Heading for a healthier, more equal future Research shows that the health benefits of heterosexual marriage are likely to apply to same-sex unions too. Erin Dean reports



Same-sex couples in England and Wales have had the right to marry since March 2014. Scotland followed suit in December. Legally, there is little difference between gay marriage and civil partnerships, which were introduced across the UK in December 2005. Nevertheless, the change in the law last March was welcomed by campaigners and many lesbian, gay and bisexual (LGB) people as a landmark move towards full equality. In the first three months since the change in legislation, more than 1,400 gay couples married, according to the Office for National Statistics. From December last year, couples in a civil partnership can convert their status to married in England, Wales and Scotland. Stonewall says civil partnership already offered gay couples the same legal rights as marriage in areas such as inheritance, pensions, life assurance, immigration and child maintenance. The

legal status of a same-sex married couple is almost identical to that of a couple in a civil partnership, but there are small differences. A same-sex marriage, for example, can be ended for a number of reasons, such as adultery, which may not end a civil partnership. Research has suggested that heterosexual marriage has many health benefits, with people who are married less likely to develop cancer, have heart attacks or develop

dementia. Emerging research now suggests that at least some of these benefits also apply to those in same-sex marriages. This is important because there is evidence that LGB people can have worse physical and mental health than the rest of the population. Stonewall and others have found higher rates of mental health problems, including depression, among LGB people. The charity also found that lesbians are more likely to drink heavily and smoke than heterosexual women and have higher breast cancer rates. Some studies suggest that opening the door to marriage for same-sex couples may improve the health of gay people generally, by reducing the inequalities they face.

The legalisation of gay marriage in three of the four UK countries last year was welcomed as an important move towards equality. Marriage is associated with health benefits and there is some evidence that where gay marriage is permitted the health of the entire gay community, not just couples who marry, may improve. Author Erin Dean is a freelance journalist

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A study published in the American Journal of Public Health in 2012 suggested that the legalising of gay marriage in Massachusetts had a positive effect on the health of all gay and bisexual men in the US state, and not just on those who got married. The study followed 1,200 men during the 12 months before and the 12 months after gay marriage was legalised in 2003. Researchers discovered that in the 12 months following the change in legislation, medical visits about physical problems among gay and bisexual men decreased by 13 per cent and healthcare costs decreased by 10 per cent compared with the 12 months before. Medical visits about mental health issues decreased by 13 per cent. Stonewall head of policy James Taylor says that the legalisation of gay marriage can reduce the stigma that contributes to health inequalities: ‘Anything that advances equality for LGB people

‘We already feel married’ Nurses Lizzy and Jane Burgess-Havard may get married on the tenth anniversary of their civil partnership. Lizzy, a senior community staff nurse and clinical trainer at Staffordshire and Stoke on Trent Partnership Trust, says they are likely to tie the knot in 2016, with their four-year-old daughter, Tilly, as bridesmaid. The couple, who were featured in Nursing Standard in 2012, are not in a rush to make the move from civil partners to spouses. Their civil partnership ceremony was a lavish event, with 150 guests and both brides in traditional white wedding gowns. They have seen attitudes to homosexuality improve in the NHS in recent years, and the couple are already open with their colleagues about their sexuality. ‘We don’t actually feel the need to get married, because to be honest, we already feel that we are,’ says Lizzy. ‘We will though, saying that, probably go ahead and have a low-key affair with family for Tilly’s sake. She would love to be part of the pomp and circumstance for a day and be a fairy princess while her mums wear their wedding gowns. It would be a lovely memory for her and us.’

Gay marriage around the world Marriage between same-sex partners has been legal in England and Wales since March 2014, and in Scotland since December of the same year. Northern Ireland currently has no plans to introduce gay marriage. Civil partnerships were introduced across the UK in 2005. The first country to introduce equal marriage was the Netherlands in 2001. It was followed by South Africa, Belgium, Denmark, France, Iceland, Norway, Portugal, Spain and Sweden. Argentina, some parts of Mexico, Uruguay, Canada, New Zealand and some US states have also legalised same-sex marriage. Countries that offer most or all the rights of marriage, through arrangements such as civil partnerships, are Austria, Finland, Germany, Hungary, Ireland, Liechtenstein, Malta, Switzerland, Brazil, Colombia and some parts of Mexico, the US and Australia. Some countries offer more restricted rights. There are still 78 countries where homosexual acts are illegal, and at least five countries, and parts of others, where homosexual acts are punished with the death penalty. Source: International Lesbian Gay Bisexual Trans and Intersex Association report State-sponsored Homophobia (published May 2014)

and treats them as equal citizens is going to have a positive impact on health and wellbeing, and how they are perceived and can expect to be perceived by society,’ he says. ‘The overwhelming support for this legislation shows that society’s attitudes have moved positively in recent years.’ Research certainly suggests that homophobia can have a negative effect on health. A US study, published in Social Science and Medicine in June 2013, found that people from sexual minorities living in high-prejudice communities had a life expectancy 12 years

researchers in the American Journal of Public Health in February 2014. Qazi Rahman, senior lecturer at the Institute of Psychiatry at King’s College London, says: ‘The general message from research is that reducing societal stigma, such as legalising gay marriage, does seem to have an impact on health outcomes. In US research, there seems to be better mental and physical health for gay men since the law was changed. The US study also found reductions in healthcare costs which, if replicated here in our public

‘ANYTHING THAT ADVANCES EQUALITY FOR LGB PEOPLE IS GOING TO HAVE A POSITIVE IMPACT ON HEALTH AND WELLBEING’ shorter than those living in low-prejudice areas. Rates of death by suicide, homicide or violence and cardiovascular disease were higher in the high-prejudice areas. Studies have also found that heterosexual men with anti-gay prejudice may have shorter life spans than those who are not homophobic. There is a ‘growing body of research suggesting that reducing prejudice may improve the health of both minority and majority populations,’ wrote

health system, could result in savings for the NHS.’ Dr Rahman says there is no research yet on how the health benefits of civil partnership compare to those of marriage. Any difference would come down to whether society gives a different, and higher, level of recognition to same-sex married couples than to civil partners. ‘It may be that there are very subtle differences, and may depend on how important society views marriage,’ he says NS

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Heading for a healthier, more equal future.

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