*Why Integrated Lung Health Must Become a National Priority
By Prof. Chiwuike Uba, PhD
There is a health crisis in Nigeria that remains largely invisible, insufficiently measured and dangerously normalised. Nigerians breathe polluted air in their homes, on congested streets, at workplaces, in markets and around the generators that power homes and businesses. Smoke from firewood and charcoal, vehicle emissions, industrial pollution, construction dust, open waste burning and occupational exposure to dust, fumes and chemicals all contribute to the problem. In oil producing communities, gas flaring adds another source of exposure.
These are not merely environmental problems. They are public health risks that contribute to respiratory disease, disability and premature death. Tuberculosis (TB), pneumonia, asthma, chronic obstructive pulmonary disease (COPD), lung cancer and other respiratory conditions already impose a substantial burden on Nigerians and an overstretched health system.
The deeper problem is that Nigeria has not yet treated lung health as an integrated national development, environmental and public policy issue.
This is why the World Health Assembly Resolution WHA78.5, Promoting and prioritizing an integrated lung health approach, adopted on 27 May 2025, is so important. It calls for integrated action across the entire lung-health continuum, including prevention, early detection, diagnosis, treatment, rehabilitation and palliative care, while addressing air pollution, tobacco use, occupational risks and other determinants of lung health. Crucially, it calls for integrated lung health within primary healthcare as part of the attainment of universal health coverage.
For Nigeria, WHA78.5 should not become another international commitment to be acknowledged and forgotten. It should provide the foundation for a National Integrated Lung Health Agenda, with Primary Health Care (PHC) and Universal Health Coverage (UHC) at its centre.
*A National Responsibility, Not Just an International Commitment*
WHA78.5 is also consistent with Nigeria’s own constitutional policy framework. Section 17(3)(d) of the 1999 Constitution directs the State towards ensuring adequate medical and health facilities for all persons, while Section 20 provides that the State shall protect and improve the environment and safeguard Nigeria’s air, water and land. Section 19 recognises international cooperation and respect for international law and treaty obligations among Nigeria’s foreign-policy objectives.
WHA78.5 is a World Health Assembly resolution, not a treaty requiring domestication under Section 12. Its implementation should therefore not be presented as a matter of treaty domestication. Rather, it provides an international policy framework that is closely aligned with responsibilities already reflected in Nigeria’s constitutional policy objectives.
The question is therefore not whether Nigeria has a basis for action. It is whether the country will translate that policy direction into practical measures that protect the air Nigerians breathe and ensure that people with lung disease receive timely, affordable and quality care.
*Clean Air Is a Health Intervention*
Nigeria’s air pollution problem is driven by interconnected household, energy, transport, industrial and environmental conditions. The State of Global Air 2025 estimates that air pollution contributed to 7.9 million deaths globally in 2023, including more than 200,000 deaths in Nigeria. Globally, 4.9 million deaths were attributed to ambient PM2.5 and 2.8 million to household air pollution.
Nigeria’s exposures come from multiple sources: household cooking with polluting fuels, vehicle emissions, generators, factories, construction, waste burning and occupational hazards.
Then there is gas flaring. The World Bank’s 2026 Global Gas Flaring Tracker reports that global flaring reached 167 billion cubic metres in 2025, with Nigeria among the nine countries responsible for 83 percent of global flaring. The health implications deserve far greater attention. Gas flaring releases pollutants into surrounding environments, while research in Nigeria has linked exposure to flaring with childhood cough and respiratory illness.
Reducing routine gas flaring should therefore be understood not only as an energy, climate and economic objective, but also as a public-health intervention.
The same principle applies to clean cooking. If Nigerians are expected to move away from firewood and other polluting fuels, cleaner alternatives must be affordable and accessible. Reducing generator emissions requires more reliable electricity and cleaner energy alternatives. Better public transport can reduce traffic pollution, while effective waste management and stronger industrial and occupational standards can reduce exposure. Nigeria must stop treating clean air as an environmental luxury. Clean air is a health intervention.
*The Burden Is More than Disease*
The consequences extend beyond hospital statistics. Respiratory disease means missed school days, lost working days, reduced productivity, disability, premature death and household expenditure.
Nigeria’s TB burden illustrates both the scale of the challenge and the possibility of progress. Nigeria notified 458,534 TB cases in 2025, a substantial increase in case detection in recent years, but WHO continues to identify a significant gap between estimated disease incidence and cases diagnosed and notified.
