Where you live may matter more to your health than what you know about healthcare

Every morning, Nigerian families make decisions about their health. Parents remind children to wash their hands, prepare what they can afford, and send them to school. Yet they may have little control over the water coming from the tap, the fumes along the route to school, the safety of the road they cross or the drainage that overflows when it rains.

We often tell people how to live healthier lives: eat well, exercise, practise good hygiene and seek care early. This advice matters. But after more than three decades in public health, I believe we must ask a harder question: how much control do people have over their health when the conditions around them make healthy living difficult?

Nigeria’s cities make the answer plain. UN-Habitat’s World Cities Report 2024 estimated that about 48.5% of Nigeria’s urban population—more than 56 million people—lived in slums or informal settlements in 2022. WHO and UNICEF estimates for that year suggest only 29% of Nigerians had access to safely managed drinking water: water available at home when needed and free from contamination. These are not simply housing and infrastructure statistics. They describe daily exposure to risk, and the time and money families must spend compensating for systems that do not reliably serve them.

The consequences reach across generations. A child’s repeated exposure to unsafe water can mean illness and missed school. A young worker walking beside fast-moving traffic faces risks that no amount of road-safety messaging can eliminate. The World Health Organization estimated 36,722 road-traffic deaths in Nigeria in 2021, far above the 6,205 deaths officially reported that year—a gap that also points to the need for stronger injury surveillance. Meanwhile, air pollution from traffic, generators, industry and household fuels contributes to diseases of the lungs and heart. WHO says 99% of the global population breathes air that exceeds its air-quality guideline limits.

The recent Ebola diagnosis in Nigeria adds another lesson. On 20 October 2026, authorities confirmed a case in Abuja linked to a wider outbreak of Bundibugyo Ebola virus disease in Central and East Africa. Reporting has raised questions about the time between symptom onset and diagnosis, as well as the identification and monitoring of contacts. The source of infection and the full extent of possible exposure remained under investigation in reports available at the time of writing. This is not a reason for panic or stigma. It is a reminder that preparedness depends on more than border checks: health workers need training and protective equipment, facilities need clear triage and referral pathways, laboratories and surveillance systems must work promptly, and the public must be able to seek care without fear or misinformation.

These issues may appear different—unsafe water, dangerous roads, polluted air and an emerging infection—but they share a common truth: health is shaped by the environments and systems people depend on. Those with secure housing, reliable services and easier access to care can avoid or manage risks that poorer households cannot. The difference is not simply knowledge or personal discipline; it is the unequal distribution of protection and opportunity.

Nigeria must therefore treat urban planning as public health policy. Safe water, sanitation, drainage, affordable and secure housing, clean air, walkable streets and strong frontline health services are not luxuries to be postponed until after economic growth. They help determine whether children learn, young people thrive, adults remain productive and older people age with dignity. Governments at every level must work across health, transport, housing, environment and education; employers and communities also have a role in making the places where people live and work safer.

We should keep encouraging healthier personal choices. But we must stop pretending that choice alone determines health. A healthier Nigeria will require more than healthier people. It will require healthier places to live—and public systems capable of protecting people before illness begins.

Dr. Anne Adah-Ogoh is the Director of Policy and Programmes, Private Sector Health Alliance of Nigeria (PSHAN).