Since the landmark announcement by President Obama in support of same-sex marriage, just about every media outlet has carried some form of coverage addressing the issue.  Here we are interested in exploring the connection between marriage and health, since in the heterosexual community there has developed a strong body of evidence that marriage generally confers a positive health outcome, with men benefiting slightly more than women.

Ezra Klein, in a Washington Post article, addressed the economic issues around marriage in general and gay marriage specifically. He noted that the traditional construct of marriage was based on a division of labor, where one partner specialized in earning an income, and the other specialized in managing domestic concerns.  In other words, this construct was based on a system where “opposites,” or two people with very different interests and skills, formed an “ideal” (and romantic) image that was based on an unequal partnership. Today, he argues, marriage in general has shifted – earning an income has become not only necessary, but desirable, for both partners, and managing domestic concerns as a “specialty” has changed dramatically as appliances, conveniences of food preparation, mass production of clothing, and so forth, have entered the market.  This shift has pushed marriage in general to become more of a partnership of “equals” where each partner can and typically does contribute to generating income, and domestic chores demand less specialized skills (e.g. ability to make clothes, to prepare meals, etc.).  Because of this shift, Klein proposes, marriage now requires partners who are more similar than not in terms of skills, interests, and values.  Klein argues that the more similar the partners in a marriage, the more benefits they are likely to realize in the partnership.  His conclusion is that “it’s into this institution that gay couples are being admitted, because the nature of this institution doesn’t provide a good argument for their exclusion.”  The benefits of a marriage partnership in this “new” institution have significant health implications – when both partners contribute economically, they are likely to also reap health benefits associated with economic resources.

But there remain a number of issues that plague attempts to understand the actual health benefits of marriage.  To date, most of the research on this question has been conducted, obviously, on heterosexual couples. The few studies that have been conducted on same-sex couples where same-sex marriage is legal do tend to bear out the general findings of a positive relationship between marriage and health.  However, the underlying issues involved in research and interpretation of research findings have still not been addressed sufficiently to claim a clear and definitive health benefit of marriage.

In a 2007 report titled The effects of marriage on health: a synthesis of recent research evidence (click for a free download of the report) the authors point to a number of confounding factors surrounding the investigation of marriage and health.  They point out that the now well-established fact that there is a positive relationship between heterosexual marriage and health does not mean that marriage “causes” better health.  It could be that healthier people are more likely to marry (stay married) than people who are less healthy (the issue of selection of married people being healthier to being with).  On the other hand, it could be that marriage does indeed offer a degree of “protection” against poor health outcomes .. it can improve economic status (as Ezra Klein points out), provide a partner who supports and encourages better physical and emotional patterns of behavior, and/or protection against various stigmas associated with being single (and in the case of LGBTQ folks, stigmas associated with sexual or gender identity).  The challenge for researchers is to sort out the influences of selection (married people are already healthier to begin with), and protection (married people have a degree of protection against poor health). And this technicality of research design does not even begin to address the issues of the nature and quality of a relationship – whatever that relationship its!

The question remains for those of us who are concerned with the health of LGBTQ people, do we have a basis from which to argue in favor of marriage in our communities?  It seems clear to me that the opposing position against same-sex marriage is one that confers great harm in our communities.  It is a position that amplifies the many homophobic and anti-human rights stigmas that plague our communities and cause great harm with both physical and mental consequences (now well documented).  So even for those of us who are skeptical about the institution of marriage for anyone, I believe we must support the social and political energies that are moving toward legal status of marriage for LGBTQ people.  The research that does exist, even though it may not be as conclusive as we would like, generally supports potential health benefits of marriage and we can point to those studies and use them in our discussions.  Any evidence that is available can be valuable in educating our friends, families and allies.  But the bottom line is, for me, there is one simple argument that can and does stand alone … as long as the institution of marriage is legal for anyone, it needs to be legal for everyone.  It is a basic civic human right.