Asthma illustrates another dimension of the crisis. A national Nigerian study estimated that approximately 15 million Nigerians were living with clinical asthma, highlighting a substantial chronic respiratory burden. Although this estimate should not be interpreted as a current 2026 population count, it remains an important indication of the scale of the problem, particularly because Nigeria still lacks comprehensive national surveillance for asthma, COPD and other chronic respiratory diseases.
Globally, the 2021 Global Burden of Disease analysis estimated 260 million people were living with asthma and 21.4 million disability-adjusted life years were attributable to the disease. Asthma also causes preventable deaths, with mortality disproportionately affecting low and middle-income countries.
The burden of asthma is not simply a matter of having the disease. Poorly controlled asthma can lead to repeated attacks, emergency visits, school and work absenteeism, reduced productivity and avoidable healthcare expenditure. Yet many patients face barriers to diagnosis, regular monitoring and access to affordable inhaled medicines.
This is precisely why asthma cannot remain outside the core of primary healthcare and universal health coverage. A patient with recurrent wheezing or breathing difficulty should be identified early, properly assessed, provided with appropriate treatment and supported to manage the condition before it becomes an emergency.
COPD and other chronic respiratory conditions present similar challenges. They are frequently underdiagnosed, particularly where access to spirometry and other diagnostic services is limited.
The country therefore needs to ask not only how many Nigerians are sick, but also how many are being missed, inadequately treated or forced to live with preventable disability.
*Primary Health Care (PHC) Must Become the Front Line*
The most important implication of WHA78.5 for Nigeria is that lung health must become an integral component of Primary Health Care and Universal Health Coverage. This does not require another vertical programme. It requires making essential lung health part of routine PHC.
Primary healthcare facilities should progressively have the capacity to recognise respiratory symptoms, identify people requiring TB investigation, detect childhood pneumonia, recognise and manage uncomplicated asthma, identify chronic respiratory disease, provide tobacco and nicotine cessation counselling, assess major environmental and occupational exposures, promote vaccination and respiratory hygiene, provide essential medicines and refer patients requiring more advanced care.
Lung health should cover the continuum from prevention and early detection to diagnosis, treatment, rehabilitation and palliative care, with effective referral pathways connecting communities and PHC facilities to secondary and tertiary services.
This is the practical meaning of integrated lung health: moving from fragmented disease programmes to patient-centred care.
*Universal Health Coverage (UHC) Must Actually Protect Patients*
Universal health coverage cannot mean merely having a health facility within reach. It means obtaining needed services without financial hardship.
Nigeria’s health-financing architecture, including the National Health Insurance Authority and state health insurance schemes, should progressively cover essential lung-health services. This must include equitable access to affordable diagnostics, medicines, vaccines, oxygen and appropriate respiratory technologies.
For the millions of Nigerians living with asthma, financial protection must mean more than treating an acute attack. It must include access to the essential medicines needed to control the disease and prevent attacks in the first place. For COPD, this means reliable access to essential inhaled medicines. For TB, accessible diagnostics and treatment. For pneumonia, timely diagnosis, treatment and oxygen where required. For advanced lung disease and cancer, appropriate referral, specialist care, rehabilitation and palliative services.
A patient who cannot afford an essential inhaler or diagnostic test is not meaningfully protected by UHC.
*Prevention Must Begin Outside the Health System*
A health system can diagnose asthma, treat pneumonia and provide inhalers, but it cannot prevent repeated exposure to polluted air if the sources of pollution remain unchanged.
Lung health therefore requires a whole-of-government response. Health authorities must work with environment, energy, transport, labour, education, finance, housing and urban-development institutions.
Clean cooking is an energy and health intervention. Reliable electricity is an infrastructure and health intervention. Better public transport is a transport and health intervention. Stronger workplace protection is a labour and health intervention. Reducing gas flaring is an energy, environmental and health intervention.
This is why the integrated approach envisaged by WHA78.5 must extend beyond the health sector.
*People, Medicines, Data and Preparedness Matter*
No integrated lung-health strategy will succeed without a capable workforce. Nigeria needs stronger respiratory-care training for doctors, nurses, community health workers and other frontline providers. Community health workers can support early recognition, TB referral, health education, tobacco prevention and awareness of household air pollution.
The country must also improve access to affordable diagnostics, medicines, vaccines, oxygen and respiratory technologies, supported by stronger regulation, procurement and local manufacturing.
Asthma demonstrates why this matters. A country may have millions of people living with a chronic respiratory disease but still have limited reliable information on who they are, where they live, how well their disease is controlled, what medicines they can access and how much they spend on care. Data must improve as well. Nigeria needs an integrated lung-health surveillance system covering TB, pneumonia, asthma, COPD, lung cancer, tobacco and nicotine use, occupational exposure, air pollution, diagnostic capacity, medicine availability and health outcomes.
