In ruling that the 14th Amendment requires states to issue marriage licenses to same-sex couples and recognize same-sex marriages performed in other states, the U.S. Supreme Court, in Obergefell vs. Hodges, not only addressed a fundamental issue of equality, but may have unwittingly contributed to improved public health.

Consider the research devoted to the health of LGBT (lesbian, gay, bisexual and transgender) populations. A growing body of work shows that their health is worse on multiple levels than the health of comparable majority populations. This work reflects a key foundation of public health that I have discussed previously: Context plays an ineluctable role in shaping the health of populations.

The world has enjoyed tremendous improvements in health over the past century.  We have gained almost 20 years in life expectancy globally over the past 50 years. Just to give one example, children in Chile now can expect to live to age 79, while in 1950 they could expect to live to 55.   Much of this improvement in the health of populations comes from changes in the world around us, structural efforts that create the conditions that enable population health.  Some of these core changes in the past century were improvements in food supplies, sanitation, cleaner air, and declining birth rates.

To the Editor: 

It is unfortunate that Nina Teicholz throws out the methodological baby with the policy bathwater.

She is right that we have not been served well by policy making that has been enamored of compelling but probably unsound dietary advice. But epidemiologic data is not the culprit. Observational studies can yield insights that guide causal inference as much as experimental studies can.