The Institute of Medicine of the National Academies of Science defines public health as "what we do collectively, as a society, to assure the conditions in which people can be healthy." This definition evolved from the growing evidence that health is determined by more than just medical care and individual behaviors. It recognizes that health is particularly influenced by the social and economic conditions created by policy decisions at all levels of government and the private sector.

Minnesotans will be asked to make such a policy decision when they vote on the marriage amendment in November. While most of the debate has been focused on the issues of equality, economics, morality, and civil and human rights, we must recognize that this amendment is also a major public health issue.

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. He 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. Married men and women have lower rates of depression, Alzheimer's disease, cardiovascular 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.

Since same-sex marriage has only recently become more common, there are no 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, and there are no studies suggesting that the health benefits of marriage are limited to heterosexual couples.

A Massachusetts study done the year after legalization of same-sex civil marriages in that state demonstrated a 13 percent drop in health care visits and a 14 percent reduction in health care costs among gay men. Conversely, it has been shown that the passage of anti-same-sex-marriage laws have adversely affected the health of lesbian, gay, bisexual and transgender (LGBT) individuals.

In its policy titled "Health Care Disparities in Same-Sex Partners," the American Medical Association states that "... 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 Minnesota Medical Association Board of Trustees has adopted a similarly worded position.

Noting that "marriage amendments may lead to an increase in bullying and violence against LGBT youth and greater intolerance for them and their families," and that "nearly one-quarter of all same-sex couples are raising children and eight percent of them are raising children with special health care needs," the Minnesota Chapter of the American Academy of Pediatrics has also declared its opposition to "the marriage amendment." It affirmed "the right of every child and family to the legal, financial, and psychosocial security that results from having legally recognized parents who are committed to each other and to the welfare of their children."

The evidence is growing 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.

Public health has been called "the continual redefining of the unacceptable." The increasing evidence of the health benefits of marriage highlights the fact that, from a health perspective, it is unacceptable to deny the benefits of marriage to any committed couple. A defeat of the marriage amendment will be a step toward rectifying that situation and will be a major step toward assuring the conditions in which Minnesotans can be healthy.


Dr. Edward P. Ehlinger is commissioner of the Minnesota Department of Health.