Agricultural wealth better predicts mental wellbeing than market wealth among highly vulnerable households in Haiti: Evidence for the benefits of a multidimensional approach to poverty

Abstract

Objectives Lack of wealth (poverty) impacts almost every aspect of human biology. Accordingly, many studies include its assessment. In almost all cases, approaches to assessing poverty are based on lack of success within cash economies (eg, lack of income, employment). However, this operationalization deflects attention from alternative forms of poverty that may have the most substantial influence on human wellbeing. We test how a multidimensional measure of poverty that considers agricultural assets expands the explanatory power of the construct of household poverty by associating it with one key aspect of wellbeing: symptoms of mental health. Methods We used the case of three highly vulnerable but distinctive communities in Haiti—urban, town with a rural hinterland, and rural. Based on survey responses from adults in 4055 geographically sampled households, linear regression models were used to predict depression and anxiety symptom levels controlling for a wide range of covariates related to detailed measures of material poverty, including cash‐economy and agricultural assets, income, financial stress, and food insecurity. Results Household assets related to the cash economy were significantly associated with lower (ie, better) depression scores (−0.7, [95% CI: −1.2 to, −0.1]) but unrelated to anxiety scores (−0.3 [95% CI: −0.8 to 0.3]). Agricultural wealth was significantly—and more strongly—associated with both reductions in depression symptoms (−1.4 [95% CI: −2.2 to −0.7]) and anxiety symptoms (−1.8 [95% CI: −2.6 to −1.0]). These associations were consistent across the three sites, except in the fully urban site in Port‐au‐Prince where level of depression symptoms was not significantly associated with household agricultural wealth. Conclusions Standard measures of poverty based on success in the cash economy can mask important associations between poverty and wellbeing, in this case related to household‐level subsistence capacity and crucial food‐producing household assets.

An Agricultural Wealth Index for Multidimensional Wealth Assessments

“…In addition to disparities in growth and nutrition, the AWI index may be useful in understanding other important demographic and health differences (Hadley, Maxfield, and Hruschka 2019; Lachaud et al. 2019). For example, the AWI may provide insights into the patterns of fertility change in many low‐ and middle‐income countries.…”

“…Wealth indices that prioritize assets accrued through cash-based transactions can mask important sources of economic capacity and neglect crucial distinctions between individuals and households engaged in livelihoods outside of the cash economy. For example, a recent study of mental health in Haiti showed that a wealth index capturing agricultural success showed stronger associations with reduced anxiety and depressive symptoms than did a wealth index that captured success in the cash economy (Lachaud et al 2019).…”

“…In contrast to the unidimensional models of wealth that underlie the most commonly used asset-based indices, a multidimensional model of wealth assumes households have multiple pathways for accumulating economic resources (Ayenew et al 2007;Guyer 1997;Lachaud et al 2019;Little et al 2008;Manger 2000). Assuming multiple pathways for accessing resources opens new ways to approach the asset data used in constructing indices.…”

“…While such asset‐based wealth indices have grown in popularity, an emerging literature has raised concerns that many indices rely on assets that privilege only certain forms of economic activity (Garenne 2015; Howe, Hargreaves, and Huttly 2008; Hruschka, Hadley, and Hackman 2017; Kaiser, Hruschka, and Hadley 2017; Lachaud et al. 2019; Rutstein 2008). For example, the DHS wealth index frequently reflects possession of goods that are obtained primarily through cash‐based transactions (e.g., TV, refrigerator, phone) or public services that may not be available to households who are only marginally engaged in cash economies (Bingenheimer 2007; Ferguson 1992; Guyer 1997; Manger 2000).…”

“…For example, a recent study of mental health in Haiti showed that a wealth index capturing agricultural success showed stronger associations with reduced anxiety and depressive symptoms than did a wealth index that captured success in the cash economy (Lachaud et al. 2019).…”