When men and women cannot attain idealized gendered forms of economic provision and dependence, how do they make sense of this perceived failure? In this article, we posit that poor health narratives serve as a gendered tool to make sense of inadequate livelihoods, even when that inadequacy is attributable to structural conditions. We draw on survey and life-history interview data from middle-aged and older rural South Africans. The survey data show that even after adjusting for biometrically measured health differences, working-age (...) men report poorer health when they are unemployed, and women and pension-age men report poorer health when they live without household earners. Life-history interviews show parallel patterns: When their economic circumstance is not troubled, individuals regularly minimize health concerns; conversely, when they have a troubled livelihood, individuals draw on poor health to explain it. When women and men cannot perform idealized gendered practices in the family, poor health becomes a tool to reduce the resulting cognitive dissonance. Poor health narratives recast perceived gender failures to an individualized, biological explanation. Our study illustrates how the epidemiological context can be a resource that forestalls a redefinition of gender norms when the gender order is in crisis. (shrink)