Marriage Equality is Sound Public Health Policy

Testimony given by Dr. William Buffie to the House Judiciary Committee on February 7, 2011 on Marriage Discrimination Amendment.

Thank you for the opportunity to address the assembly today.  I am an internist and have practiced on the south side of Indianapolis for nearly 27 years.  I graduated Phi Beta Kappa from Northwestern University, then attended Indiana University School of Medicine and graduated with highest distinction in 1981.  I completed my internal medicine residency in 1984, also at IU.  I have served as CEO of one of the largest internal medicine groups in the state for the past 15 years in addition to maintaining full time clinical practice.

It strikes me, after listening to the testimony of others preceding me today -- both those for and against HJR-6 -- that what we have heard are a lot of opinions and interpretations relative to various facets of the arguments presented, but we have heard very few facts.  I would like to challenge the committee members to cast your votes based upon facts rather than voting from a position of fear or tradition.

Last fall the Indiana State Medical Association, based upon facts supporting the preamble clauses, passed the resolution 10-02A:

1) Whereas, legal marriage status confers numerous financial and legal benefits upon married individuals that improve access to health care;
2) Whereas, better access to health care results in lower overall mortality;
3) Whereas, the Lesbian, Gay, Bisexual, Transgender (LGBT) community has diminished access to health care;
4) Whereas, the LGBT community suffers from significantly worse mental and physical health  outcomes compared to the community at large;
5) Whereas, the American Medical Association, at the November 2009 convention, acknowledged that same-sex marriage bans do contribute to health disparities in the U.S.;
6) Whereas, evolving medical/social science literature attest to the health benefits conferred by the social and legal recognition of same-sex marriage;
7) Whereas, the ISMA is a body that is to be guided in its decision-making by science, reason, and public policy standards that promote the health and well being of all Indiana citizens;
8) Whereas, same-sex marriage equality has not been demonstrated to have any deleterious consequences for society in general;

Therefore, be it resolved that the Indiana State Medical Association (1) recognizes that exclusion from civil union or marriage contributes to health care disparities affecting same-sex households; (2) will work to reduce health care disparities among members of same-sex households, including minor children; and (3) will support measures providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits, as afforded opposite-sex households.

This resolution was the culmination of four years of research and discussion involving ISMA proceedings and it passed on September 26th, 2010 because members were educated.  They studied the evidence-based literature and voted in a rational manner supporting a measure designed to improve health outcomes for the gay community. 
The data was compelling.  The facts were beyond question.  Position statements from the national organizations of pediatricians, psychologists, psychiatrists, social workers, and anthropologists all provided additional validation of the conclusions reached. 

Many letters of support from prominent physicians and community members added credibility to the research that I had provided.  Letters from leaders such as Dean Brater of the IU School of Medicine; former state health commissioner Richard Feldman; distinguished professors of medicine Doug Rex, Joe Mamlin, and Larry Einhorn; Indianapolis Chamber of Commerce president Roland Dorson, just to name a few, galvanized the way for the ISMA to overwhelmingly pass resolution 10-02A which made Indiana the first state in the nation to pass a resolution mirroring the American Medical Association’s November 2009 convention resolution of almost the same language.

The research presented is further validated by the fact that the nation’s premier journal of public health -- the American Journal of Public Health -- in December accepted for publication {will be available on line April 14; in print in June} an article I authored titled Public Health Implications of Same-Sex Marriage.  Understand that for an article such as this to be published in a journal of this repute, it must undergo vigorous peer review.  This is not just me passionately expressing opinions born of bias, but rather the process is one that requires objectivity and independent validation.

Let me just share with you the bottom line conclusions that come from such research:

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.  Children of same-sex couples fare just as well as any others on standardized academic testing and emotional scales, and their own sexual orientation is unaffected by having same-sex parents.

No doubt objections will be raised today.  I’d like to anticipate and address some of those now.

Some will cite opposing literature.  They will cite “facts” from organizations that were founded in order to preserve “the basic father/mother unit within the context of marriage as the optimal setting for childhood development” {American College of Pediatricians}.  What one finds is that their “research” does not reference peer-reviewed current journal articles, but contains numerous publications from the 1960’s and 1970’s offering opinions based upon outdated and offensive stereotypes of gays.  Same-sex attraction is explained as being caused by such things as poor parenting and traumatic childhood experiences offering examples such as:  “Mother was overprotective; lack of rough and tumble play; dislike of team sports; lack of hand/eye coordination and resultant teasing by peers” {Homosexuality and Hope from the Catholic Medical Association}. 

Organizations such as the National Association for Research and Therapy for Homosexuality/Family Research Institute {led by Paul Cameron, Ph.D., who was removed from membership in the American Psychological Association for consistently misinterpreting and misrepresenting research on sexuality} support “cures” for the “sin” of homosexuality.  Reparative therapy, as such “cures” are called, has been categorically dismissed as not only unethical, inappropriate and ineffective by every reputable medical organization, but also as being frankly dangerous to the individuals in question.  The “studies” referenced are not peer-reviewed, but rather are opinion pieces that are published in vanity journals wherein homosexuality is characterized as a “gender identity disorder” -- a position that has been condemned by health care experts since 1973 when homosexuality was declassified as a disease state.    
  
