Gender differences in health and illness tal health problems increased as income declined. This is also true of other studies (42-44). The reasons within the Korean context were explained by Kim et al. (41) by the fact that, even among non-standard workers, men tended to occupy higher-level positions in construction and manufacturing, whereas women were employed more in unskilled jobs. The average wage for women was less than 40% of that of men, and only a tenth of women received fringe benefits. Wom- en also had many other family responsibilities which they had to fulfill, in addition to their paid labour. Results of research in industrialized countries con- sistently indicate that women have higher rates of anxi- ety and depression than men, independently of race, time, age, and rural-urban residence. The fact that men have greater control over resources, and decision- making power is one explanation, but there is conside- rable evidence that even when women have control over resources and income through employment anxi- ety and depression is not necessarily reduced (45). A national cross-sectional survey of British adults found that people in the most disadvantaged socioeconomic positions reported higher rates of affective disorders and minor physical illnesses than those in higher posi- tions. The gender differences were found in the other socioeconomic classes. Among healthy older women, for example, those in the skilled occupational class re- ported the highest rates of affective disorders, whereas among men, the highest rates were found in the cleri- cal class. Generally, in positions occupied by both the sexes, and among men and women with similar in- come levels, women reported higher rates of both af- fective disorders and minor physical morbidity (46). The authors concluded that the experience of a particu- lar social or occupational position might be different for men and women, explaining why women consis- tently experience more affective disorders and minor physical morbidity. In an analysis of gender, employment, and mental health, Rosenfield compared men and women from the United States using measures of power in work and family, demands on time and personal control, and symptoms of depression and anxiety (45). Men and women with similar demands on their time in fam- ily and work situations had similar symptoms of psy- chological distress. However, women in situations of higher demands, either as unemployed housewives or as working women with significant familial responsi- bilities, had higher rates of depression and anxiety than men. Thus, the gender differences in economic roles strongly influence mental health outcomes. 51 Gender differences in biological determinants of health and illness The gender differences in the biological determinants of health and illness include differential genetic vulner- ability to illness, reproductive and hormonal factors, and differences in physiological characteristics during the life-cycle. Until recently, a male model of health was used almost exclusively for clinical research, and the findings were generalized to women, except for the reproductive period. Clinical trials typically excluded women to protect them and their unborn children from possible negative effects. However, research in the United States in the early 1990s seriously questioned the validity of a male model for female health issues and highlighted significant gender differences in the biological determinants of health and illness (47). For example, protocols for the diagnosis and treatment of heart disease, the number one cause of all deaths in the United States, were based upon findings from middle- aged white male patients. As a result, women were diagnosed later with more advanced disease and were consequently harder to treat successfully. Questions about gender differences in heart disease, mental illness, and osteoporosis led to the important rec- ommendation that women be included in clinical stud- ies to uncover gender differences and their impact on the prevention, diagnosis, and treatment of disease. In 1993, the U.S. Food and Drug Administration established an Office of Women’s Health and published “Guidelines for the Study and Evaluation of Gender differences in the Clinical Evaluation of Drugs” which ended the policy of exclusion, recommending that women be ap- propriately represented in clinical studies and that their findings be analyzed from a gender perspective (48). Such policies are still not implemented in most of the developing world. The interaction between biological and social de- terminants is also important when considering gender differences in health. The biological differences can be amplified or suppressed by socialization and how so- ciety responds to sex-specific behaviour. Social norms endorsing particular kinds of behaviour may exacer- bate negative tendencies, such as violence, or reinforce positive propensities, such as nurturing. By contrast, socialization can suppress innate negative or positive tendencies. The example of longevity is used here for demon- strating how gender affects the biological determinants of health conditions. Universally, women live longer than men but the gender gap is greatest in developed so- cieties where women outlive men by about seven years,