Some global health threats take us by surprise, sparking fires we never expected to fight. Take Ebola, for instance – the world couldn’t have foreseen the 2014 outbreak, particularly in West Africa, which had never before experienced it. Other fires, though, have been smoldering quietly for decades, and are now building strength and becoming difficult to contain.

This year, IntraHealth International’s annual list is filled with such challenges. These topics will shape the global health agenda in 2016, defining what many global development organizations do this year and how we do it:

10. Ebola’s unprecedented survivors. Never before have there been so many survivors of the virus. Survival, it turns out, is both a boon and a burden – many now face a lifetime of social exile and chronic health problems. Ebola survivors will present new health-care challenges in 2016 as health workers learn to care for their unique needs. We’ll learn more than we’ve ever known about Ebola’s damaging physical, psychological and economic legacy.

9. Mental health for trauma survivors. In 2016, the mental health consequences of war, displacement, Ebola, gender-based violence, natural disasters and other traumas will become more and more apparent. Today’s global health workforce isn’t ready for these challenges – there are too few social service workers and others trained to provide complex, specialized mental health care, and far too few are based where the need is greatest. In fact, there just aren’t enough health workers right now to go around – period.

8. A reversal in the health worker shortage. According to the World Health Organization, there’s a global shortage of 7.2 million doctors, nurses and midwives. As we begin the first full year of our new Sustainable Development Goals, more countries will be working toward universal health coverage and to meet their health-related targets through stronger, more equitably distributed health workforces that include community health workers, widespread access to technology and a health team approach to bringing care to those in need. And for the first time ever, there will be a global strategy to achieve it: Human Resources for Health: Workforce 2030 is slated for release in 2016.

7. Air pollution. A study last year linked air pollution to 6 million deaths per year in China. Last month, Beijing issued its first red alert for smog. And smoking, which contributes to poor air quality, continues to rise in China, where it may cause about 20 percent of all adult male deaths during this decade. But air pollution is even worse in the United Arab Emirates, where the air contains 80 micrograms of pollutants per cubic meter, compared to China’s 73 and India’s 32. Health workers and systems around the world should be preparing for a rise in respiratory and other related health troubles.

6. Emerging and waning health threats. Polio and HIV are two of the most devastating diseases of our time – but they’re waning or, in the case of polio, on the verge of eradication. At the same time, Zika virus, Ebola flare-ups and other unexpected threats will make headlines in 2016, and pose challenges to global health security. For many health systems around the world, these dangers are already in the back yard.

5. Climate change. More extreme weather and rising sea levels, temperatures, and carbon dioxide levels could usher in a wide array of human health effects, the CDC warns – from asthma to chikungunya to mental illness. Will countries begin to make progress in curbing carbon emissions after the Paris climate accord of 2015? Or will the commitments made there fall by the wayside? And will progress come in time to protect the most vulnerable countries, such as the low-lying Marshall Islands, which are already disappearing as sea levels rise?

4. The health system as a whole. The U.S. government and other donors are finally recognizing and addressing health systems as whole, complex entities, rather than reducing them to series of disease-specific services. There’s even a first-of-its-kind bill pending in the U.S. Congress devoted to strengthening health systems as part of foreign aid, and global health security and planning is becoming a greater priority for the U.S. and the global community.

3. Politics and power shifts. The stakes are high for global health and development during any U.S. presidential election year, and this one will be no different. The U.S. is slated to contribute $37.9 billion in foreign aid during fiscal year 2016. But changes in the White House determine development policies and funding, and certain public health topics become highly politicized targets (reproductive health and family planning come to mind). For all countries – rich or poor – powerful data and up-to-date information are crucial when it comes to advocating for health investments.

2. The enduring wealth gap. Globally, the percentage of people living at or below $1.90 per day dropped from 44 percent in 1981 to 12.7 percent in 2012. Despite this remarkable progress, the wealth gap is growing. New Oxfam research indicates that the world’s 62 richest billionaires possess as much wealth as the 3.65 billion people who make up the poorer half of the human population. This inequality goes beyond wealth disparities; it means health disparities as well, as the poor are more likely to suffer chronic health problems, more likely to fall into financial hardships because of health costs, and less likely to have access to health care.

1. There are more than 59.5 million refugees today. That’s more than at any time in human history, even at the end of World War II. The movement of people – not just of those exiting Syria, but of all who are on the move worldwide – has huge implications for health systems around the world. The challenges of providing care to so many who’ve been displaced are staggering. And what about the families and friends they’ve left behind? Any mass exodus is sure to include skilled health workers, particularly as they and their facilities are common targets during wartime. And when health workers are forced to flee, their home towns are left without care. As the numbers shift in 2016, we’ll see the true public health implications of such a massive population of vulnerable human beings.

Of course, these aren’t the only fires that will shape global health in 2016. Every year brings adversities or victories we didn’t expect. What do you foresee for 2016? And are we ready for it?

Read more of IntraHealth’s annual lists: