Global Health on the Edge of a World War III

As the COVID-19 pandemic clearly illustrated, the well-being of populations is shaped not by the health systems that generate diseases alone but also by the macro structural factors that influence the ecosocial determinants of health. Wars are among the most severe threats to public health, triggering widespread mortality, the collapse of health care systems, food insecurity, disease outbreaks, psychological trauma, and long-term socioeconomic destabilization, as well as other forms of social and environmental destruction. This article explores the current geopolitical landscape, analyzing political tensions and the major causes of conflicts in order to evaluate the potential of a Third World War developing in the near future. It argues that, from a public health perspective, comprehending the geopolitical motivations behind armed conflicts is crucial for their prevention. Given the current era of escalating geopolitical tensions and the looming threat of nuclear conflict, the authors urge public health institutions and their educators and researchers to engage deeply with war and conflict as a determinant of health and health inequity, and advocate for peace through diplomacy and disarmament.

The Public Health Impacts of World Wars

Public health has long been intricately tied to the broader economic, political, cultural, and ecological conditions of the world. ¹ As the COVID-19 pandemic clearly illustrated, the well-being of populations is shaped not by the health systems that generate diseases alone but also by the macro structural factors that influence the ecosocial determinants of health. ² Wars, particularly those with the potential to escalate globally, ³ are among the most severe threats to public health, triggering widespread mortality, the collapse of health care systems, food insecurity, disease outbreaks, psychological trauma, and long-term socioeconomic destabilization. ⁴ As current geopolitical conflicts heighten—mainly in Ukraine, Congo, Gaza, Lebanon, Syria, Yemen, Sudan, Myanmar, Ethiopia Sahel, and other regions—the risk of a potential escalation toward World War III (WWIII) poses a profound threat to global health and even risks human extinction. ⁵ Historical precedents, such as World Wars I and II, resulted in not only immense loss of life but also the destruction of health care infrastructure, environmental degradation, and enduring impacts on the mental and physical health of entire populations.^6,7 In the present context, the potential for nuclear escalation further exacerbates these risks, making it imperative for public health professionals to assess and prepare for the complex health crises that could arise from such conflicts, including radiation exposure, displacement, and the breakdown of essential services. ⁸ Understanding the interplay between geopolitical instability and global health is critical for anticipating and mitigating the far-reaching consequences of contemporary conflicts, including the possibility of human extinction.

World War I (WWI) and World War II (WWII) stand as two of the most significant public health tragedies in modern history. In WWI, approximately 17 million people died, while WWII resulted in an estimated 60 to 85 million deaths, making it the deadliest conflict in human history so far. ⁹ These wars caused not only mass casualties but also devastated public health infrastructure, displaced populations, and contributed to epidemics of infectious diseases. ¹⁰ The global influenza pandemic of 1918, often referred to as the “Spanish Flu,” which killed approximately 50 million people, was exacerbated by the conditions of WWI. ¹¹ Soldiers living in close quarters, combined with poor sanitation and international troop movements, created the perfect environment for the rapid spread of viruses. Similarly, WWII saw widespread outbreaks of diseases like typhus and cholera, particularly in concentration camps and among displaced populations. ¹⁰ The war also led to food shortages, malnutrition, and long-term health consequences for survivors, including psychological trauma and disability. ¹² Public health professionals today must understand how ongoing conflict can exacerbate or even trigger global health crises. In addition, the risk of thermonuclear war poses a unique risk of the extinction of our species.

The Current Global Geopolitical Situation

The world today faces the most dangerous situation in the history of humankind.^13,14 The ongoing wars in Ukraine, Palestine, Lebanon, and Syria, and over 20 other active conflicts across the globe have led many to point out that we may be approaching a global conflict on the scale of WWIII or even that, somehow, we are already in it. Tensions between the United States and emerging global powers have escalated in recent years, reflecting the idea of a new kind of global conflict unfolding in nontraditional forms, rather than a full-scale military World War. To understand the potential for a Third World War, it is essential to examine the key players, their motivations, and the geopolitical dynamics at play.

