Health behaviours and health service use
One of the most well-established gender differences in health is that men's life expectancy, worldwide, averages 3 years less than women's (Population Reference Bureau 2000). It is perhaps less widely recognized that the size of the gender gap varies greatly between regions. In Eastern Europe, for example, men's life expectancy is 11 years less than women's, while by contrast, men's life expectancy is equal to or greater than women's in countries such as Afghanistan, in which religious, cultural and legal institutions ensure that women do not have adequate access to health and social services. In developed countries, men can generally expect about 8 years of life less than women (Population Reference Bureau 2000).
There is considerable debate about the causes of the difference in life expectancy. While it is widely assumed that men are biologically predisposed to earlier death, the range of differentials between regions and populations make it clear that cultural, social, environmental and behavioural factors must play a major role. In Australia, for example, the life expectancy of indigenous men is 19 years less than that of non-indigenous men and 23 years less than that of non-indigenous women (Anderson et al. 1996), a difference which seems far too large to be explained entirely by biological differences in susceptibility to disease.
Males are certainly biologically less robust than females, as is demonstrated by consistently higher neonatal death rates among males than females. In Australia, for example, the neonatal death rate is 3.4 per thousand live births for males, compared with only 2.5 per thousand for females (Australian Bureau of Statistics 1996a). These differences so early in life must find their explanation in biological differences, but the role of sociocultural factors is demonstrable for other causes of death. To take a well-researched example of gender differences, coronary heart disease is second to cancer as the leading cause of death for both men and women in most developed countries (for example Australian Bureau of Statistics 2000), but men die of