Self-rated health is a frequently used health indicator, but there is little data on its comparability across cultures. We employed samples from Tampere, Finland, and Florence, Italy, of the European Longitudinal Study on Aging to examine the cultural and gender differences in self-rated health. Personal interview data was used and vital status ascertained after 7 years. After adjusting for several health-related variables, we found no substantial difference in self-rated health between genders, although women in Florence were three times and men in Florence four times more likely to report good self-rated health than men in Tampere. The correlational structure of self-rated health was similar in both areas. The significant graded association between self-rated health and mortality in both areas was mostly explained by other health indicators included in a multivariate model. Results suggest that self-rated health is a useful summary of physical health, but it may predict mortality better in men than in women and be sensitive to cultural environment. Therefore, direct gender and cultural comparisons of self-rated health should be made with caution.