Marriage – A Social Determinant of Health?

This week is LGBT Health Awareness Week, a nationwide observance that promotes the unique health and wellness needs of the lesbian, gay, bisexual, and transgender (LGBT) people. This year, we have something new to consider in terms of LGBT health – marriage.

We have known for years that marriage confers a constellation of benefits that span financial, legal, and health realms. Married heterosexuals live longer, enjoy better health, and experience lower rates of depression compared to unmarried heterosexuals. Research suggests that same-sex individuals who marry may experience some of the same health rewards as heterosexuals, including potentially lower risk for HIV infection, sexually transmitted diseases, and viral hepatitis by increasing access to care and prevention services and decreasing risk factors for those infections. Being in a domestic partnership has been associated with decreased risk behaviors for sexually transmitted diseases and HIV among gay men, including a reduced rate of multiple partnerships, one-night stands, and intercourse without a condom. It appears that legal recognition of relationships, as found in marriage, may be more protective of health than even registered domestic partnerships.

The research on the positive health aspects of marriage is strong enough that many medical organizations, including the American College of Obstetrics and Gynecology, American Medical Association, the American Academy of Pediatrics, and the American Psychological Association, note potential health benefits associated with same-sex marriage, ranging from reducing stigma and health care disparities to enhancing the welfare of children living with parents of the same sex. By ensuring that an individual can share a spouse’s health insurance or be assured of making medical decisions for a spouse unable to do so, same-sex marriage may open the door to additional positive outcomes.

Lesbian, gay, bisexual, and transgender people often experience stigma and discrimination that can make it more difficult to live a full and healthy life – and increase the risks for many of the infections, diseases, and poor health outcomes that we, working in public health, spend our day-to-day lives preventing. Until recently, discussions about the health benefits of same-sex marriage were mostly theoretical. Will recognized same-sex marriage improve health and longevity for LGBT people? It is a question worth answering, not only for persons directly affected by this change in policy, but for everyone interested in the public health of the nation.