One of the most influential geopolitical theories that can help explain the current global situation is John Mearsheimer's realism theory. ¹⁵ Mearsheimer, a prominent political scientist, argues that international relations are governed by the principle of power politics, where states act in their self-interest and seek to maximize their power relative to other states. This realist perspective helps explain the current tensions between major world powers, as each state seeks to assert its dominance in an increasingly multipolar world. Following the end of WWII, the United States emerged as the dominant global power, mainly due to the establishment of the Bretton Woods system, which created a global economic order centered on the U.S. dollar and institutions like the International Monetary Fund (IMF) and the World Bank. For much of the twentieth century, the United States dominated the global economy, military affairs, and international institutions. In 1950, the United States accounted for around 30 percent of global gross domestic product (GDP), and its unipolar dominance lasted until the early 2000s.^16,17

Since the early 2000s, the global balance of power has begun to shift toward Asia. China, with its rapid economic growth, followed by India, and Russia, with its military development, have emerged as major economic, geopolitical, and technological competitors to the United States. China's rise as an economic powerhouse has been characterized by its vast manufacturing capacity, technological advancements, and state-driven economic and social model capable of lifting 800 million people out of poverty in a few decades. ¹⁸ Prominent economists of different ideological views^19,20,21 describe China's system as “state capitalism,” including significant control of the state over the economy and society through technology and surveillance, such as the social credit system and extensive use of artificial intelligence (AI) for governance. Consequently China has grown rapidly and now challenges U.S. dominance in some leading technological fields. Russia, meanwhile, has reasserted itself as a military power, particularly through its actions in Ukraine, making good on its longstanding complaint to the United States and its allies that Ukraine's NATO membership poses an existential threat to the nation.^22,23 Paradoxically, both the United States and Russia's current political systems are often described as oligarchies,^17,24 with a small group of billionaire elites or oligarchs controlling the country's wealth and resources for their benefit. Despite having a relatively smaller economy than the United States and China, Russia's military capabilities and large reserve of commodities make it a significant player on the global stage. China and Russia have formed a strategic partnership with BRICS countries (which already surpassed the G7 in population and wealth), further challenging U.S. hegemony and Bzrezinsky's (the father of U.S. foreign policy since the 1980s) 1997 predictions. ²⁵ This alliance has manifested in various ways, including joint military exercises, economic cooperation, and diplomatic coordination in international forums like the United Nations. At the same time, the United States has faced some internal divisions between its elites, in particular between the globalists, who favor policies that benefit multinational corporations and support international military dominance, and the nationalists, who endorse protectionist and often neofascist policies. Although both aim to promote narratives that support corporations and military power, nationalists are more likely to advocate for rising tariffs on international competitors, pushing pro-white working-class narratives and authoritarian neofascist policies intended to halt immigration, to suppress dissent, and to suppress the rights of women, people of color, and immigrants while preserving the nationalists’ ideological hegemony both domestically and internationally.

One of the primary drivers of warfare and conflict is the pursuit and exploitation of natural resources, a trend that intensifies as global ecosocial crises escalate. ²⁶ Nations and corporations strive to control and utilize natural resources such as oil, gas, minerals, and water, resulting in geopolitical tensions, internal unrest, or even full-scale wars. ²⁷ This competition for dwindling resources is closely tied to ecosocial crises, where environmental degradation intersects with social and health inequities. Over the past 60 years, roughly 40 percent of intrastate conflicts have been linked to the exploitation of natural resources. ²⁸ This encompasses high-value commodities like diamonds, timber, and oil, as well as scarce resources like water and arable land. For example, the global competition for oil has significantly influenced conflicts in the Middle East, contributing to long-term instability in the region. The recent threats by the President of the United States to annex Canada and Greenland ²⁹ can also be interpreted in light of this neocolonial, resource-driven strategy.

Are We on the Brink of WWIII?

As the United States faces challenges from China and Russia, it also contends with the rise of new economic powers, notably the BRICS countries (Brazil, Russia, India, China, South Africa, and others). These nations have formed a coalition to promote their interests in the global economy, in opposition to the United States-led international order. The BRICS have discussed creating a new global currency to challenge the dominance of the U.S. dollar and have established institutions like the New Development Bank to provide an alternative to the IMF and World Bank. The United States, unwilling to relinquish its position as the world's dominant currency, has responded to these challenges with a variety of strategies. Given its economic and military strength, direct confrontation with China would not seem a viable option, leading to mutual assured destruction (MAD), yet the rhetoric of an upcoming war with China before 2030 often appears among representatives of the “Deep State.” Currently, the United States has adopted a strategy of creating global instability, which some analysts describe as “undeclared WWIII.” This strategy involves supporting proxy wars and fostering conflict in regions where China's and Russia's influence is growing.

Conflicts such as those in Syria, Yemen, Palestine, Lebanon, Iraq, Somalia, and Sudan are part of this extensive, permanent geopolitical struggle. These wars have devastating public health repercussions, including—as previously mentioned—the displacement of millions, the destruction of health care infrastructure, and the spread of infectious diseases. From a public health perspective, comprehending the geopolitical motivations behind these conflicts is crucial for their prevention. Wars, especially those stoked by global power struggles in an increasingly multipolar world with various great powers (i.e., United States, Russia, China, India, and others), foster conditions where diseases flourish, health care systems deteriorate, and populations encounter long-term health ramifications. Public health professionals must acknowledge that tackling the root causes of health inequalities often necessitates engaging with the political forces that shape global dynamics and conflicts by promoting peace, diplomacy, and global equity.

Given the current geopolitical landscape, the question arises: Are we on the brink of a Third World War? While a direct global conflict between major powers may not be imminent in the wake of peace talks between the United States and Russia, the widespread use of proxy wars and the growing tensions between the United States, China, Russia, and other emergent global powers^30,31 suggest that the world is moving closer to a state of multipolarity and perpetual conflict. This “undeclared WWIII” may not resemble the World Wars of the twentieth century, but it could have equally devastating consequences for global public health. The rise of new global powers, the relative or partial decline of U.S. dominance, and the increasing number of proxy wars all point to the world becoming more unstable and conflict-prone.

Moreover, the risk of a nuclear conflict remains alarmingly high due to several factors. ³² Geopolitical tensions between nuclear-armed political actors, particularly the United States, Russia, Israel, and Europe, have escalated, increasing the potential for miscalculation errors or apocalyptic conflict. With over 12,000 nuclear warheads existing worldwide, the potential for accidental or deliberate use of these devastating weapons is ever present. ³³ Nuclear weapons today are far more powerful than those used during World War II, and a single detonation could result in millions of casualties, long-term environmental destruction, and global economic collapse. ³⁴ Failure to control nuclear proliferation and manage escalating tensions via diplomacy may bring the world closer to an unprecedented humanitarian disaster. The threat of nuclear war continues to be one of the most pressing global security risks of our time. By understanding the basic principles of geopolitics, public health professionals can better address the root causes of health inequalities and work toward a healthier, more peaceful world. Public health professionals must be prepared to prevent and deal with the health impacts of these conflicts.

Given this panorama, it can be concluded that the world currently faces the risk of a Third World War, driven by the modernization of nuclear arsenals and rising geopolitical competition for scarce resources in a context of global warming. To avert this crisis, global leaders need to prioritize peace through diplomacy, agreements, and political dialogue. Diplomatic efforts must focus on resolving conflicts before they escalate, making diplomacy a necessity rather than an option. On a multilateral level, countries must strengthen arms control treaties, such as the Nuclear Non-Proliferation Treaty (NPT) and the Treaty on the Prohibition of Nuclear Weapons (TPNW), which have proven effective in reducing tensions. Moreover, global agreements should promote peace alongside sustainable development, ensuring social justice and environmental balance and reducing the risk of resource- or climate-driven conflicts. The United Nations and similar international organizations are crucial for mediating conflicts and promoting global cooperation. Ultimately, only through political will and the establishment of peaceful solutions can the world avoid the devastating consequences of another global war. As Einstein famously said, “I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones”, ³⁵ a scenario that today seems more likely than ever.

Conclusion: The Imperative Role of Public Health Values

In an era marked by escalating geopolitical tensions and the looming threat of nuclear conflict, public health institutions and their educators and researchers bear a profound responsibility. Professionals and academic programs within these institutions must engage deeply with war and conflict as a determinant of health, not only to understand the growing risks of war and nuclear warfare but to actively integrate these critical issues into their curricula, research agendas, and advocacy efforts. The interconnectedness of global health and global security is undeniable: wars devastate health systems, displace populations, cause widespread death and sickness, and create long-term physical and psychological trauma. Public health educators, researchers, and practitioners cannot remain passive observers. We must confront this urgency by advancing rigorous study of the root causes of conflict, fostering research on its role as a determinant of health and health inequity, and embedding teaching on peacebuilding and conflict prevention into public health training. Beyond academia, we must amplify our commitment to peace through policy, dialogue, community engagement, and partnerships that prioritize diplomacy and disarmament.

Peace is not merely the absence of war—it is a cornerstone of planetary health and global justice, and is necessary for achieving a healthy, equitable, and sustainable future. ³⁶ By equipping future professionals with the knowledge, ethics, and tools to tackle these existential threats, public health institutions can become catalysts for a safer, more resilient, and fairer world. The time for passive concern has passed; this moment demands bold scholarship, education, and action. Let us teach peace, research peace, and practice peace through diplomacy, because the survival of humanity depends on it.