Now Reading: Equality equals health – Study of the impact of marriage equality laws on health care use


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Hatzenbuehler ML, O’Cleirigh C, Grasso C, et al. Effect of Same-Sex Marriage Laws on Health Care Use and Expenditures in Sexual Minority Men: A Quasi-Natural Experiment. American Journal of Public Health. 2012;102(2):285-291.

This paper hit the news about a month ago (“Same-sex marriage boosts gay men’s health, study suggests – HealthPop – CBS News“). I always like to read the actual study on anything pronounced in the news so I waited for the article to be populated in one of the databases I have access to before writing about it.

It’s interesting how times have changed – in 2005, a group of Canadian Physicians predicted that same-sex marriage was a health risk to people. And….it looks like they were wrong.

This paper studies a group of sexual minority men in Massachussetts around an important event 10 years ago in 2003 (!), the end of marriage discrimination. The question the researchers asked was whether this had an impact on their health.

To the extent that pro-gay marriage laws reduce structural forms of discrimination against sexual minorities such policy-level changes likely would improve health, thereby leading to reductions in health care use by lesbian, gay, and bisexual individuals.

They found that indeed this did happen, following the institution of marriage equality in Massachussetts:

  • 13 % decrease in medical care visits
  • 10 % decrease in mental health care visits
  • 14 % decrease in medical expenditures

All statistically significant, all independent of whether the men were partnered or not, without an impact from HIV Care. The Massachusetts health reform program did not go into effect until 2 years later in 2006, so there is no confounding there.

We were able to confirm that our results were not restricted to sexual minority men who were in partnered relationships, indicating that same-sex marriage policies may have a broad public health effect. The magnitude of the overall effects, which corresponded to small and medium effect sizes,30 were particularly striking given that policy-level changes are likely to be more distal determinants of health.

There is a huge inaccuracy in the first paragraph of the paper, though. It says “Six states and the District of Columbia currently offer same-sex marriages.” By the time you read this, the number will be 7.

Congratulations Washington, State, on being the first on the West Coast to join the East in promoting equality, which means promoting health. It’s time.

“I don’t feel diminished when another human being is allowed to exercise the same rights that I enjoy,” Pflug said. “I would feel diminished if I voted to deny others the right to exercise those same rights and freedoms.” – Republican Sen. Cheryl Pflug, Maple Valley, Washington


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Kathleen Furtado
Kathleen Furtado

"Equality equals health" also applies to *economic* equality. See this excellent TED Talk video: "Richard Wilkinson: How economic inequality harms societies" at <http://www.ted.com/talks/richard_wilkinson.html>. How do we reduce the inequality?

Ted Eytan
Ted Eytan moderator

@Kathleen Furtado Dear Kathleen,

Thanks for reading the post and the link to Wilkinson's TED talk. I hadn't seen it before and I like that it goes through social determinants (in this case income) in an easy to follow way.

I have thought about this some and realize that in the United States, where we don't have close ties between social care and health care, we may not have the ability to directly influence social inequality. However, I think we can collaborate with other industries/institutions that influence it. One way for us to do this is to demonstrate the impact of policies on health that promote inequalities, such as marriage discrimination. It's too bad that in the past parts of the medical profession tried to characterize granting equal rights as harmful to health, so I think this paper is significant in that it reflects common sense better,

Ted

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  1. Applauding Suze Orman for Speaking Out for Marriage Equality – it Will Save Lives | Ted Eytan, MD says:
    June 26, 2012 at 11:46 pm

    [...] How do we know this? There’s now data that in places where there is no discrimination, the opposite is true see: Now Reading: Equality equals health – Study of the impact of marriage equality laws on health … [...]