The health impact of marriage inequality

In light of the recent Supreme Court decision ruling that the Defense of Marriage Act (DOMA) is unconstitutional, now is an appropriate time for clinicians to explore how marriage equality effects health.

As licensed medical practitioners committed to scientifically sound practice, we are obligated to follow the evidence wherever it leads us in the pursuit of improving health for the public, as well as our individual patients. Marriage inequality, defined as unequal access to marriage and its benefits by specific populations, is dismissed by many as political.

Some PAs and other clinicians may feel that engaging in the debate about marriage inequality is outside of the practice of medicine, and that it falls more in the “social issues” category. But when evidence points to the specific ways that marriage inequality negatively impacts the health of our LBGT patients, it is tough for any licensed medical practitioner to stand on the sidelines. Part of being a scientific profession means we go where the research takes us, so PAs are making consequential decisions when we pick and choose which evidence will drive our practice.

There are many resources from widely respected organizations and researchers looking at the health impact of marriage inequality. The American Psychological Association (APA) has a helpful resource from their Public Interest Government Relations Office, titled Marriage Equality and LGBT Health. This 2009 fact sheet summarizes medical literature related to the negative impact of marriage inequality, observing most notably three key findings: 

1. There is no scientific basis for the assertion that lesbian, gay, bisexual and transgender persons are not fit to marry or to become parents of healthy and well-adjusted children (Herek, 2006; Kurdek, 2004; Peplau & Fingerhut, 2007).

2. Marriage bestows substantial psychosocial and health benefits to individuals, due to the moral, economic and social support given to married couples. The denial of marriage rights to same-sex couples, therefore, adversely affects the health and well-being of the individuals involved, as well as their families and friends (Herdt & Kertzner, 2006).

3. Empiric evidence illustrates the harmful psychological effect of policies restricting marriage rights for same-sex couples. 


Additional references and citations are included, and one of the most striking pieces of evidence notes that the negative health impact of marriage inequality may extend beyond LBGT couples, and in fact have similar negative impact on their families and allies. The APA document states:

“Beyond the negative effect of marriage restrictions for gay, lesbian and bisexual individuals, new research evidence indicates that the families of origin and allies of sexual minorities may suffer from some of the same serious negative physical and mental health consequences experienced by their loved ones (Arm, Horne, and Levitt, 2009).”

Another resource is the non-profit Human Impact Partners, whose website describes this interesting vision of a world where:

• Health is understood broadly as complete physical, mental and social well-being
• Health and equity are primary considerations in public and private sector decision making
• Health inequities due to race, class, gender, age, immigrant status, geography and other attributes do not exist
• The health of all communities is improved
• All people have the information, tools and power needed to influence decisions that affect their health
• Health provides a holistic framework that brings diverse people and organizations to work together

A recent blog published on their website describes the effect marriage equality has on health, and observes that marriage, separate from co-habitation, appears to have a protective health benefit.

As PAs and other clinicians move forward in to the post-DOMA world, we’ll continue to be faced with challenging health issues and the need to integrate evidence-based policies into our daily practice. Following the research will be a challenging task, particularly when it clashes with political beliefs and notions, but the scientific foundations of medicine insist on such evidence-based methods.

I plan to share more about each of the four dimensions of health disparities in my weekly blog posts. Check back often and don’t hesitate to share your thoughts with me at [email protected].

Jim Anderson, MPAS, PA-C, ATC, is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.