Air-quality monitoring should be expanded, particularly in major cities, industrial areas, transport corridors, schools and communities affected by oil and gas activities. Research should better connect environmental exposures with health outcomes.
Preparedness for respiratory emergencies must also form part of the system. COVID-19 demonstrated the importance of surveillance, infection prevention and control, oxygen capacity, emergency supply chains and health-worker protection. A resilient lung-health system is therefore also an investment in national health security.
*Equity Must Be at the Centre*
The burden of lung disease is not equally distributed. Poor households are more likely to experience household air pollution and barriers to healthcare. Rural and underserved communities often have less access to diagnostics, medicines and specialist care. Children, older people and workers in hazardous environments face particular risks, while communities around industrial and oil-producing areas may experience sustained environmental exposure.
An integrated lung-health strategy must therefore prioritise vulnerable and underserved populations and measure progress not only through national averages, but through reductions in inequalities in exposure, access and outcomes.
*Building on the Work Already Underway*
Nigeria is not starting from zero. Patient organisations, professional bodies, civil society and development partners are already helping to move lung health higher on the policy agenda.
The Global Allergy & Airways Patient Platform (GAAPP) deserves particular commendation for providing a regional and global platform that brings patients, clinicians, advocates, policymakers and other stakeholders together around asthma, COPD and airway diseases. Its AMEA regional programme places strong emphasis on translating World Health Assembly resolutions into national advocacy, strengthening the patient voice, improving health literacy, engaging young people, supporting policy change and building multisectoral collaboration.
The Amaka Chiwuike-Uba Foundation (ACUF) is contributing to this broader agenda by connecting lung health with primary healthcare, universal health coverage, public financing, governance and sustainable development.
The work of GAAPP and ACUF demonstrates an important principle: global commitments become meaningful only when they are translated into locally owned policies, adequately financed systems and sustained action that improves the lives of patients and communities.
*What Nigeria Should Do Now*
Nigeria does not need to wait for another five-year strategy. Within the next 100 days, the Federal Government should formally adopt WHA78.5 as a national policy reference and establish a high-level National Integrated Lung Health Steering Committee bringing together health, environment, labour, education, finance, energy, transport and other relevant sectors.
It should undertake a rapid national lung-health assessment covering respiratory disease, air pollution, household energy, occupational exposure, PHC capacity, workforce, diagnostics, medicines, oxygen, financing and data.
It should develop and cost an Essential Lung Health Package for PHC, integrating prevention, early detection, diagnosis, treatment, rehabilitation, palliative care and referral into the UHC architecture. This package should be reflected in health-insurance benefits and PHC financing.
Government should simultaneously accelerate clean cooking, strengthen air-quality monitoring, reduce routine gas flaring, improve occupational protection, strengthen tobacco control, expand respiratory-workforce training and establish a national lung-health surveillance and research framework.
States should translate the national framework into state-level action, while local governments and communities should support prevention, awareness and PHC delivery.
Most importantly, Nigeria should develop a fully costed National Integrated Lung Health Action Plan, with measurable targets, financing requirements, institutional responsibilities and public accountability.
*The Bigger Development Question*
Ultimately, this is about more than lungs. Nigeria cannot aspire to greater productivity and human-capital development while millions of citizens breathe polluted air. It cannot pursue UHC while essential respiratory care remains unaffordable. It cannot protect children while ignoring the environments in which they live, learn and breathe. And it cannot continue treating diseases generated by poverty, energy insecurity, unsafe workplaces and environmental degradation without addressing those underlying conditions.
WHA78.5 provides Nigeria with an opportunity to change direction. It brings together prevention, early detection, treatment, rehabilitation, palliative care, PHC, UHC, clean air, affordable medicines, workforce development, data, research, equity and preparedness within one integrated framework.
Nigeria should seize that opportunity. The country does not need another isolated respiratory programme. It needs to make lung health part of what primary healthcare means, what universal health coverage guarantees, what environmental policy protects and what national development values. Because a nation that cannot protect the air its people breathe, prevent avoidable respiratory disease and ensure affordable care when people become ill cannot fully protect its most valuable asset: its people.
Nigeria must stop treating the symptoms of a crisis it continues to breathe into existence. It must protect the air its people breathe and make lung health part of what primary healthcare, universal health coverage and national development mean.
Nigeria must act now.