The Supreme Court’s ruling that marriage is a right for all couples, including same-sex couples, is rooted in the question of gay and lesbian health.

The gay and lesbian community has cited the need for legal married status so partners can help make difficult medical and end-of-life decisions for one another.

Friday’s court case decision, Obergefell v. Hodges, originated from a health issue. Jim Obergefell sued the state of Ohio for the right to have himself listed as his partner John Arthur’s surviving spouse on Arthur’s death certificate.

marriage equality

Obergefell and Arthur had been partners long before Arthur became gravely ill with ALS, also known as Lou Gehrig’s disease, Obergefell told NPR in an interview.

One day in 2013, as Arthur lay in his bed in the living room watching the news with Obergefell by his side, the verdict from the Supreme Court striking down the Defense of Marriage Act was announced. This act was one of the first steps towards legalizing same-sex marriage.

“I just immediately leaned over, hugged him, gave him a kiss, and said, let's get married. It just seemed like the most perfect thing possible to do at the moment,” Obergefell told NPR.

The Ohio couple chartered a medical plane to go to Maryland, where gay marriage was legal. Because of Arthur’s illness, they married on the tarmac of Baltimore/Washington International airport.

But despite their dramatic effort, the two learned that Ohio would not allow Obergefell to be listed as a surviving spouse on Arthur’s death certificate. The entry on the form would remain empty.

So began the lawsuit that was decided today, establishing that all states must permit same-sex couples to marry.

More Rights, Better Health?

According to medical groups, gay and lesbians may not have to be gravely ill like John Arthur to see health benefits from the law. The American Psychological Association (APA) was one of the parties that filed briefs advising the court to extend marriage rights to same-sex couples.

The group points to evidence that gay men and lesbians who are stigmatized have a higher risk of experiencing distress and adverse psychological outcomes.

Studies have also shown that LGBT people are more likely to have mental illness and to engage in risky behaviors, such as smoking and alcohol use.

A 2009 study found that among 1,500 lesbian, gay, and bisexual participants, living in a U.S. state where same-sex marriage was banned was directly related to chronic social stress and psychological problems. The research ruled out pre-existing mental health issues and other factors. Another study showed that being denied the right to marry reinforces the stigma associated with a minority sexual identity and can interfere with young adults’ ability to form healthy social attachments of various sorts.

“Empirical research demonstrates that the psychological and social aspects of committed relationships between same-sex partners largely resemble those of heterosexual partnerships,” said Barry Anton, Ph.D., president of the APA, in a statement. “Like heterosexual couples, same-sex couples form deep emotional attachments and commitments. Heterosexual and same-sex couples alike face similar issues concerning intimacy, love, equity, loyalty and stability, and they go through similar processes to address those issues.”

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More Research on the Way

But what effect does the stress of discrimination present to physical health?

We asked Dr. Kirsten Bibbins-Domingo, Ph.D., who is part of a newly launched large-scale LGBTQ (lesbian, gay, bisexual, transgender, queer) health survey that is asking participants to share their health data through an Apple health mobile app.

There’s evidence linking discrimination and heart health, she said. But LGBTQ health is not well studied and many questions remain.

“We know that how we live and with whom we live can have important effects on our physical health and our mental health,” Bibbins-Domingo said. “While social context is critical for our understanding of health and disease, we unfortunately don't have sufficient data on LGBT communities to know specifically how such factors play out.”

The University of California San Francisco study that Bibbins-Domingo is part of, dubbed with the acronym PRIDE, is the first large-scale, long-term health study of people who identify as LGBTQ.

The Institute of Medicine flagged the need for more research on LGBTQ health in 2011.

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