Same-Sex Marriage Policies Harm LGBT Health
By Mark L. Hatzenbuehler, PhD, Robert Wood Johnson Foundation (RWJF) Health & Society Scholar at Columbia University. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health. Hatzenbuehler is a member of the program’s 8th cohort.
The topic of same-sex marriage in the United States was once again front and center in the public discourse several weeks ago when North Carolina joined 30 other states in banning same-sex marriage. The debates surrounding same-sex marriage policies have been waged on many grounds—moral, legal, religious, and economic. Conspicuously absent from this debate has been a discussion of whether same-sex marriage bans harm the health of lesbian, gay, bisexual, and transgender (LGBT) individuals.
In a New York Times article from May 11, Gary Pearce, a former advisor to Jim Hunt, a Democratic governor in North Carolina, explained that those who voted against same-sex marriage “genuinely and honestly believe it violates their fundamental religious beliefs.” He added, “They don’t really want to hurt people.”
This may well be true, but social science research indicates that policies banning same-sex marriage do, in fact, hurt people. In a series of studies that my colleagues and I have conducted, we have shown that same-sex marriage policies affect the mental and physical health of LGBT individuals.
In one study we used data from a nationally representative survey that assessed the mental health of 34,654 U.S. adults. Respondents were interviewed in 2001-02 and then again in 2004-05. In 2004, during the presidential election, multiple states passed constitutional amendments banning same-sex marriage. We were therefore able to examine the mental health of LGB adults nationwide before and after the passage of these bans.
The results showed that rates of mental health problems significantly increased for LGB adults living in states that banned same-sex marriage, compared to LGB individuals living in states without the bans. Specifically, we found a 37-percent increase in mood disorders, a 42-percent increase in alcohol disorders, and a 248-percent increase in generalized anxiety disorder among LGB adults living in states that banned same-sex marriage.
Whereas banning same-sex marriage has negative mental health consequences for LGB individuals, enacting same-sex marriage laws may actually improve their health. A study that my colleagues and I recently published in the American Journal of Public Health supports this idea. In this study, we used data from a sample of gay and bisexual men living in Massachusetts, which in 2003 became the first state to legalize same-sex marriage.
In the 12 months after the legalization of same-sex marriage in Massachusetts, there was a substantial reduction in several mental and physical health problems among gay and bisexual men, including a 14-percent decrease in depression and an 18-percent decrease in hypertension. Our results also revealed a nearly 15-percent reduction in medical and mental health care utilization and costs among gay and bisexual men, suggesting that their improvements in health translated into a reduced need for health care. In contrast, during this same time period, health care costs increased for the general population in Massachusetts, as they did for much of the country.
There are other, less direct, ways that same-sex marriage bans can harm the health of LGBT individuals. Laws that exclude same-sex couples from marriage reflect, and in some cases create, an environment that marks LGBT individuals as second-class citizens. Within this social context, it is perhaps not surprising that 85 percent of LGBT students report being verbally harassed because of their sexual orientation or that gay men face the highest rates of hate-motivated crimes compared to other federally protected groups. In turn, LGBT targets of bullying, harassment, and hate crimes experience a variety of negative health outcomes, including post-traumatic stress disorder and suicide attempts.
In stating that many people who disagree with same-sex marriage do not “want to hurt people,” Mr. Pearce expresses a common sentiment. The social science data reviewed above, however, clearly demonstrate that this is an untenable position. The public discourse over same-sex marriage, which tends to focus on political and moral arguments, has lost sight of an important point: Laws that ban same-sex couples from marrying harm the health of LGBT individuals. We should be mindful of the negative health consequences of these laws as the debate over same-sex marriage continues to unfold.