54 J Health Popul Nutr Mar 2007 possible explanation is that girls may internalize stress more than boys who tend to deal with their stress by more positive behaviour, such as practising sports and following a controlled diet. Cruickshanks reported that adolescent diabetic girls are engaged in fewer physical activities than boys, possibly contributing to poorer dia- betic control (73). As has been found in other studies cited in this pa- per, the assistance and emotional support received from their spouses has been found to influence health out- comes for people with diabetes. A study of men and women with diabetes over a 10-year period found that male patients reported more satisfaction with the sup- port received than women (74). Similarly, wives of diabetic patients reported fewer problems in giving medication and in testing blood glucose levels than did husbands of female patients. Men with diabetes re- ceived more support from their partners than women, as demonstrated by the greater attendance of wives in ed- ucation programmes than husbands of diabetic women. Men reported better self-care, such as eating meals on time, less binge eating, and less late insulin injections. Men also recounted fewer incidents of ketonuria, better blood sugar levels, and fewer diabetes-related compli- cations. Men generally mentioned greater satisfaction with their diet and their treatment regime. Whereas men were less likely to miss work or activities because of their disease, wives of diabetics reported missing more work because of their husband’s condition than husbands of female diabetics (74). This again indicates the greater support received from women by men who are ill than the reverse. Similar results concerning posi- tive coping behaviour of men and support from spouses have also been reported elsewhere (75-77). Research in Sweden on coping strategies of men and women with type 2 diabetes found that women used more negative coping strategies, including res- ignation, protest, and isolation, whereas men took a more problem-solving approach (78). Another Swedish study found that men under-estimated diabetes-related problems more than women and worried less about long-term complications. However, they were more concerned about the impact of illness on their personal freedom. Although women were more worried about their health, they were able to find positive aspects in having diabetes. Younger people also had more posi- tive attitudes than older people, although they were more likely to consider that the disease had negatively af- fected their relationships with others (79). Vlassoff C depth interviews with girls and boys with chronic dis- eases—type 1 diabetes and asthma—Williams found that youngsters managed their conditions in “gendered ways, with the aim of projecting different, gendered identities” (80:394). The majority of girls adapted to the illness by incorporating it into their social and per- sonal identities. Boys tended not to identify with the illness but rather to find ways of combating it or keep- ing it at bay. These findings support the observations of Charmaz (5) and Prout (81) who emphasized the stigmatizing impact that chronic illness can have on males at different ages. The greater acceptance by girls of their condition had detrimental consequences in that they had lower expectations of themselves and were also less capable of managing their illness by diet and exercise as well as boys did. Boys tended to use exer- cise as a means of keeping their blood sugar under con- trol, whereas girls were more likely to give themselves more insulin instead. Gender differences in the economic consequences of illness The gender differences in the economic consequences of illness include how work of men and women is af- fected by illness, such as availability of substitute la- bour, opportunity costs of health-related actions, avail- able income, and the impact of economic policies. When poor women in developing countries are ill, they tend to delay seeking modern treatment until their symptoms are too severe to ignore, meanwhile perhaps visiting a traditional healer or local pharmacy. Thus, they take longer to recover and often return to work be- fore they have completely recuperated (82). When men are ill, others encourage them to seek medical help, and hence they are appropriately diagnosed and treated ear- lier than women. They also receive greater care from wives and others and are not expected to perform other duties until they are better. Women often substitute for their husbands in agricultural work when they are ill but husbands rarely substitute for their wives, and only essential duties are assumed by other family members. When women recover, they are faced with many pend- ing tasks, in addition to their normal work. Those who own small businesses lose necessary income for daily survival, and many have to use their scarce resources for medicines and other health-related costs (82). The fact that women are often paid less for the same jobs as men also means that they have fewer resources to fall back on when they become ill, and their control over their own earnings is often limited (83). Research in the United Kingdom found similar re- sults as in the Swedish research. Reporting on in- The impact of economic restructuring policies on access to and use of health services by the poor is an is-