Don’t Look Up. Or perhaps just don’t look too closely?

The Lancet Commission on 21st century global threats to health is an impressive attempt to map the dangers facing humanity. But identifying the approaching train is only half the problem. Somebody still has to persuade the driver to apply the brakes.

There is something reassuring about a major scientific commission telling us that the world faces a collection of potentially catastrophic threats. Reassuring, that is, in the same way that being told by your oncologist that your tumour has been identified, measured and carefully classified might be reassuring. We have made progress. We know what we are dealing with. We can even put numbers on it. The uncomfortable question is what happens next. Sadly, I think we all know the answer…

The newly published Lancet Commission on 21st century global threats to health [1] is an ambitious attempt to assess the threats that could undermine human health between now and 2100. Drawing on forecasts covering 204 countries and territories, you will be glad to hear that it considers hundreds of potential threats and identifies 17 major catastrophic risks, ranging from obesity, air pollution and antimicrobial resistance to climate change, nuclear conflict and the malicious use of artificial intelligence.

It is a formidable piece of work. It is also a timely reminder that we have become rather good at generating problems that require considerably more cooperation to address than we seem capable of delivering.

A pyramid of impending trouble

The Commission's approach is particularly interesting because it does not simply rank disasters according to how frightening they sound. It estimates the cumulative health burden that might be avoided by moving from a plausible worst-case scenario towards a plausible best-case scenario. The measure is disability-adjusted life-years, or DALYs, which combines years of life lost through premature death with years lived with disability.

The resulting estimates are sobering. Obesity alone has a modelled cumulative amenable burden of approximately 23.1 billion DALYs between 2025 and 2100. Climate change, income inequality, inadequate education, antimicrobial resistance and poor mental health also feature prominently. At the summit of the threat pyramid sit two possibilities with extinction potential: nuclear conflict leading to nuclear famine, and malicious uses of AI, including the development of biological weapons [1].

There are important qualifications. These figures are not predictions of the number of healthy years that will definitely be lost. They represent modelled differences between plausible scenarios, with substantial uncertainty, particularly where historical data cannot reliably estimate the probability of unprecedented events. The Commission also acknowledges that its health-focused metric does not capture every dimension of human wellbeing.

Nevertheless, the exercise has considerable value – assuming we need to be able to SEE the problems if leaders can ever be expected to address them. It gives policymakers a common framework for comparing problems that are usually discussed in separate scientific, political and commercial silos. There is a catch, however. A carefully constructed model can tell us what might happen and what we could change. It cannot make us change it.

Welcome to the age of Don't Look Up

Anyone who watched the 2021 film Don't Look Up will recognise the predicament (and some of the protagonists). Scientists discover a comet heading towards Earth. They calculate the consequences, explain the evidence and attempt to alert the authorities. Their message becomes entangled in political vanity, commercial interests, media entertainment and the public's limited appetite for inconvenient information. The comedy works because the underlying behaviour is painfully recognisable. The problem is not that humanity lacks people capable of identifying a threat. It is that recognising a threat and responding to it are entirely different activities.

The Commission explicitly identifies short-termism and localism as obstacles to preparedness. Politicians concentrate on immediate electoral rewards; governments prioritise problems within their own borders; international cooperation becomes difficult when the benefits of acting are widely shared but the costs are concentrated. Its proposed remedies include better-prepared health systems, investment in innovation and a recurring global threats monitor [1].

All sensible recommendations. But we should ask whether another report, however authoritative, is enough to overcome the forces that have repeatedly prevented action.

Research on income inequality and population health illustrates why these questions cannot be separated from the distribution of power and resources. Reviews have found evidence that greater inequality damages population [2], although the strength and causal interpretation of particular associations remain debated [3]. The Commission goes further by treating inequality itself as a threat, recognising that it shapes exposure, vulnerability and the capacity to recover. This matters because the people with the greatest influence over policy are not necessarily those who suffer most from its failure.

The curious psychology of the powerful

Sadly, we are not naturally equipped to give equal weight to every future consequence. Psychological research on decision-making shows how strongly immediate rewards influence choices, even when delaying gratification might produce greater benefits later. At the institutional level, the same tendency gets solidly embedded in budgets, election cycles and investment decisions.

Governments will often announce long-term strategies while quietly postponing the expenditure required to deliver them (leaving it to the next administration to deal with). A business will publish ambitious environmental commitments while rewarding executives for this quarter's results. A political leader can praise scientific innovation while undermining the institutions that make reliable scientific advice possible. None of this requires everyone involved to be stupid, malicious or incapable of understanding the evidence (though we know that there is plenty of that). The problem is often that the incentives favour a different course of action.

And then there is obscene wealth…

At what point do those who have accumulated extraordinary fortunes begin to recognise that the conditions required for their continued prosperity are not independent of the conditions required for everyone else's survival? A billionaire can purchase private healthcare, a fortified residence and a comfortable escape from most of society's immediate inconveniences. Money buys them insulation from most of the risks they can perceived – often focused on protecting their stash. It cannot buy immunity from every consequence of a destabilised climate, a major nuclear conflict, a global food-system failure or the collapse of the social institutions on which economic activity depends (unless you plan to escape to Mars).

