Marriage and Public Health

by Maggie Gallagher

Married people live longer than otherwise similar people who are not married. i One study put it this way: take two middle-aged men with the same race and family background, except that one is married and the other is single or divorced. What are the relative odds each man will live to at least age 65? The answer: Nine out of ten husbands, but only six out of ten single guys. Absent remarriage, an extra three out of ten men lose their lives more quickly when they lose their wives. Married women also live longer: Nine out of ten middle-aged wives will make it to age 65, compared to about 8 out of 10 single and divorced women. ii One study of developed nations as diverse as Japan and the Netherlands found that the unmarried in virtually every country have lower life expectancies than the married, even in countries with nationalized health care systems. In most developed countries, single, divorced or widowed men of any given age are about twice as likely to die as married men, and nonmarried women face risks about one and a half times as great as married women. iii

Marriage reduces the risk of illness as well as mortality. iv A recent study of the health effects of marriage drawn from 9,333 respondents to the Health and Retirement Survey concluded “Greater numbers of persons will soon enter old age with fewer chances of being married, and/or a more checkered marriage history compared to current cohorts of elderly persons. All else being equal, recent changes in marriage behavior may have untold negative consequences for the health and well-being of future cohorts and the care they receive.” This study, which looked at Americans between the ages of 51 and 61, compared the incidents of major diseases as well as functional disability in married, cohabiting, divorced, widowed and never married individuals. “Almost without exception,” the authors report, “married persons have the lowest rates of morbidity for each of the diseases, impairments, functioning problems, and disabilities.” Divorce had a greater overall negative consequence for women’s health compared to men’s health, and the health benefits of marriage appeared somewhat stronger among African-Americans and Latinos than Whites. v

“Marital status differences in disability are dramatic even when controlling for age, sex and race/ethnicity,” the researchers report. “The odds of disability among cohabitors, for example are almost 1.7 times the odds for married persons.
Similarly the odds of disability among divorced persons are nearly 1.6 times the odds for married persons. All unmarried groups are significantly more likely to be disabled than married persons.” vi

As more Americans enter the illness-prone years unmarried, and as more children are raised outside of intact homes, the health costs in Medicaid, Medicare and the private insurance system are likely to increase. Even after taking into account severity of illness, age, gender, race and medical diagnosis, for example, single hospital patients were two and a half times more likely to be discharged to a nursing home. vii A study of elderly Medicare recipients found that both elderly married men and women were much less likely to enter a nursing home than their unmarried counterparts. viii

The declining incidence of stable marriage, health researchers note, suggests “inequality in health...may grow as greater number of persons enter retirement outside of marriage...Entering retirement without a spouse simultaneously increases the risk of an adverse health event and decreases one’s available network of family caregivers.” ix

Social science evidence is clear and powerful: Marriage promotes the nation’s public health and well-being among men, women and children by encouraging healthy behaviors and lifestyles, providing social support, reducing economic hardship, and by encouraging unpaid caregiving among parents and partners.

Maggie Gallagher serves as Director of the Marriage Program at Institute for American Values and co-authored The Case for Marriage with Linda J. Waite (Doubleday: 2000).

i. Catherine E. Ross, John Mirowsky, and Karen Goldsteen, 1990. “The Impact of the Family on Health: Decade in Review” Journal of Marriage and the Family 52: 1059-1078.

ii. Lee A. Lillard and Linda J., Waite, 1995. “’Til Death Do Us Part: Marital Disruption and Mortality” American Journal of Sociology 100: 1131-56.

iii. Yuanreng Hu and Noreen Goldman, 1990. “Mortality Differentials by Marital Status: An International Comparison,” Demography 27(2): 233-50.

iv. Linda J. Waite and Mary Elizabeth Hughes, 1999. “At the Cusp of Old Age: Living Arrangements and Functional Status Among Black, White and Hispanic Adults.” Journal of Gerontology: Social Sciences 54b (3):S136-S144.

v. Amy Mehraban Pienta, et. al., 2000. “Health Consequences of Marriage for the Retirement Years,” Journal of Family Issues 21(5): 559-586.

vi. Ibid. (Pienta, 2000). 579.

vii. Howard S. Gordon and Gary E. Rosenthal, 1995. “Impact of Marital Status on Hospital Outcomes: Evidence from an Academic Medical Center,” Archives of Internal Medicine 155: 2465-2471.

viii. Kenneth G. Manton, et.al., 1995. “Longitudinal Models of Disability Changes and Active Life Expectancy in Elderly Populations: The Interaction of Sex, Age and Marital Status,” in W. Morgenstern et.al., eds Modeling Noncommunicable Diseases (Berlin: Springer-Verlag) 113-130. See also Vicki A. Freedman, 1996. “Family Structure and the Risk of Nursing Home Admission,” Journal of Gerontology: Social Sciences 51B(2):S61-S69.

ix. Pienta, 2000. op. cit. 583.