Constrained Choice: A New Framework for Understanding Gender and Barriers to Health

Researchers have long sought to make sense of the paradoxical gender differences in health. Taken separately, current biological and social explanations are insufficient to explain both women's greater longevity and higher morbidity compared to men. To identify the antecedents of these differences, models of health determinants need to include the concept of constrained choice, that is, the ways in which decisions and actions at the family, work, community, and government levels differentially shape men's and women's health-related choices. We contend that this approach is critical to clarifying the complex differences in men's and women's physical and mental health.

Clearly, some men and women are able to create and maintain healthy lifestyles, while others are not. We introduce the innovative framework of constrained choice to shed light on how decisions by different social groups—from governments to employers and families—affect the ease or difficulty of pursuing a healthy life. The impact of these decisions becomes apparent in the context of work and family. We call for cross-disciplinary dialogue and research to advance the understanding of the paradoxical differences in men's and women's health around the globe. Finally, we consider how our framework offers new insights into possible interventions to improve men's and women's health.

**This abstract is adapted from our book Gender and Health: The Effects of Constrained Choice and Social Policies recently published by Cambridge University Press in 2008. The work was funded by a grant from NIH/National Library of Medicine and a Bellagio Residency from the Rockefeller Foundation.