Any “literature” coming out of such organizations that demonstrate this type of bias and fundamental lack of understanding of the gay community are not relevant to our discussion today.

As one begins to understand the facts surrounding marriage equality and its implications for public health, it is most important to recognize that this is about so much more than just access to health insurance, hospital visitation rights, survivor benefits, etc.  More importantly, it is about stigma.  The Defense of Marriage Act enacted in 1996 created a class of 2nd class citizens by institutionalizing stigma.  HJR-6 and SJR-10 are proposals to endorse such stigma in the state of Indiana -- an endorsement which stands at the forefront of a cycle that marginalizes a minority group in a fashion that tears families apart and adversely affects health outcomes.  Stigma, and its attendant “minority  stress” with the feelings of isolation, shame, and self-doubt resulting from the internalization of prejudice by those challenged with being gay in a heterosexist society, directly contributes to the high rates of depression, anxiety, suicide attempts, substance abuse, risky sexual behavior, and fractured family support that are all too common in the gay community.

Imagine a prominent MD in this city who was driven from his successful practice by bullying partners who threatened to destroy him and his practice by exposing him for being gay?  Imagine a child who being kicked, spat upon, and called a faggot by bullies at school?  Imagine children who are homeless, living under a bridge in a cardboard tent because they have been kicked out of their home for the crime of being gay.  Imagine children having their life disrupted because they are dismissed from their school and torn from their classmates just because their parents are lesbians.  Imagine children mourning the death of one of their mom’s who died of colon cancer because she failed to have screening colonoscopy as was recommended because she didn’t have health insurance due to lack of spousal benefits despite having been with a committed partner for 30 years and having raised a family together?  Imagine a 13 year old boy who chooses to hang himself rather than face the shame and  disappointment of telling his dad that he is gay?  Imagine the boy who did tell his dad he was gay and then spent the next five years of his adolescence receiving daily beatings chained to a pole in his basement?  Imagine the fear, shame, and self-loathing that a young, closeted, gay man feels growing up fearing rejection by his church and family.  Imagine him questioning his own value as a human being.  Think about how he must feel when he comes out to his mother at the age of 22, but making her promise to keep it a secret.  Recognize, as he did, that his mother had never kept a secret her entire life.  But this secret she kept, and they both knew that she kept it not to honor her word to him, but rather because she was ashamed of him.  Imagine the next 8 years of his life in a downward spiral marked by heavy drug use, contracting AIDS, and near death.

Now, imagine no more.  All of these are true events.  Surely you are aware of the number of teens who have committed suicide across the nation within the past year as a result of incessant bullying by those who may be empowered and enabled by government-sponsored legislation which suggests that gays are not be valued in the same way as all others.  

Parents, too, conflicted by their love for their child yet being torn by the messages inherent in a heterosexist society and measures such as these constitutional amendments calling for marriage to be narrowly defined as between one man and one woman, struggle with their own sense of isolation and the coming out process experienced by the parents of a gay child.  Many families do not survive this stress.  Stories like those above illustrate that one simply cannot overemphasize the fundamental importance of being valued and accepted by family, friends, and peers. 

Particularly germane for this group to consider is the experience surrounding the 2004 election cycle with respect to constitutional amendments of this ilk.  Empirical evidence of the negative health effects of discriminatory policies relative to marriage equality was described by public health researchers at Yale, Harvard, and Columbia universities who reported that lesbian, gay, and bisexual individuals living in the 14 states which, in 2004, approved constitutional amendments limiting marriage to opposite-sex union, reported significantly higher rates of psychiatric disorders -- with increases of 36% for any mood disorder, 248% for generalized anxiety disorder, 42% for alcohol use disorder, and a 36% increase for psychiatric co-morbidity.  In the comparable control group from states without such amendments during the same  time period, there were no significant increases in these psychiatric disorders.

Marriage equality does not detract from importance of family; rather it provides affirmation for this fundamental institution -- an institution that parties on either side of the aisle embrace.  Evidence-based literature strongly supports the notion that family is indeed a critical building block of our society.  Same-sex marriage does not threaten that institution; it simply expands the number of people who benefit from this social structure and the legal and social safety net that it provides. 

Acknowledging the health benefits of marriage equality is not just a symbolic gesture.  To do so is sound public health policy supported by evidence-based literature.  It will change, and save, lives.

So, again, I challenge you as leaders of our state to live up to your responsibility to educate yourselves, your colleagues, and your constituents.  I encourage you to cast your vote armed with facts and knowledge -- and not be guided by fear or tradition.

Let me offer one final philosophy for you to consider as legislators:

"Do not believe in anything simply because you have heard it.  Do not believe in anything simply because it is spoken and rumored by many.  Do not believe in anything simply because it is found written in your religious books.  Do not believe in anything merely on the authority of your teachers and elders.  Do not believe in traditions because they have been handed down for many generations.  But after observation and analysis, when you find that anything agrees with reason and is conducive to the good and benefit of one and all, then accept it and live up to it."  ~Buddha

Comments

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Married people acquire same health benefits also their child. But there are countries who allow same sex marriage but when it comes to benefits in health care there are some problems. Yet as a person, whether you are engage with same sex marriage, it is your right to avail own benefits.