Analysis of women's health has historically been associated with women's reproductive roles (Gender and Health Group, 1999). Thus, it is necessary to differentiate between analysis of women's health and gender analysis of health, which "focuses attention on the dialectics of relations between biology and the social milieu, which translates into situations of disadvantage or advantage of women vis-a-vis men . . . inequality understood in terms of the probabilities to enjoy health, fall ill or die" (Gomez, 1993, p. xi). A gender analysis of health needs to establish the relation between biological factors and the definitions and values that culture allocates to both women and men. This approach will help us to highlight what seems so obvious because of its pervasive occurrence: the ways in which gender influences roles, needs, risks, responsibilities, and access to resources (Gomez, 1993).
Understanding gender differences in the health-disease process and gender relations within the household and at the community level is necessary to fully grasp the determinants and consequences of disease in women and men. For example, certain diseases are not adequately diagnosed because gender stereotypes lead physicians to establish a differentiated diagnosis, depending on whether the patient is a man or a woman, thus underestimating the actual morbidity or mortality rate of certain diseases. Myocardial infarction is an example of this. It has been demonstrated that the diagnosis is established sooner in men than in women, because the same symptoms are evaluated differently (McKinlay, 1996).
In the Third World, the influence of gender issues in morbidity and mortality of women and men has been often concealed with factors such as lack of economic resources and inaccessibility to health services, among others. Some scholars contend that these factors affect women and men alike. However, others have argued that women face specific constraints in the health system in terms of the access and quality of the provided services (Cassel quoted in McKinlay, 1996). Several studies have shown that although women and men may share a number of problems resulting from geographic location, living conditions, and ethnicity, gender inequality places women in a vulnerable situation regarding their health (Okojie, 1994; Vlassof, 1994). Hudelson (1996) suggests that the response to disease is different in women and men, and that the barriers for early detection and treatment vary for both genders. The intention in this essay is precisely to explore how the interplay between economic and gender factors shapes women's and men's perceptions of disease, search for attention, and likelihood of success in treatment.
Research was conducted among all individuals diagnosed with ganglionary and pulmonary tuberculosis between January 1, 1998, and December 31, 1999, by Mexican health institutions responsible for servicing the municipalities of Pajapan, Tatahuicapan, Mecayapan, and Soteapan, located in the Sierra de Santa Marta of southeastern Veracruz.
Information was gathered in two phases. In the first phase, secondary sources (health archives, government censuses) were reviewed, health officers and practitioners were interviewed, and a survey was applied in the homes of the 40 individuals (21 women and 19 men) diagnosed with tuberculosis. The survey was conducted using a structured and precoded questionnaire in order to obtain information on the sociodemographic characteristics of individuals, as well as information about their disease. In the second phase, in-depth interviews were conducted with 13 informants, who were selected according to the criteria of age, sex, ethnic group, and treatment status. These interviews were designed to delve into the perception of symptoms and attributed causes, the process of searching for health attention, and the possibility to successfully complete treatment. Pseudonyms are used throughout the essay in order to maintain the anonymity of informants. …