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The costly retreat from marriage.

The costs of providing medical care in America, it is frequently noted, have skyrocketed recently, and they promise to continue rising in the future. There is, of course, at least a

al solution to this em, one involving little or no expenditure of either public or personal funds. This solution calls for an increased emphasis on preventive medicine: exercising and dieting today help avert heart disease tomorrow; not smoking now increases the likelihood of avoiding lung cancer later.

My purpose in writing this essay is to suggest something else Americans can do on their own to improve their health, something that government ought to do more to encourage: Americans can get married and stay married. Quite simply, marriage, no less than jogging and lowering cholesterol intake, is good for your health. Although it is obviously up to individual Americans to decide whether to marry, stay single, or divorce, it is nevertheless past time for policymakers to acknowledge the profound health benefits of marriage. The nation's runaway medical costs could be partly controlled were government to implement policies that did more to foster and encourage longer-lasting, child-producing marriages.

The new evidence linking health to marriage and family life is voluminous. Writing recently in Social Science and Medicine, Catherine K. Riessman and Naomi Gerstel observe: "One of the most consistent observations in health research is that married [people] enjoy better health than those of other marital statuses." Drs. Riessman and Gerstel note that compared with married men and women, the divorced, single, and separated suffer much higher rates of disease, morbidity, disability, mental neuroses, and mortality: "This pattern has been found for every age group (20 years and over), for both men and women, and for both whites and nonwhites." James Lynch of the University of Maryland Medical School says the health advantage enjoyed by the married over the unmarried has actually grown in recent decades.

Only a small fraction of the statistical health gap separating the married from the single and divorced can be accounted for by the common sense observation that sick people either don't get married or don't make satisfactory marriage partners. Dr. Lynch says that married people are healthier largely because marriage per se "influences the general lifestyle of the individual." In a study published recently in the Journal of Health and Social Behavior, Debra Umberson of the University of Michigan finds that mortality rates are consistently higher" for the unmarried than for the married, because marriage exerts a "deterrent effect on health compromising behaviors," such as excessive drinking, drug use, risk taking, and disorderly living. By providing a system of "meaning, obligation, [and] constraint," family relationships markedly reduce the likelihood of unhealthful practices. Interestingly, Dr. Umberson's research also underscores the difference between the widowed and the divorced. Although both the divorced and the widowed have poorer health habits than the married, the habits of the divorced are far worse.

Yet in a study published in 1988, researchers at Ohio University found that divorced and separated men suffer from poorer health-and even have poorer cellular immune system control"-than married men with similar health habits (including hours of sleep and the use of alcohol, tobacco, and caffeinated drinks).

In research into the effects of marriage on health, Harold Morowitz of Yale University concludes: "Being divorced and a nonsmoker is slightly less dangerous than smoking a pack or more a day and staying married." He adds facetiously: "If a man's marriage is driving him to heavy smoking, he has a delicate statistical decision to make." Happily and Healthily Wed

The advantage the married enjoy over the unmarried in death rates due to cancer and heart disease is astonishing. The lung cancer rate for divorced men is twice that for married men, and the rates for some forms of cancer (genital, buccal, and pharyngeal) are three to four times as high among the divorced. The pattern among divorced women, although not quite so stark, is similar. Among both men and women, the single and divorced die from hypertensive heart disease at rates between 21/2 and 31/2 times those found among the married. Dr. Lynch reports that even when divorced and single persons' diseases are not fatal, they stay in the hospital longer than do married men and women suffering from the same illnesses. This pattern of longer hospital stays is costing America "uncounted billions of dollars" every year.

Just as impressive are the mental health benefits bestowed by marriage. Peggy A. Thoits of Indiana University says: Married persons have significantly lower anxiety and depression scores than unmarried persons, regardless of gender." Dr. Thoits notes that the married appear to enjoy better mental health even when they have experienced more potentially traumatic experiences than the unmarried. Surprisingly, even the mentally ill sometimes find psychological benefits in marriage. The British medical journal Lancet recently reported that in some cases marriages between the mentally ill prove "stable and may even show improved function.... The support provided by a shared mental disability may have a beneficial effect."

Some feminists have claimed that marriage benefits only men, but available health statistics show otherwise. Although men do realize a somewhat greater health advantage from marriage than women, both sexes are clearly healthier if married than if unmarried. The latest findings only partly confirm Emile Durkheim's famous hypotheses that marriage is more important for the mental health of men than for that of women and that rearing children is more important for women than for men. Dr. Umberson's 1987 study says, "Marriage and parenting relationships work together to deter health-compromising behaviors" for both men and women. In fact, for at least one disease-breast cancermarriage protects women's health in particular, by increasing the likelihood that they will bear two or more children. A recent study at the University of Bergen in Norway found a correlation between the number of children a woman has borne and her likelihood of developing breast cancer, the childless and the mothers of only one being most vulnerable.