There is a delicious irony here. The more wealth becomes concentrated, the easier it may become for those who possess it to mistake personal security for collective security, the more resources they have to help us all. The evidence does not establish that every wealthy individual ignores these risks, nor that inequality alone explains our failure to act. It does, however, give us good reason to question whether systems that concentrate resources and influence are reliably serving the long-term interests of society [1][3].

Perhaps the more interesting question is not whether the very wealthy will eventually recognise the danger. It is whether they will recognise it while there is still time to do something useful about it.

Science needs leadership, not just better spreadsheets

The Commission makes a strong case for foresight, monitoring and investment. Yet foresight is only one component of leadership. Somebody must be prepared to turn evidence into decisions, explain why those decisions matter, challenge vested interests and accept the consequences of acting before the benefits are immediately visible. That is a very different skill set from commissioning a report.

Good scientific leadership also requires the intellectual honesty to acknowledge uncertainty, distinguish evidence from speculation and change direction when new information emerges. Scientific integrity is not a decorative quality to be added after the policy has been agreed. It is central to whether decision-makers and the public can trust the process in the first place. Research on scientific reproducibility, for example, argues that improving research practices and empowering scientists is more constructive than simply declaring science to be in crisis [4].

Trust cannot be demanded as a professional courtesy. It has to be earned.

Nor can it be manufactured through increasingly polished communications. The Commission itself identifies trust, effective global governance and social cohesion as enabling conditions for reducing threats [1]. These are not minor administrative details. They are the social infrastructure of collective action.

There is also a human dimension that deserves more attention. A meta-analysis of 91 studies involving more than 18,000 participants found a modest association between gratitude and prosocial behaviour [5]. Gratitude is not a substitute for regulation, taxation or sound public policy. But the evidence reminds us that cooperation is influenced by how people perceive their relationships with others, not merely by the information available to them.

It seems to me that our leaders should be better at recognising and rewarding the people who contribute to collective progress, rather than concentrating attention on those who accumulate the greatest personal rewards. That means recognising the technicians, nurses, researchers, public servants, community workers and countless others whose contributions rarely make the headlines. It also means creating institutions in which people can question decisions without being punished for doing so. Research on psychological safety in teams suggests that an environment in which individuals feel able to speak up is important for learning and improvement [6]. At a time when humanity needs to detect mistakes early and correct them rapidly, this is hardly an optional extra.

So what is the point of the report?

The Commission deserves to be welcomed. It is like a grown-up version of Tony Robinson’s 2008 mini-series Catastrophe. Its attempt to bring diverse threats into a common analytical framework is valuable, and its recommendations provide a starting point for action. Its proposed recurring monitor could help prevent familiar cycles of alarm, neglect and rediscovery. However, it is not particularly approachable to the general public – it more serves as a reminder to that sector of our population (scientists) that recognise how close we are to the edge.

A monitor is only useful if somebody pays attention to it. A warning system cannot compensate indefinitely for a leadership system that prefers not to hear the warning.

The philosophical questions raised by the Commission's companion work are equally important. How much responsibility do we have towards people who will live beyond our own lifetimes? What obligations do we have to future generations when the costs of protecting them fall on people living today? These are not abstract puzzles. They are questions about the moral legitimacy of decisions made now that may shape human health for decades or centuries [7].

The 2100 horizon is useful, but it should not become an excuse to ignore consequences that extend beyond it. Ultimately, the purpose of scientific foresight is not to produce increasingly sophisticated descriptions of the future we might lose. It is to expand the range of futures we can still choose.

That requires governments willing to act, businesses willing to accept constraints when necessary, scientific leaders prepared to speak uncomfortable truths and citizens willing to look beyond the next headline. It also requires the people who hold disproportionate wealth and influence to recognise that their own fortunes are embedded in a much larger human enterprise.

Perhaps the comet in Don't Look Up is not the most useful metaphor after all. Comets arrive from outside our control. Many of the threats described by this Commission are consequences of choices we continue to make. We are not merely watching something approach. We are helping to determine its trajectory.

And if those with the power to change that trajectory are waiting for a more compelling report, a better forecast or a more convenient political moment, they may eventually discover that the science was never the missing ingredient. The missing ingredient was the willingness to act on what we already knew. By then, of course, it will be too late to say we were not warned.

References

1. Murray CJL, et al. The Lancet Commission on 21st century global threats to health. Lancet. 2026 Oct 10.
2. Wilkinson RG, Pickett KE. Income inequality and population health: a review and explanation of the evidence. Soc Sci Med. 2006;62(7):1768-1784.
3. Pickett KE, Wilkinson RG. Income inequality and health: a causal review. Soc Sci Med. 2015;128:316-326.
4. Fanelli D. Opinion: Is science really facing a reproducibility crisis, and do we need it to? Proc Natl Acad Sci U S A. 2018;115(11):2628-2631.
5. Ma LK, Tunney RJ, Ferguson E. Does gratitude enhance prosociality?: a meta-analytic review. Psychol Bull. 2017;143(6):601-635.
6. Edmondson AC. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350-383.
7. Andreou C, et al. Addressing threats to future global health: what is the right timeframe? Lancet. 2026 Oct 10.