Intersecting vulnerabilities: Health and wellbeing of older adults in Uganda during a global health crisis

The COVID-19 pandemic exacerbated vulnerabilities among older adults, particularly in Sub-Saharan Africa where structural inequities shape access to essential resources. Older adults are among the most vulnerable populations globally, yet their experiences during the pandemic remain understudied in resource-limited settings. Drawing on feminist political ecology of health and necropolitics, this research examined how pre-existing disadvantages, pandemic-induced disruptions, and structural inequities shaped health and wellbeing. We analyzed a cross-sectional survey (n = 288) of adults aged ≥60 years in rural Uganda in the acute phase of the pandemic (late 2021-early 2022), which documented access to essential resources to meet daily needs along with psychosocial health and wellbeing. Findings indicate some of the highest reported emotional distress (87 %) and low wellbeing (33). Contrary to expectations, being partnered or self-employed correlated with greater emotional distress, while WASH access indicators had limited influence on health outcomes. These patterns reflect how pandemic restrictions amplified household stresses and economic pressures, particularly for those with established social and economic resources, while limited WASH influence suggests acute pandemic stressors overshadowed chronic inadequacies. Satisfaction with government response also showed paradoxical effects, correlating with better psychosocial health but lower wellbeing, reflecting how interventions alleviated immediate anxieties while undermining economic stability. Overall, this research demonstrates how chronic structural inequities, rather than just acute emergencies, shape health outcomes among vulnerable populations. Aligned with the UN Research Roadmap, these findings suggest that addressing health inequities requires moving beyond emergency response toward systemic changes that enhance social protection and infrastructure access for older adults in resource limited settings.