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The 2022 report of the Lancet Countdown is published as the world confronts profound and concurrent systemic shocks. Countries and health systems continue to contend with the health, social, and economic impacts of the COVID-19 pandemic, while Russia’s invasion of Ukraine and a persistent fossil fuel overdependence have pushed the world into global energy and cost-of-living crises. The changing climate is affecting the spread of infectious diseases, putting populations at higher risk of emerging diseases and co-epidemics. Heat exposure led to 470 billion potential labour hours lost globally in 2021, with potential income losses equivalent to 0.72% of the global economic output.