By Ebuka Ukoh

This columnist explores African public health, institutions, and governance, connecting global lessons to local challenges to promote systemic reform and investment in Nigeria’s human capital.

Japan has just crossed an extraordinary threshold.

As of September 1, the country had 107,677 people aged 100 or older, the first time its centenarian population has exceeded 100,000.

In 1963, Japan counted only 153 centenarians. The number has now risen for 56 consecutive years. Women account for nearly 88 per cent of the total today.

One hundred and seven thousand, six hundred and seventy-seven people have lived for at least a century. I read that number and marvelled. Then, as a Nigerian, another thought entered my mind. Who will build the health systems that will enable our own people to grow old?

Not merely hospitals. Systems. Because perhaps one of the greatest differences between nations is not whether their citizens dream of longevity. We all do. It is whether their institutions make long life more possible.

Longevity Isn’t an accident
We should be careful not to romanticise Japan.
Its extraordinary longevity isn’t due to hospitals alone. Diet, genetics, sanitation, education, income, social conditions, public health, lifestyle and community all matter. An ag(e)ing population also presents Japan with enormous challenges, including rising healthcare needs, pension pressures, and a shrinking workforce.

But 107,677 centenarians do not emerge from nowhere. Somewhere along the journey from birth to 100, a society has to work. Children must survive infancy.

Mothers must survive childbirth. Vaccines must reach people. Clean water must flow. Diseases must be detected. Doctors must be trained. Nurses must be retained. Medicines must be available. Emergency services must function. And when people grow old, a system must still be able to care for them.

Longevity is therefore not simply a biological achievement. It is partly an institutional achievement. That is what Nigeria should think about.

We have the young people
Nigeria has something many ageing societies increasingly wish they had: youth. Most of our population is young. That is routinely described as our demographic advantage. And it can be. But a young population is not automatically a demographic dividend. It is only potentially so.

The dividend arrives when young people are educated, healthy, productive, skilled, and able to build institutions stronger than those they inherited. Otherwise, an unplanned demographic dividend can be disappointing. The question, therefore, is not simply how many young Nigerians we have.

It is: What are we preparing them to build? Who among today’s children will become the epidemiologists who stop the next outbreak? Who will become the nurses who transform maternal care? Who will design our emergency-response systems? Who will build diagnostic laboratories in communities where people currently travel hours for basic tests? Who will develop Nigerian medical technologies? Who will modernise primary healthcare? Who will research diseases that disproportionately affect Africans? Who will build the hospitals in which Nigerians will one day turn 100?

They are probably already here.

Some are sitting in overcrowded classrooms. Some are studying by generators. Some are brilliant children whose parents cannot afford university fees. Some are medical students wondering whether the future they want exists in Nigeria. And some of the doctors and nurses we have already trained are preparing to leave our shores for greener pastures.

We cannot keep training other people’s health systems
Nigeria’s health workforce problem should trouble us.
The WHO’s 2025 health-system profile says Nigeria’s supply of doctors, nurses, and midwives remains below recommended levels, with shortages compounded by uneven distribution, poor working conditions and the movement of health professionals abroad.

This is painfully ironic. Nigeria can educate a child from primary school. Subsidise parts of that child’s education. Train that child to become a doctor or nurse. Then create working conditions so frustrating that another country receives the mature product of that investment.

The Nigerian professional is not wrong for seeking a better life. People have families. They have ambitions. They want functioning equipment, professional development, reasonable compensation, and environments where doing their jobs doesn’t require daily heroism.

So perhaps the better question is not: Why are they leaving?

It is: What have we built that should persuade them to stay? Patriotism cannot substitute indefinitely for functioning institutions. A surgeon cannot operate with patriotism. A laboratory cannot run on patriotism. An ambulance cannot be fuelled with patriotism. And a nurse cannot feed a family with applause.

A hospital is built long before brick and mortar arrive

When politicians speak about healthcare infrastructure, we often see buildings. A new hospital is commissioned. There are cameras. There is a ribbon. There are speeches. But a health system is neither concrete nor brick and mortar. A beautiful building without nurses is architecture. An intensive-care unit without working equipment is just a room. An ambulance without an emergency network is a mere vehicle. A medical school without research investment is an incomplete promise. A hospital’s most important infrastructure is ultimately human. That human infrastructure takes decades to build. The consultant physician of 2050 may be sitting in a secondary school today. The biomedical engineer who will design equipment suited to Nigerian hospitals may currently be a child taking apart broken electronics somewhere in Aba.
The public-health specialist who will prevent an epidemic may be sitting in a classroom in Kano. The nurse who will hold a 99-year-old’s hand may not yet have been born. Nation-building requires the imagination to invest in people whose contributions may mature long after the politicians making today’s decisions have left office.

Real meaning of centenarian
Japan’s milestone should therefore not make us ask whether Nigerians can live to 100. Some already do. Nor should we turn longevity into a competition between countries. The better question is whether an ordinary Nigerian child born today can reasonably expect to live, supported by institutions that value survival.

Will pregnancy be safer? Will childbirth be safer? Will infancy be safer? Will cancer be detected earlier? Will emergency care arrive faster? Will people treat the elderly as human beings rather than burdens? Will quality healthcare depend less on whether your surname opens doors or your bank account can purchase treatment abroad? That is the journey from birth to 100.

And we must understand something else. The health system we refuse to build today is the one we will desperately need tomorrow, and won’t have.

Politicians grow old too. Civil servants grow old. Business leaders grow old. Presidents grow old. Governors grow old. The body eventually makes everyone equal.

Our young are the infrastructure
Nigeria’s youth are frequently described as a problem to be managed. Too many are unemployed. Many more are leaving. So are the frustrated. Countless have lost faith in their nation. Perhaps we should see them differently. They are the people who must build what does not yet exist.

Our responsibility is to give them the education, healthcare, laboratories, mentorship, research funding, employment opportunities, and functioning institutions that let their abilities become national assets.

Japan’s 107,677 centenarians tell one story about a country growing older. Nigeria’s millions of young people tell another story about a country still extraordinarily young. Neither youth nor longevity guarantees prosperity. Both require planning.

One country must ask how it will care for an ageing population. Nigeria must ask whether it will prepare its young population to build a country where growing old is worthwhile. That is our assignment. Because somewhere in Nigeria today is a child who could transform African medicine.

Somewhere is tomorrow’s surgeon. Tomorrow’s nurse. Tomorrow’s scientist. Tomorrow’s hospital administrator. Tomorrow’s biomedical engineer. Tomorrow’s public-health leader. The question is whether we will find them, educate them, equip them, and give them a country where they can do their best work.

Japan has more than 107,000 people who have reached 100. I celebrate them.
But in Nigeria, I think about the future. Who will build the health systems that will carry our children safely into old age? The answer is already among us. We have to stop wasting them.

Ukoh, a PhD student and coauthor of Built By The Ancestors, writes from his base in New York, the United States.