50 J Health Popul Nutr Mar 2007 the most affected by poor nutrition if lacking in social support and capital. White men were in the best overall position, with white women in the second best posi- tion, and black women in the third. The study found that social isolation and lower income contributed most to nutritional risk for all groups, except black men, for whom lack of social support and capital were the most important determinants of nutritional risk. The studies discussed in this section demonstrate that gender matters in terms of nutritional outcomes, but, at the same time, generalizations as to how gender affects the social determinants of nutrition can be mis- leading. The complexity of social, economic and cultural contexts and also demographic and epidemiological in- dicators must be taken into account to fully understand the additional impact that gender has. Gender differences in economic determinants of health and illness Productive labour is usually defined as labour performed outside the household in income-generating employ- ment; reproductive labour includes work done within the household, such as food preparation, childcare, housework, care of livestock and kitchen gardens. Re- productive labour, in addition to reproducing the daily conditions of domestic survival, also assures the reproduction of human values, attitudes, and culture. In both industrialized and developing countries, women spend considerably more time than men in reproductive, volunteer and other unpaid labour, whereas men spend significantly more time in productive, remunerated work (3). In most cultures, productive and reproductive ac- tivities are valued differently. Generally, earning an in- come brings greater autonomy, decision-making power, and respect in society. Given the greater involvement of men in the paid labour force and their higher earnings even when domestic and other activities of women are costed, they generally enjoy more autonomy and higher social status. The gender differences in economic status and purchasing power affect the health-seeking behav- iour and health outcomes of men and women. Recent schools of thought have recognized that many types of non-market or reproductive labour are also productive. For example, gender-aware economics includes unpaid caring work in the home in the concept of productive labour and informal paid work, such as home-based income-generating activities and work in non-profit or non-governmental organizations. Research on gender and the economic determinants of health and illness is relatively scarce, especially in Vlassoff C the area of non-communicable diseases. The example of mental health is used here because there is consider- able research on this topic in industrialized countries, and some studies can also be cited from developing coun- tries. The relative paucity of research on gender and economic aspects of mental health in developing coun- tries reflects the fact that mental health services are less numerous and comprehensive than those in industrial- ized countries. Nonetheless, interesting studies have been carried out in several countries that demonstrate a clear relationship between economic factors and men- tal health by gender. A study of gender and mental health in China that combined historical, epidemiological and qualitative data found significantly higher rates of schizophrenia among women than among men, a finding contrary to western studies in which men suffer more from schizo- phrenia (38). Interestingly, however, men occupied more hospital beds than women in psychiatric hospitals, in which at least three-quarters of patients were suffering from schizophrenia, indicating that hospital-bed occu- pancy did not reflect the male-female ratio of people affected by the disease. While several possible reasons for this imbalance were cited, significant gender differ- ences in ability to pay were noted. Men were much more likely to have health insurance from their em- ployers than women, who tended to be treated more as charity cases. Reports from other parts of the world show that women constitute the large majority of in- dividuals seeking psychological services (39). Given this gender imbalance, services are not positioned to respond adequately to their female clients (40). The gender differences in the economic determi- nants of mental health were also encountered in South Korea. A recent study examined the impact on men and women of escalating job insecurity due to increas- ing numbers of non-standard workers. The propor- tion of non-standard workers was considerably higher among women than among men. In general, non-stan- dard workers (part-time, temporary, and daily labour) were more likely to suffer from mental problems than standard employees, and non-standard female work- ers suffered more mental illness than men, in terms of self-reported depression and suicidal thoughts (41). Married women reported more psychological prob- lems than single women, and the pattern was reversed for men. The links among mental health, gender, and eco- nomic status were clear in several aspects of the Ko- rean study. Women had about twice the incidence of poor mental health indicators than men, and the men-