Nor is it just husbands and wives whose health is affected by marriage. In a study published last year in the New England Journal of Medicine, researchers at the National Center for Health Statistics found that unmarried women, compared with married women, run "a substantially higher risk of having infants with very low or moderately low birth weights." Because birth weight is one of the best predictors of infant mortality, many more illegitimate than legitimate babies die. The NCHS researchers believe that marriage exerts no "direct causal influence on the outcome of pregnancy" but that a life course which includes marriage is likely to be healthier than one that does not. (For example, single mothers are more likely to smoke than married mothers.)

Although divorce is less threatening to a child's health than is illegitimacy, it still takes its toll. The Canadian Journal of Psychiatry reports that divorce increases the likelihood of mental disturbances among children, with more than a third of them still "troubled and distressed at the five-year mark" after their parents' divorces. John McDermott of the University of Hawaii says: "Divorce is now the single largest cause of childhood depression." Dr. Lynch believes that parental divorce not only causes mental neuroses among children but also contributes to various physical diseases, including cardiac disorders," later in life. In examining two national health surveys, researchers from Rutgers University found in 1988 that single mothers report "poorer overall physical health for their children" than do married mothers. Finnish health authorities at the University of Tampere find that children from nonintact families are much more likely to require medical attention for psychosomatic symptoms than their fight to contain ballooning health costs. Richard Morse of Kansas State University sees "some movement, at present, to deny welfare or Medicaid to those individuals whose families cannot prove they are unable to perform that responsibility." Alexa K. Stuifbergen of the University of Texas at Austin likewise has stated that many policymakers "are increasingly looking to the family as a hedge against the rising cost of healthcare services."

This rediscovery of family responsibility could mark a positive first step in reshaping public health policy. Unless, however, it is matched by some policies that help intact marriages, the rediscovery of family responsibility could create economic injustices. It could push intact families to the end of the line of those eligible for federal benefits, while keeping them near the front of the line of those responsible for paying for those benefits. One possible approach would be to restructure Medicare rates so that married recipients pay a lower monthly premium than the unmarried.

But it is politically unthinkable and ethically questionable for government to favor the married over the unmarried directly. Millions of older Americans are unmarried because of the death of a spouse; many others either had no opportunity to marry or divorced only for the most serious of reasons, after making every effort at reconciliation. Yet government policymakers could benefit most young marriages by framing a tax policy that offers greater advantages to households with children present. First, tax reformers could raise the personal federal income tax exemption for dependent children from $2,000 to $4,000. (Even at 4,000 the personal exemption would remain hundreds of dollars below its 1948 value when adjusted for inflation.) Second, the income ceiling for the earned-income tax credit could be raised-to perhaps $25,000 or $27,500-and the benefits could be scaled to the number of children in the home (while still restricting the credit to no more than the total payroll taxes paid by the recipient). Third, the current childcare tax credit could be universalized, which would allow households with stay-at-home mothers to share the benefits now received by dual-income homes.

Admittedly, such a child-centered approach would help unwed and divorced mothers, but not childless couples and older married couples with no children at home. Yet the young married couple remains the most fertile unit, and it would therefore receive most of the benefits. Although married American women now bear fewer children than in past decades, only about one married couple in 20 is both childless and infertile. Even a cohabiting couple is only half as likely as a married couple to have a child in their household.

Moreover, improving the economic status of the nation's children is a worthy policy objective in itself, quite apart from the gain for marriage. The two objectives of helping children and encouraging marriage could actually prove mutually reinforcing: married couples might well choose to have more children if some of the economic hardship of child rearing were eliminated, and children arguably provide the strongest cement for a marital union. It is no accident that the divorce rate dropped appreciably during the baby boom of the 1950s.

Many of the forces fueling America's retreat from marriage are ultimately cultural, hence not under the direct control of policymakers in a liberal democracy. Nonetheless, policymakers must cope with the rising medical costs created by the flight from marriage.

In discharging this responsibility, simple prudence suggests the need for approaches that will successfully reduce these medical costs by encouraging people to marry. At the same time, justice dictates that those who build successful marriages and families be relieved of at least some of the public burdens created by those people who repudiate marriage. Child-based tax benefits could help achieve these objectives without unfairly penalizing those who are unmarried for reasons beyond their control. A
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Title Annotation:married individuals deemed healthier
Author:Christensen, Bryce J.
Publication:Saturday Evening Post
Date:Jan 1, 1990
Previous Article:Heart disease: women at risk.
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