Health poverty alleviation is a vital project for people’s livelihood in China，so it is essential to pay attention to the achievement and influencing factors of health poverty alleviation in the general environment. Based on six CFPS data from 2010 to 2020，this study first analyzed the prevalence of chronic diseases among the middle - aged poverty population of China. Subsequently，this study analyzed the self - rated health of the middle-aged poverty group and its influencing factors in 2020 CFPS data under social-ecological system theory. The results showed that the micro-level influencing factors were the habit of lunch breaks，positive emotions and higher educational background. The meso-level influencing factors were the poor medical treatment level and the well - trust in doctors. The macro - level influencing factors revealed that the absence of employment problems significantly positively affects the self - rated health of the middle - aged poverty group. Therefore，this study suggests constructing the logic of health -based poverty alleviation from three aspects：individual participation， social support and policy improvement，emphasizing the synergistic and diversified treatment for health poverty alleviation of middle-aged poverty group.