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What Does 'I Do' Do for You?

By Dr. Robyn Liu

On June 24, my Facebook page was lit up with “I Love New York,” pictures of the rainbow-hued Empire State Building, and articles heralding the historic news that a sixth state, the largest so far, was about to grant full marriage equality to same-gender couples.

Many of the major medical organizations, including ACOG, the AAP, and the AMA, have also come out in support of extending marriage benefits across the lines of sexual orientation. In my own specialty society, the American Academy of Family Physicians (AAFP), last year’s Congress of Delegates fell just a few votes shy of doing the same. The subject will come up again when the Congress reconvenes in September, and along with many other members I am crossing my fingers that this will be the year the scales finally tip.

Some have argued in the past that marriage is a “social issue,” and that the AAFP’s stance on equality of health care access under its definition of a family is sufficient for the purposes of health advocacy for LGBT patients. However, without universal marriage equality, health disparities in this marginalized population will persist. Others argue that civil unions will provide equal benefit without changing the definition of marriage. But civil unions, not being federally recognized, are not enforceable across state lines and do not reach the same legal threshold as marriage. A domestic partnership, often incorrectly equated with a civil union, is by legal definition an agreement between unmarried individuals, and carries the least weight of all.

Physicians who care about the health of all patients must advocate for full equality of marriage rights. The health disparities that result from a committed couple’s inability to marry are well-documented. The most obvious causes are lack of benefits like hospital visitation, survivor benefits, and access to spouse and family health insurance plans. Nobody can argue that these discrepancies do not have an impact on the health of LGBT families. But beyond that, ample research demonstrates the real impact that marriage inequality has on physical and mental health. In February of this year, Dr. William Buffie testified to the Indiana House Judiciary Committee:

“Formal, legal marriage confers survival advantage and better health outcomes to heterosexuals regardless of race/ethnicity, religion, or socioeconomic status.  Recent medical and social science literature now assure us that the same holds true for gays and lesbians who are given the opportunity to enter into legal marriage.  Furthermore, it is clear that the most important factor in successful child-rearing is an intact 2-parent unit, and this holds true regardless of the sexual orientation of the parents.”

Dr. Buffie published his findings last month in the American Journal of Public Health. That marriage inequality has real and demonstrable impacts on the health of our population is not a fringe belief – it is evidence-based fact. The government’s Healthy People 2010 project even contains an LGBT companion document outlining this research. It states clearly, “Research suggests that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights.”

There is a very thoughtful discussion on the health benefits of marriage and the detrimental impact of marriage inequality for same-gender couples, published by Gregory Herek of the UC Davis Department of Psychology in 2006. If you find my brief arguments unconvincing, please read parts I, II, and the conclusion of his essay.

Marriage equality still has a very long way to go in our nation, and it is a complex and heavily fraught issue for many people. There is some fear about what legal same-gender marriage will mean for our nation. But from the standpoint of advocating for the health of our patients, it is fairly simple: Nothing less than full equality will break down the walls of health disparities that hold our patients back.


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