saharan Africa bearing 70% of this blow.
A key, central argument of the report is that these threats amplify one another. For instance, climate change directly exacerbates childhood malnutrition, air pollution, antimicrobial resistance, and mental health issues. Focusing on climate mitigation alone, without strengthening local healthcare infrastructure, again, will fail to stop the downstream health fallout. It also indicates that the estimated 1.89 billion DALYs saved by meeting climate targets is a conservative underestimation, accounting for direct heat and pollution harms. It advises nations to plan for unmodeled “invisible” consequent threats such as mass displacement, geopolitical instability, and drought.
However, the primary criticism against the Commission report is that it skirts acknowledging the current geopolitical crisis, the growing rise of intolerant governments, and the collapse of international collaboration between nations. Even recently, the terse flow of information from Russia where a suspected case of pneumonic plague death was reported highlights the frigidity between nations that prevents seamless global co-operation.
Though it does have a cascade of priorities, in effect the Commission does not attempt to present “a fixed ranking of threats or policy priorities.” Instead, it makes it very clear that the analysis is a dynamic process and findings are amenable to change as and when evidence shifts. But the most important contribution that can be attributed to the Commission is how it managed to pivot the global approach to health threats — to move it from attention and focus on individual subjects to move to a larger consideration of all the complex factors impacting human health. Whether the global axis will now swivel on this pivot remains to be seen, given how complex a task this report has laid out for the world.