We summarise the main findings of the Global Wetland Outlook (2018) about the status of wetlands, including their biota and ecosystem services, the drivers of change in wetlands, and the responses being adopted by the Ramsar Convention. The Outlook, which is the Ramsar Convention’s flagship publication, generally paints a bleak picture of wetland status. On the basis of these findings, we identify 10 key issues for decision makers to consider and recommend actions to implement so as to reverse the overall downward trends for wetlands. A switch from documenting the change in wetland biodiversity towards more emphasis on taking decisions is needed to implement effective responses and reverse the negative trends for wetlands. Although further data are needed, we contend that failure to place greater emphasis on effective responses could lead to the Convention becoming an irrelevant force for the wise use of wetlands.