In this Perspective, the authors review the scope and operation of global health security, identify emerging threats, and assess how adequately current visions of global health security account for these threats.

To (i) develop a methodology for using historical and comparative perspectives to inform policy and (ii) provide evidence for antimicrobial-resistance (AMR) policymaking by drawing on lessons from climate change and tobacco control. Using a qualitative design, we systematically examined two other complex, large-scale policy issues-climate change and tobacco control-to identify what relevance to AMR can be learned from how these issues have evolved over time. During 2018-2020, we employed a five-stage approach to conducting an exploratory study involving a review of secondary historical analysis, identification of drivers of change, prioritisation of the identified drivers, scenario generation and elicitation of possible policy responses. We sought to disrupt more 'traditional' policy and research spaces to create an alternative where, stimulated by historical analysis, academics (including historians) and policymakers could come together to challenge norms and practices and think creatively about AMR policy design. An iterative process of analysis and engagement resulted in lessons for AMR policy concerning persistent evidence gaps and uncertainty, the need for cross-sector involvement and a collective effort through global governance, the demand for new interventions through more investment in research and innovation, and recognising the dynamic relationship between social change and policy to change people's attitudes and behaviours are crucial towards tackling AMR. We draw on new methodological lessons around the pragmatism of future- and policy-oriented approaches incorporating robust historical and comparative analysis. The study demonstrates proof of concept and offers a reproducible method to advance further methodology, including transferrable policies that could tackle health problems, such as AMR.

There is increasing concern in many advanced economies about the risks of disruption and crises in agri-food systems. Government departments and non-governmental organisations are working to identify and understand specific risks but struggle to take broad, holistic perspectives and therefore underestimate the potential for civil unrest. In the interests of helping move from understanding to action, we convened a group of experts through a Delphi process to map out potential pathways to acute UK food system crises and identify interventions that would build resilience and sustainability. To this end, we consulted 31 experts, carrying out 15 expert interviews, followed by three surveys and two workshops with a further 16 experts. The experts highlighted the many existing chronic issues creating a tinderbox for an acute risk to lead to a food crisis in the UK. These chronic issues include climate change, poor policy implementation, rising inequality, food supply chain consolidation and the risks from just-in-time supply of food. They voted to include three acute triggers—(a) cyber-attack, (b) a major extreme weather event and (c) a major new international conflict—and described how any combination of these could lead to (d) a UK food availability and/or price shock that could result in widespread fear of unsafe or inadequate food, leading to violence. A total of 7 system-wide interventions were prioritised to help address these pathway elements together and build sustainability, and a further 21 were identified to address elements individually.