56 J Health Popul Nutr Mar 2007 victims may be beaten, killed, or driven to suicide (85). In these situations, even those who survive are likely to face precarious economic futures, as they may be driv- en away from their families and be left without social or economic support (85). Gender differences in biological consequences of illness Generally, men are more vulnerable to major life-threat- ening chronic diseases, including coronary heart dis- ease, cancer, cerebrovascular disease, emphysema, cir- rhosis of the liver, kidney disease, and atherosclerosis. Women suffer more from chronic disorders, such as anaemia, thyroid and gall bladder conditions, migraine headaches, arthritis, colitis, and eczema. The biological advantage of women appears to be related to their abili- ty to bear children and the physiological systems that permit pregnancy and child bearing, whereas men’s health advantage seems to be due to lower levels of role stress, role conflict, and lower societal demands (91). Men and women have different responses to drugs for treatment. These gender differences are not only bi- ological: gender plays an important role in determining healthy or unhealthy life styles. As men and women modify their behaviour to reduce or increase certain risks, such as stress relating to high-pressure jobs, their respective vulnerability can change over time and across societies. The gender differences in the biological conse- quences of health and illness can be illustrated by the example of occupational health. Until recently, little attention was paid to gender differences in occupation- al health, and most social science literature focused on differences in exposure to health risks (92). The litera- ture on tropical diseases found significant gender dif- ferences in the impact of infectious diseases on men and women because of their differential exposure to vectors, such as mosquitoes or sandflies (82). Social scientists are now investigating the impact of differ- ent kinds of work environment on health of men and women but considerably more research is needed to confirm early findings in this regard. Research in in- dustrialized countries has shown that working outside the home is related to improved health for women (93- 95) because of increased self-confidence and econom- ic independence. Similarly, among men, employment is associated with increased life expectancy (96-97), and unemployed men are at greater risk of psychological problems and early mortality (97). In developing countries, however, there is insuffi- cient evidence to conclude that non-domestic labour Vlassoff C has a positive impact on women’s health. Women may suffer more ill-health because labour conditions are generally much poorer in developing countries, their status is lower than men’s, and they often assume the large burden of domestic work, in addition to paid la- bour (83). Research on factory work in both low- and high-income countries has found that women who are employed in monotonous and repetitive work are likely to develop repetitive strain injuries (83) or to be exposed to carcinogenic substances (98,99). Men are more often employed in dynamic jobs involving physi- cally strenuous activities, such as construction, with considerable lifting and moving of heavy loads. Work-related accidents resulting in death seem to be much more common among men in both industrialized and developing countries because men are employed in occupations involving greater danger, such as transpor- tation, construction, mining, and fire-fighting. Men in developing countries are also more at risk of accidents than men in high-income countries because of poorer safety regulations and protective equipment (83). Because of women’s double responsibility for both household and outside work, and their lack of decision- making power and often arduous tasks in the workplace, female managers tend to experience more ‘negative stress’ than men (100). In several studies, Oslin has shown that women at all levels of employment reported more such stress (83). For example, women who had to work more than 10 hours of overtime per week had a higher risk of heart attacks than other women, whereas men who worked the same amount of overtime were at lower risk. Moreover, women’s level of negative stress increased at the end of the working day, whereas men’s level of negative stress decreased considerably. DISCUSSION This paper has reviewed many studies and health and illness examples as they relate to gender differences us- ing a framework from the field of tropical diseases. Clearly, the framework which links gender to the so- cial, economic and biological determinants and conse- quences of tropical diseases is applicable to non-infec- tious diseases and conditions too. Several conclusions regarding the importance of gender for understanding health and illness can be derived from the studies reviewed in this paper. First, gender clearly plays a role in the determinants and con- sequences of poor health, and it can no longer be as- sumed that a male model for health also applies to women. The way in which gender affects these deter- minants and consequences may vary according to the