This paper compares the degree and patterning of health inequalities among men and women in 4 different welfare states: in Britain and in 3 Nordic countries (Finland, Norway and Sweden). It is argued that the structural position including social class/employment status and material living standards are determinants of men's health, but additional determinants of women's health include family roles. Employment patterns are similar for men in all 4 countries and for Finnish women, but differ for women in the other 3 countries where women take part-time jobs or, particularly in Britain, where more women are full-time housewives. Prevalence data from comparable surveys in the 4 countries are presented and further analysed by means of logistic regression analysis. Associations with limiting long-standing illness are examined by age, social class, material living standards and family roles. Contrary to expectations inequalities in health are more pronounced for both employed men and employed women in the Nordic countries than in Britain. For men in all 4 countries and for Finnish and Swedish women, age and social class are strongly associated with ill-health. For Norwegian women the evidence remains unclear. Employment participation among British women is lower than in the other 3 countries and in the examination of their ill-health a role framework complements the structural one: in addition to age and social class, marital status and parental status are associated with their ill-health.