Gender differences in health and illness a partner was a significant predictor of the will to live among men, but not among women (61-62). Gender differences in consequences of health and illness This section reviews research on how gender affects the social, economic and biological consequences of health and illness, focusing on three non-communicable dis- eases or conditions: diabetes for social consequences, domestic violence for economic consequences, and oc- cupational health for biological consequences. Gender differences in social consequences of health and illness The gender differences in the social consequences of health and illness include how illness affects men and women, including health-seeking behaviour, the avail- ability of support networks, and the stigma associated with illness and disease. Men and women respond dif- ferently when ill, in terms of time before acknowledg- ing that they are ill, recovery time, and how women and men are treated by their families and society. In developing countries, men seek treatment more frequently at formal health services, whereas women are more likely to self-treat or use alternative therapies. This has been explained by factors, such as multiple roles of women which limit their activities mainly to the domestic sphere and make it difficult for them to go to clinics during opening hours. By contrast, tradi- tional healers or community shops are easier to access and will often accept delayed payment or payment in kind or delayed. Traditional healers also provide expla- nations in ways that are easily understood, in contrast to the more scientific explanations of clinic staff (3). Women are often treated in an inferior way at health services and are blamed for coming late or for not bringing their children for regular immunization or check-ups. This only exacerbates women’s reluctance to access healthcare, even when other access barriers are removed (63). Insensitive treatment by health per- sonnel is also a problem in industrialized countries, al- though in these situations women have more options for restitution. The lower social status of women influences how society responds when they are affected by stigmatiz- ing illnesses, such as HIV/AIDS, leprosy, tuberculosis, and mental illness. While both men and women suffer considerable discrimination and from society, women are more marginalized by these health problems. The example of diabetes, a non-communicable dis- ease, demonstrates the gender differences in its social 53 consequences. Research on gender differences in the social consequences of diabetes is limited, especially in developing countries. Even in industrialized countries, the studies in this area are difficult to compare because they deal with different variables, measurement tools, and outcomes. However, it is possible to draw some conclusions from the existing literature which are rel- evant from a gender perspective. A recent study from Trinidad found that men with type 2 diabetes mellitus were less compliant with treat- ment than women and that they were less satisfied with the way they were treated in the dispensary and clinic they attended. Men tended to smoke and drink alcohol much more frequently and, hence, were predisposed to a wider range of health risks, including hypertension and cerebrovascular and cardiovascular diseases. The authors hypothesized that men with diabetes probably had a lower life expectancy than women (64). Some evidence from India showed that boys have better access to care for insulin-dependent diabetes mel- litus (IDDM) than girls. The reasons were not studied but it is likely that son preference plays a role here, in keeping with other health-related research findings. Sridhar noted that mothers tended to take responsibility for looking after diabetic children, which could result in alienating fathers and making them uninterested in helping to care for their children (65). A common finding in developing countries is that urban dwellers have a higher prevalence of diabetes than rural residents because of the shift from low to high fat intake (66-68) but there does not seem to be a consis- tent pattern of gender differences within this rural-ur- ban categorization. Studies on gender differences in diabetes in industri- alized countries have focused on how men and women or girls and boys cope with the illness, including the types of coping strategies they develop. Perhaps the most common finding is that women and girls gene- rally have a more negative way of dealing with diabetes than men and boys. Anxiety and depression are more common among females (69-71). In a sample of ad- olescents in the United States, even after controlling for other correlates, such as levels of knowledge about diabetes and metabolic control, girls were less positive about their illness than boys (71). More research is needed to understand the link be- tween diabetes and depression (71). Some researchers have reported a higher incidence of eating disorders among diabetic adolescent girls than among boys with IDDM or than among non-diabetic girls (72). Another