Intersecting Health, Economic, and Environmental Challenges Among Older Adults Living in Poverty in Haiti: Evidence from a National Survey

Background and Purpose:
Aging in poverty presents profound challenges in low-income countries such as Haiti, where systemic barriers, including inadequate healthcare, food and water insecurity, and fragile social safety nets, leave older adults particularly vulnerable. From both public health and social work perspectives, these conditions highlight a failure of structural support systems to uphold the rights and dignity of aging populations. Despite the growing global focus on aging, older adults in Haiti remain largely invisible in national policies and development agendas. Social workers are uniquely positioned to advocate for this population by promoting social justice, resource equity, and community-based solutions. This study investigates the intersection of aging, poverty, and environmental hardship in Haiti, with an emphasis on gender and geographic disparities. Key research questions include: (1) What is the prevalence of health and poverty-related challenges among older Haitian adults? (2) How do these outcomes vary by gender, location, and socioeconomic status, and what implications do these have for social service delivery and policy?

Methods:
We analyzed data from a 2024 nationally representative health and nutrition survey in Haiti, using a subsample of 1,408 adults aged 60 and over(56.4 % female). Data were collected from all 10 departments, excluding high-risk areas due to security concerns. Outcomes assessed included self-rated health, chronic illnesses (e.g., hypertension, diabetes), disability, food and water insecurity, and stress (measured by PSS-4). All outcomes were dichotomized. We conducted prevalence analyses and logistic regression models to examine associations between sociodemographic characteristics(e.g., sex, rural vs. urban residence, and socioeconomic status) and outcomes, controlling for education and marital status. Sensitive analyses were conducted to assess the stability of the estimates.

Results:
A significant portion of the older population reported very poor or poor health(30.4%), chronic illness (e.g., hypertension 54.3%, diagnosed diabetes 12.7%), and functional limitations. Food insecurity (60.4%) and water insecurity (29.1%) were widespread, with 27.4% experiencing high stress. Regression analyses showed that older women had greater odds of poor health (OR=1.31**), hypertension (OR=1.72***), and economic strain (e.g., food insecurity OR=1.25**, water insecurity OR=1.28**). Rural living was associated with worse self-rated health (OR=1.87***), but lower odds of some chronic conditions; however, it substantially increased the likelihood of food insecurity (OR=1.89***).

Conclusions and Implications:
These findings highlight a syndemic of aging, poverty, and environmental vulnerability that disproportionately affects older women and rural residents in Haiti. From a public health perspective, the results underscore the need for preventive health programs, geriatric care access, and investment in infrastructure to mitigate chronic disease and stress. From a social work perspective, there is a call to action for rights-based, community-driven interventions—including mobile health services, food and water support, and elder care networks. Policy initiatives must center older adults within national development plans, addressing both immediate needs and systemic inequalities. Collaboration between local governments, social workers, and public health stakeholders is essential to ensure that aging populations are supported with dignity and inclusion. This study contributes evidence for a rights-based, social work-driven response to aging in poverty in Haiti, one that foregrounds equity, dignity, and inclusion.