J HEALTH POPUL NUTR 2007 Mar;25(1):47-61 ISSN 1606-0997 $ 5.00+0.20 © 2007 International Centre for Diarrhoeal Disease Research, Bangladesh Gender Differences in Determinants and Consequences of Health and Illness Department of Epidemiology and Community Medicine, University of Ottawa, Canada Carol Vlassoff ABSTRACT This paper uses a framework developed for gender and tropical diseases for the analysis of non-com- municable diseases and conditions in developing and industrialized countries. The framework illus- trates that gender interacts with the social, economic and biological determinants and consequences of tropical diseases to create different health outcomes for males and females. Whereas the framework was previously limited to developing countries where tropical infectious diseases are more prevalent, the present paper demonstrates that gender has an important effect on the determinants and conse- quences of health and illness in industrialized countries as well. This paper reviews a large number of studies on the interaction between gender and the determinants and consequences of chronic diseases and shows how these interactions result in different approaches to prevention, treatment, and coping with illness. Specific examples of chronic diseases are discussed in each section with respect to both developing and industrialized countries. Key words: Gender identity; Health; Tropical medicine; Developing countries; Developed countries; Chronic disease; Impact studies; Review literature INTRODUCTION Gender refers to “the array of socially constructed roles and relationships, personality traits, attitudes, behavi- ours, values, relative power and influence that society ascribes to the two sexes on a differential basis. Gen- der is relational—gender roles and characteristics do not exist in isolation, but are defined in relation to one another and through the relationships between women and men, girls and boys” (1). Simply put, sex refers to biological differences, whereas gender refers to social differences. In the last decade, a considerable amount of research has been conducted in the area of gender and health, including gender differences in vulnerability to, and the impact of, specific health conditions. Gender has been shown to influence how health policies are conceived and implemented, how biomedical and contraceptive technologies are developed, and how the health system responds to male and female clients (2). Correspondence and reprint requests should be addressed to: Dr. Carol Vlassoff 754-76B St.-Andre Orleans, Ontario K1C2S3 Canada Email: vlassofc@gmail.com Gender analysis in health has been undertaken mainly by social scientists who observed that biological dif- ferences alone cannot adequately explain health be- haviour. Health outcomes also depend upon social and economic factors that, in turn, are influenced by cul- tural and political conditions in society. To understand health and illness, both sex and gender must be taken into account. This paper builds upon a gender framework from the field of tropical diseases (3) by examining to what extent the framework applies equally to non-commu- nicable diseases. The framework includes the social, economic and personal/biological determinants and consequences of tropical diseases and analyzes how gender interacts with these factors to produce different outcomes for males and females. For example, the gen- der differences in the social determinants of tropical diseases include the different roles of men and women in the household, status within the household and com- munity, and cultural norms affecting risks of infection. These factors influence exposure of women and men to diseases such as malaria because men are more likely to be exposed to mosquitoes in certain work environ- ments such as forestry or mining (3). The gender differ- ences in the consequences of tropical diseases include how illness is experienced, treatment-seeking behavi- our, nature of treatment, and care and support received