Syndemic Effects of Food and Water Insecurity on Blood Pressure and Stress in Haiti: Integrating Public Health and Social Work Perspectives

Background and Purpose

In low-income countries like Haiti, the intersection of food and water insecurity presents an urgent public health crisis and a profound social justice issue. These insecurities often co-occur, forming a syndemic that amplifies the risk of chronic diseases such as hypertension and psychological stress. Public health literature has well documented the biological pathways linking poor nutrition and hydration to chronic conditions. However, the structural and environmental causes, poverty, gender inequality, political instability, and weak infrastructure, are equally critical and align closely with the core concerns of social work. In Haiti, nearly half the population faces food insecurity, while water insecurity remains rampant due to recurring natural disasters and poor infrastructure. Vulnerable populations, especially older adults, women, and the economically disadvantaged, face heightened risk. This study applies a syndemic framework to examine the compounded effects of food and water insecurity on health outcomes in Haiti, focusing on high blood pressure and stress. The research integrates public health analysis with a social work lens to identify multi-level interventions for systemic change.

Methods:
We used data from a nationally representative 2024 survey on health and nutrition in Haiti, with responses from 7,040 adults aged 18 and older (48.8% men and 51.2% women). Data were collected across all 10 departments, excluding unsafe zones due to gang violence. Blood pressure was measured three times per participant and averaged; individuals with readings ≥140/90 mm Hg were categorized as hypertensive. Stress was assessed using the Perceived Stress Scale-4 (PSS-4). Food insecurity was measured using selected items from the Household Food Security Survey Module, and water insecurity via the Four-Item Household Water Insecurity Experiences Scale. Key covariates included age, gender, rural versus urban residence, and socioeconomic status. Logistic regression models were used to analyze associations and syndemic interactions. The study was approved by the Haiti National Bioethics Committee.

Results:
Among adults surveyed, 12% reported poor health, 22.7% had high blood pressure, and 23.8% experienced high stress levels. Insecurity was widespread: 59.6% faced food insecurity and 29.4% water insecurity. The intersection terms of both food and water insecurity significantly increased the odds of poor self-rated health(OR=1.4, CI: 1.11–1.69), high blood pressure(OR=2.0, CI: 1.47–2.73), and high stress(OR=2.7, CI: 2.08–3.68). Chronic conditions and physical limitations further exacerbated these outcomes.

Conclusions and Implications
This study reveals that food and water insecurity in Haiti are not only public health risks but also manifestations of systemic inequality. From a public health perspective, the findings support urgent investments in preventive healthcare, nutrition programs, and infrastructure to reduce the burden of non-communicable diseases. From a social work perspective, the results highlight the need for structural interventions that promote equity, access, and dignity. Integrated, community-driven responses are essential, such as mobile health services, mental health outreach, and food and water cooperatives to build resilience. Social workers and public health practitioners must collaborate to design and implement policies that address both the symptoms and root causes of health disparities in Haiti. This syndemic framework underscores the importance of interdisciplinary strategies to improve health and well-being in resource-limited settings.