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The Case for Wedded Bliss
Want a Long, Healthy Life? Get, Stay Married, Says Waite

By Carla Garnett

Photos By Ernie Branson

On the Front Page...

You've heard of the so-called marriage penalty tax? Well, researchers supported by NIH have identified what they believe is a benefit that more than makes up for a mere financial slight: According to NIH grantee Dr. Linda Waite, people who marry live longer and healthier than people who don't. Call it the marriage health dividend. At a Nov. 10 Wednesday Afternoon Lecture titled the "Impact of Social Institutions on Health: The Case for Marriage," Waite pronounced husbands and wives heartier than others.

Continued...

"Marriage affects health," she asserted. "Being married, staying married, being part of a married couple changes people's choices. It changes their behaviors and that changes people's outcomes — particularly their health outcomes."

Dr. Linda Waite espouses marriage.

Waite, the Lucy Flower professor of sociology and director of the Center on Aging at the University of Chicago who also has served as a member of the advisory committee to the NIH director since 2000, has for decades studied how individual lives intersect with family, and the connections between marriage, family and health. Her work with the late Dr. Lee Lillard of the University of Michigan produced the book The Case for Marriage: Why Married People Are Happier, Healthier and Better Off Financially (2000).

Introducing the speaker as a longtime advisor of his, NIH deputy director Dr. Raynard Kington said, "The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity...Dr. Waite has broken new ground in applying the rigor of NIH-supported research toward improved understanding of health in the broader positive sense."

Waite cited several NIH-funded studies as the basis for her lecture, including the Social Environment, Loneliness, Stress and Health in Aging Program Project and the National Social Life, Health and Aging Project, both sponsored by the National Institute on Aging, as well as what she called "long-term moral, financial and logistic support" from the National Institute of Child Health and Human Development and the NIH Office of Behavioral and Social Sciences Research.

"We've known for a long time," she said, "that the social is very important for health. Things like social support, advice and help improve people's ability to deal with stress." Environments like neighborhoods affect the course of disease, she continued, and religious communities and such institutions as marriage all have been shown to have an effect on comprehensive views of human health. Waite said her studies of marriage zero in on what she believes is a vital component of human well-being that is vastly under-recognized and under-explored.

Committed to an Institution

"Marriage is unique," she said, contrasting wedded unions with friendships and other social, romantic or caring relationships. "Marriage is a public promise to stay together for life. Two people getting married promise — in front of their families and communities, often their religious communities — that they're going to form a new unit, that they will work together for the good of the unit, for each other's good, for the good of any children they might have, for their larger family and for their community. People around this unit recognize the bond and support [it]." And, unlike other iterations of coupledom, she said, "marriage is a legally binding contract."

Next, Waite presented data that showed trends in marriage, and links between marital status and mortality; between marriage, family and changes in health; and between marital history and current health.

Waite cited several NIH-funded studies as the basis for her lecture.

"If marriage produces benefits, then what's happened to people's access to these benefits?" she asked, offering a snapshot contrasting marriage rates now to those a half century ago.

In 1950, about the same proportion (35 percent) of people ages 15 and older in four race/gender categories — black and white, men and women — were unmarried. "Since then, however," Waite pointed out, "there has been a tremendous divergence, with the proportion of unmarried people skyrocketing — especially for black women and for black men — and rising for white women and for white men. If there are health benefits of marriage, then this unequal access to marriage could be a cause of racial disparities in health."

To link marriage to health, Waite used a large national data set to follow the probability of survival for more than 6,000 adults ages 43 to 65 throughout an 18-year period. The results indicated that many more married women and married men were still alive at age 65; far fewer people who never married, people who divorced, and widowers survived to that age. Widows seemed to retain some of the marriage benefit, with survival rates only slightly lower than those of still-married women. The data indicated that any category of unmarried — never married, separate/divorced or widowed — is unhealthy for men.

"There are very large differences in chances of dying by marital status that change when you change marital status," Waite concluded.

Family Matters

Next, she explored the family unit and its importance to health. "Family members," she explained, "bring resources with them into the home" via various support mechanisms: social — "a shoulder to lean on"; instrumental — someone to take out the trash or wash the dishes; and financial — additional household income.

