Michael A. Tew
Recent articles in the New England Journal of Medicine and the Journal for Nurse Practitioners consider the relationship between marriage and health. Each offers several good reasons why the answer to the basic question is yes but provide some caveats to qualify their assertions. Before getting to their arguments, however, the actual state of LGBT health as compared to the general health of the heterosexual population needs to be understood. Research has consistently demonstrated that LGBT populations experience more negative health related outcomes (mental and related physical health issues) as a result of stigma and discrimination. The National Alliance on Mental Illness reported on several studies that show wide disparities between heterosexual and LGBT reports of anxiety, depression, mood disorders, and substance abuse during an individual’s lifetime. These are NOT the result of simply being Lesbian, Gay, Bisexual, or Transgender. The disparity is the result of consistent and pervasive social, institutional, and familial discrimination. More profoundly consequential are the effects of actual or threatened physical violence, verbal violence, and internalized homophobia. An article in The Lancet (February 8, 2014) indicates that anti-LGBT polices and homophobia frequently prevent LGBT persons from even seeking health care at all. While the article used Russia and Nigeria as particularly troubling examples, evidence of similar problems in both Europe and the US were included.
Understanding that LGBT persons often experience health consequences specific to discrimination, it stands to reason that Marriage Equality, a significant step forward in confronting discrimination and stigma would help. In many ways, it does. Gilbert Gonzales writes, in the New England Journal of Medicine (April 10, 2014) that “Public health research has suggested … that legalizing same-sex marriage (among other policies expanding protections) contributes to better health for LGBT people.” His report cites data from Massachusetts and California that indicate same-sex marriage recognition was related to fewer mental health care visits and reduced psychological distress. Laura C. Hein (associate professor in the College of Nursing at the University of South Carolina) asserts, in the Journal for Nurse Practitioners (June, 2014), “Marriage is associated with multiple mental and physical health benefits, including benefits that support psychological health and access to health care through a spouse. Marriage also protects and promotes the health of the children of LGBT couples by providing the legal and health insurance protections that are granted automatically through marriage.” Both authors rightly frame Marriage Equality as a public health issue as well as a political and civil rights concern.
In the same issue of the Journal for Nurse Practitioners, however, Christopher M. Fisher (assistant professor in the College of Public Health at the University of Nebraska Medical Center and Director of the Midlands Sexual Health Research Collaborative) is less optimistic about the health improving value of marriage equality. He identifies other important sources of negative health outcomes for LGBT people such as structural stigma and institutional forms of discrimination that are not resolved by marriage equality. He writes, “Regardless of the legal status of same-sex marriage, stigma-related discrimination will persist for some time. Health care providers, including nurses, are among the many on the front lines who can provide a stigma-free environment and culturally competent care, which will be as important as marriage equality in eradicating health disparities for LGBT Americans.”
So there you have it. The evidence suggests that Marriage Equality will likely lead to better health outcomes for LGBT populations but that it is not the only answer to resolving health consequences resulting from stigma and discrimination. Therein lies a message about the Equality Movement and public policy at large. Marriage continues to be an important focus for advocacy but the movement for full equality is about much, much more.