Epistles from a Public Health Metaphysician
Marriage is a Public Health Issue
On June 26, 2015, exactly ten years ago, the Supreme Court delivered its landmark decision in Obergefell v. Hodges, legalizing same‑sex marriage across the United States. While much of the debate rightly focused on equality, economics, morality, and civil and human rights, this ruling was also a profound advancement for public health.
The Institute of Medicine of the National Academies defines public health as “what we do collectively, as a society, to assure the conditions in which people can be healthy.” This definition recognizes that health is shaped by more than medical care and individual behaviors—it is significantly influenced by social and economic conditions created by public policy.
Marriage offers significant health benefits—for both adults and children. These benefits have been well documented since 1858 when William Farr, a British epidemiologist, studied death rates and found that the unmarried died “in undue proportion” to the married and concluded, “The single individual is more likely to be wrecked on his voyage than the lives joined together in matrimony.”
Recent studies confirm Farr’s observation of lower mortality rates and better physical and mental health among married individuals. Being married adds two years overall to life expectancy. The effect of marriage on longevity is especially dramatic for men. A March 2023 study found that bachelors with heart failure were twice as likely to die within five years, compared to married men with the same heart issues. A February 2025 study showed that married people face significantly lower risk of heart attacks and cardiovascular death—especially for men. Married men and women have lower rates of depression, Alzheimer’s disease, smoking, substance abuse, and cancer. After controlling for other factors, married couples have higher levels of cognitive functioning, happiness, and life satisfaction. All the health benefits of marriage are consistent across age, race, and education groups.
A Massachusetts study done the year after legalization of same-sex civil marriages in that state demonstrated a 13% drop in healthcare visits and a 14% reduction in healthcare costs among gay men. Conversely, it has been shown that the passage of anti-same-sex marriage laws adversely affected the health of lesbian, gay, bisexual, and transgender (LGBT) individuals.
Since same-sex marriage became legal nationally only 10 years ago, there are few long-term data showing the health benefits of marriage for same-sex couples. However, there is increasing evidence that these benefits hold true for same-sex couples as for heterosexual couples and there are no studies suggesting that the health benefits of marriage are limited to heterosexual couples.
In its policy entitled “Health Care Disparities in Same-Sex Partners,” the American Medical Association (AMA) states “…exclusion from civil marriage contributes to health care disparities affecting same‐sex households” and that the AMA “will work to reduce health care disparities among members of same‐sex households including minor children; and will support measures providing same‐sex households with the same rights and privileges to health care, health insurance, and survivor benefits, as afforded opposite‐sex households.”
The evidence is strong that marriage is a public health issue. Marriage can be a significant contributor to better physical and mental health regardless of sexual orientation. It can provide social recognition and acceptance, better financial security, and improved access to health insurance, disability benefits, and survivor benefits—all of which contribute to the health of individuals and their families.
Geoffrey Vickers has defined public health as “the continual redefining of the unacceptable.” The evidence is clear: marriage is a vital public health instrument for all couples, regardless of sexual orientation. It is unacceptable to deny the benefits of marriage to any committed couple who wants to get married. The Obergefell decision, seen through this lens, was not just a civil‑rights milestone—it was a decisive step toward “assuring the conditions in which all people can be healthy.