This paper examines the gender-related features of the health crisis in Russia which has produced the largest gender gap in life expectancy in the world. Stress and negative health lifestyles are the two most likely causes of the long-term adverse longevity pattern in Russia. However, this development cannot be clarified by a simple cause and effect explanation. This is because gender roles and gender-based normative behaviour, along with class influences, intervened to help shape outcomes. Men and women responded to the crisis along gender lines, with stress the best single explanation for a stunted longevity for females and negative health lifestyles accounting for much of the premature mortality among males. © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.