Nigeria’s next health crisis may not look like an epidemic

For decades, public-health discussions in Nigeria have been dominated by diseases that are immediately recognisable as emergencies. Malaria, tuberculosis, HIV, cholera and other infectious diseases have understandably occupied much of our attention, alongside the continuing challenge of maternal and newborn mortality. These remain important priorities, but another health burden is becoming increasingly difficult to ignore. Noncommunicable diseases (NCDs), including hypertension, diabetes, cardiovascular diseases and cancers, are already responsible for a substantial proportion of deaths in Nigeria, yet they rarely receive the same sense of urgency as infectious disease outbreaks.

According to the World Health Organization’s 2025 Noncommunicable Diseases Progress Monitor, NCDs accounted for an estimated 28 per cent of all deaths in Nigeria in 2021, equivalent to approximately 467,800 deaths. The estimated probability of dying prematurely, between the ages of 30 and 70, from one of the four major NCD groups was 18 per cent. These figures describe a burden that is already present, not a distant threat that policymakers can afford to postpone addressing.

What makes this challenge particularly difficult is that NCDs rarely announce themselves in the way infectious outbreaks do. Hypertension can exist for years without obvious symptoms, diabetes may remain undiagnosed until complications develop, and cardiovascular disease may first become apparent when someone suffers a stroke or heart attack. Cancer, too, may only come to medical attention when a patient presents with advanced disease. By then, opportunities for prevention, early intervention and less costly treatment may have narrowed considerably.

Hypertension illustrates the gap between disease burden and public-health response. A systematic analysis published in 2021 estimated that approximately 27.5 million Nigerians aged 20 and above were living with hypertension in 2020, with an age-adjusted prevalence of 32.5 per cent. Yet only about 29 per cent were aware of their condition, 12 per cent were receiving treatment and just 2.8 per cent had their blood pressure controlled to target. The analysis also estimated that the number of Nigerians living with hypertension had increased by 540 per cent between 1995 and 2020. More recent research, published in 2026, estimated pooled hypertension prevalence at 34.2 per cent across 32 studies involving almost 50,000 Nigerian adults. Although substantial differences between the studies mean this should not be treated as a precise national surveillance estimate, the findings reinforce the scale of the challenge.

The implication is not simply that Nigerians need to be encouraged to check their blood pressure. A condition that is common, detectable and treatable should be addressed routinely within primary healthcare. Blood-pressure measurement should not happen only when people feel unwell, and diagnosis should not mark the end of the health system’s responsibility. Patients need affordable medicines, appropriate counselling and regular follow-up if early detection is to translate into fewer strokes, heart attacks and other complications.

Diabetes presents a similar challenge. A 2024 systematic review and meta-analysis covering 60 studies and 124,876 participants estimated the pooled prevalence of type 2 diabetes in Nigeria at 7%. The analysis identified physical inactivity, urban residence, elevated body mass index, abdominal obesity and infrequent vegetable consumption among the factors associated with the disease. It also found variation between geopolitical zones, underscoring the importance of responses that recognise differences in local circumstances rather than treating Nigeria’s population as epidemiologically uniform.

These findings also expose the limitations of reducing prevention to individual responsibility. Personal behavior matters, but health is shaped by the environments in which people live. What food is affordable and available? How easy is it to find a safe place to walk or exercise? Can someone in a rural community have their blood pressure checked without travelling long distances? If a person is diagnosed with hypertension or diabetes, can they obtain affordable treatment consistently? These are questions about public policy, the built environment and the accessibility of healthcare, not simply individual choices.

Cancer further illustrates the consequences of delayed detection. The International Agency for Research on Cancer’s GLOBOCAN 2022 estimates recorded 127,763 new cancer cases and 79,542 cancer deaths in Nigeria that year, with breast, prostate and cervical cancers among the leading cancers by number of new cases. These figures are estimates rather than a complete national cancer registry count, but they indicate the substantial burden facing the country. Screening and early diagnosis cannot prevent every cancer death, but appropriate screening, timely investigation and prompt referral can improve the prospects of effective treatment. Nigeria therefore needs to strengthen not only specialist cancer services but also the primary healthcare pathways through which prevention and early detection can reach more people.

The country has already acknowledged the need for a broader response. Nigeria developed a National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases for 2019–2025, recognising that many of the factors driving NCDs extend beyond the health sector. Food systems, tobacco regulation, transport, urban planning, education and opportunities for physical activity all influence population health. Yet a policy framework can achieve little if its commitments are not translated into implementation. A 2025 policy brief from the African Health Observatory Platform identified weaknesses in Nigeria’s NCD response, including inadequate implementation of the multi-sectoral approach and insufficient guidance for putting it into practice at primary healthcare level.

This implementation gap matters because prevention cannot depend on occasional awareness campaigns. It must become part of how the health system operates. Routine blood-pressure checks, appropriate diabetes screening, cardiovascular-risk assessment, cancer prevention and early detection should be integrated into services that people can access without prohibitive costs. The World Health Organisation recognises detection, screening and treatment as essential components of the NCD response, with many high-impact interventions deliverable through primary healthcare.

Primary healthcare must therefore be understood as more than a place where people receive treatment for minor illnesses before being referred elsewhere. Properly organised, it should connect health promotion, prevention, early diagnosis, treatment and continuing care as close as possible to where people live. This is particularly important for chronic diseases, which require sustained management rather than a single episode of treatment. Detecting hypertension is only the beginning; the health system must also ensure that patients can remain on treatment and have their condition monitored over time.

There is an economic argument for taking this approach seriously. Nigeria’s population is young, but a young population is not immune to chronic disease. Hypertension, diabetes and other NCD risk factors can affect people during their economically productive years. A stroke that disables a parent, a cardiovascular event that removes a breadwinner from work or a cancer diagnosis that consumes a household’s savings carries consequences beyond the individual patient. Families, employers and the health system all bear the cost, making prevention and early management important investments in social and economic well-being.

Nigeria must resist framing NCDs as competing with infectious diseases for attention and resources. We do not have to choose between malaria and hypertension, maternal mortality and cancer, or tuberculosis and diabetes. The country needs a health system capable of responding to all these conditions while recognising that different diseases require different approaches. Infectious disease control may demand rapid detection and interruption of transmission, while NCD control requires sustained prevention, early diagnosis, continuity of care and healthier environments.

The more fundamental challenge is changing our understanding of when healthcare should begin. Nigeria has rightly invested considerable effort in responding to people who are already ill, but protecting health also requires identifying risks before they become life-threatening complications. Many NCD deaths and complications are preventable or can be reduced through healthier environments, early detection and effective long-term management. The opportunity lies in making these interventions routine rather than exceptional, particularly for people who are least able to afford private healthcare.

Nigeria’s next health challenge may not look like an epidemic, but its consequences are already evident in the number of people living with chronic conditions and the complications that emerge when those conditions go undetected or untreated. The question is not whether the country can afford to pay greater attention to noncommunicable diseases. It is whether it can afford to continue discovering them only after they have significantly altered the lives of patients and their families. Prevention must become a central function of Nigeria’s health system, not an afterthought to treatment.