NEW @ THCB PRESS: Surviving Workplace Wellness. Spring 2014. Al Lewis and Vik Khanna. e-book edition. # INNOVATION: PCORI APP Challenge

On election night voters in Maryland, Maine and Washington state voted in favor of same-sex marriage, the first time marriage equality has been approved by popular vote. Although same-sex unions have been legalized in six states and the District of Columbia by lawmakers, the voting public have consistently rejected passing approval for same-sex unions. This is clearly a tipping point in the national discourse over the rights of gays and lesbians to marry.

However, although recent estimates suggest that more than half of the American population approves of same-sex marriage, there is still much to be done before equality is achieved. Even with all the good news, more than 30 states have approved constitutional bans on same-sex marriage.  To date the debate over same-sex marriage has centered on equality – that my right to marry should be equal to the right of a Kardashian to marry anyone from the NBA. But is this more than a question of equity? Marriage provides legal protections, affords access to services and provides a source of social support – all of which may be protective of health. There is strong evidence that providing everyone with the right to marry is not only a question of equity, it is a pathway to improving the nation’s health.

Data from a range of studies confirm that marriage is good for you: in virtually every category, ranging from violent deaths to cancer, the unmarried are at far higher risk than the married. Marriage provides companionship, a social support system, someone to make you go to the doctor. “Marriage is sort of like a seat belt when it comes to improving your wellbeing,” says Dr. Linda Waite, Professor of Sociology at the University of Chicago and author of The Case for Marriage.

Being allowed to marry may in fact have a greater impact on same-sex couples than it may on heterosexual couples. Ilan Meyer, Senior Scholar for Public Policy at the Williams Institute for Sexual Orientation Law and Public Policy at UCLA’s School of Law developed the Theory of Minority Stress.  Simply, the stress experienced by gay man or woman living in a hetero-normative environment – which denies them access to the same rights as heterosexuals, or exposes them to homophobia – may manifest itself as poor mental health. Indeed, my own recent research shows that experiences of minority stress may also lead to greater sexual risk taking and violence among gay individuals. The denial of the right to marry is one such stress: by removing this stressor, could we see gains in health among gay men and women?

Recent research suggests the answer to be yes. Research by Mark Hatzenbuehler, PhD, Columbia University, and colleagues showed that in the 12 months after the legalization of same-sex marriage, sexual minority men in Massachusetts had a 13 percent decrease in both medical and mental health-care visits. The Gay and Lesbian Medical Association, in their 2008 report on Same Sex Marriage and Health, noted that marriage can help protect and promote the mental and physical health of lesbians and gay men, a position endorsed by both the American Psychiatric Association and the American Psychological Association.

True, opponents of same-sex marriage continue to protest that the legalization of same-sex marriage weakens the sanctity of heterosexual marriage, and creates unsuitable environments in which to raise children.  There is no evidence of significant differences in parenting outcomes between same-sex and opposite sex parents: in fact, legalizing same-sex marriage may in fact increase the health of children in these households by reducing the discrimination-based stress experienced by their parents. And data from states that legalized same-sex marriage show a temporary blip in marriage rates – the product of the surge of same-sex marriages – followed by a return to regular levels of marriage. Allowing same-sex marriages does not stop heterosexuals from getting married. There is no evidence of a coming apocalypse.

Gay men are the only group to have experienced an increase in HIV infections in recent years. There is a plethora of data showing that gay men and women experience higher levels of smoking, alcohol and drug use. Each of these may be a product of stress, created by living in an environment that denies basic rights.  On Tuesday night we made a significant step towards granting those rights to all.. “We made history and sent a powerful message that we have truly reached a tipping point on gay and lesbian civil rights in this country,” said Brian Ellner, head of the pro-gay marriage group The Four. We have a unique opportunity to continue the march towards marriage equality. Presenting our argument as a public health issue is another step in that march.  Even if you don’t believe I deserve to be happily married, surely you can agree that I at least deserve to be healthy?

Rob Stephenson is a Public Voices Fellow with The OpEd Project. He is also an Associate Professor of Global Health at Emory University and an expert in HIV and sexual behavior among gay men.

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