Wednesday, April 16, 2014

[USA] - "Same-Sex Marriage — A Prescription for Better Health" by Gilbert Gonzales

The past year has proved to be a pivotal one for lesbian, gay, bisexual, and transgender (LGBT) Americans. When 2013 began, same-sex couples were allowed to marry only in 9 states plus Washington, D.C., and even when they were legally married by states, the federal government did not recognize their relationships, in accordance with the Defense of Marriage Act (DOMA). As of February 2014, same-sex couples can legally wed in 17 states (and enter civil unions or domestic partnerships in 3 others), and their unions are federally recognized, thanks to a set of court decisions and new laws passed by state legislatures legalizing same-sex marriage.

Nevertheless, approximately 60% of the population and many LGBT people live in the 33 states that still deny same-sex couples the right to marry. Though the issue remains stuck in political gridlock in Washington, growing public opinion in support of same-sex marriage is expected to lead to its reconsideration by more states in 2014. Shifting attitudes may reflect the fact that a growing number of Americans now have a close friend or family member who identifies as LGBT. Although the most central issues raised by the public discourse regarding marriage are moral and rights-oriented, there are also health-related issues at stake: legalizing same-sex marriage can improve health and access to health care for LGBT people.

A 2011 report by the Institute of Medicine on the health of LGBT persons identified substantial disparities in health and access to health care for sexual and gender minorities. Many LGBT people of all ages report worse physical and mental health outcomes than heterosexual and non-transgender populations, largely as a result of the stress caused by being a member of a stigmatized minority group or because of discrimination due to sexual orientation or gender nonconformity. Discriminatory environments and public policies stigmatize LGBT people and engender feelings of rejection, shame, and low self-esteem, which can negatively affect people's health-related behavior as well as their mental health. LGBT people living in states that ban same-sex marriage, for instance, are more likely than their counterparts in other states to report symptoms of depression, anxiety, and alcohol use disorder.

Read More at NEJM

By: Gilbert Gonzales, M.H.A. N Engl J Med 2014; 370:1373-1376 April 10, 2014 DOI: 10.1056/NEJMp1400254  

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