By the same token, family members bring demands: the need for physical care, emotional and financial support, and the inevitable conflict/criticism.

"These family constellations differ in the level of demands relative to the level of resources," Waite explained. "Too many demands and not enough resources leads to stress. In fact that is the definition of stress. Stress diminishes health directly and it may diminish health by affecting healthy behaviors. Generally, more adults in the household mean more resources; more children mean more demands."

In study results that will surely boot more live-in in-laws from the family home to less intimate environs, Waite found that even the composition of the household makes a difference to health.

Before the lecture, guest speaker Waite (second from l) is greeted by (from l) Dr. Michael Gottesman, NIH deputy director for intramural research; Dr. Norka Ruiz Bravo, NIH deputy director for extramural research; and NIH deputy director Dr. Raynard Kington.

Using one of "NIA's premier data sets, the Health and Retirement Survey" begun in 1992 that includes 12,000 respondents ages 51-61 and has followed them every 2 years since, Waite examined three categories of health: physical — "How would you assess your health?"; emotional — self-rated depressive symptoms over the last 2 weeks; and cognitive — scoring from an immediate recall test.

The verdict? Married people who live only with their spouse or with their own children reported the best physical health, while other family configurations — singles living with others, married couples living with parents, or single parents — all reported significantly lower health.

Looking at study data that considered physical and mental health as well as mobility during a 2-year interval, Waite was able to show that "the family that one lives in causes or at least contributes to changes in health even over a short period." Married couples living by themselves or with their own children were the healthiest, while single parents were the least healthy. Extended family households limit the marriage benefit in both physical and emotional health; cognitive health did not statistically differ according to family composition. "The marital advantage depends on family context, with people in multigenerational households getting less advantage," she concluded.

Cost-Rewards of Happily Ever After

"So there is some evidence that marriage improves health," Waite said. "And if marriage improves health by reducing stress, by giving people more resources to meet demands, then the end of marriage increases stress and damages health. It moves people from a relatively resource-rich to a relatively resource-poor living arrangement.

"I like to think about health sort of like money," she continued. "Marriage is also a wealth-producing institution. People over time develop, maintain a stock of health and wealth. Something like a divorce is very costly. It's capital-destructive. It burns resources and if that's the case, then we should see the scar, the mark, the lower asset balance at a later time than we would see for people who never had this experience."

Waite and colleagues separated the survey's married people into two categories: those continuously married to the same person, or those separated/divorced or widowed and then remarried. The researchers then searched for — and found — a "scar" or other evidence that a disruption in marriage had an impact on the person's health. Data also showed that continuously married couples and never-married individuals clearly had a health advantage. "This provides some evidence that disruption damages health," she said. "This stressful transition is harmful."

Waite pointed out that the health benefit of marriage has been carefully documented, but the "hows" and "whys" have proven more difficult to determine. She offered "very early-stage work" on biological responses to stress as one avenue researchers are exploring to explain how the honeymoon may translate to a health boon. Married couples differ from single people in several key measures, including exposure to stress, severity of stress and access to restorative behaviors after stress. Researchers are looking at the brain as well as cardiovascular, immune and metabolic system responses to stress for the answers.

One conclusion that could be drawn, Waite said, is that it is the permanence and stability provided only by marriage that provides the health dividend. Perhaps people bound by public vows and legal contract are less apt to take risks with their health, less prone to unhealthy behaviors, she surmised. Perhaps husbands and wives fret less about life's burdens, since they know such cares will be borne and shared by two.

"Married people can specialize," she concluded. "Two working together can produce more and then trade with each other. They get the advantage of economies of scale. Two can live as cheaply as 1.65, according to recent estimates. Married people also share risks. They form a little insurance pool. And, finally, marriage provides people with social connections, which we know are health-protecting."

Waite presents data showing trends in marriage, and links between marital status and mortality; between marriage, family and changes in health; and between marital history and current health.

Waite ended her lecture by posing questions for further research, and fielding several from the audience. The full talk is archived at http://videocast.nih.gov/.


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