Ten years ago, when Massachusetts was at the epicenter of our national debate over whether or not the marriages of same-sex couples should be legally recognized, we heard a lot of dire warnings about what would happen if marriage equality was enacted: The institution of marriage would be irreparably damaged. Children would be harmed. The sky would fall.
None of that came to pass. In fact, just the opposite. Our families and communities have been strengthened by marriage equality in ways we never imagined a mere 10 years ago. Consider, for example, that one of the side effects of marriage equality has been improved public health.
Since May 17, 2004, nearly 25,000 same-sex couples have married in Massachusetts and countless more in the 16 other states and the District of Columbia which have since joined Massachusetts in recognizing marriage equality. An unexpected benefit of these marriages is that gay and bisexual men have enjoyed a marked increase in general health and mental health since same-sex marriages have been legally recognized. These improvements in health have also led to lower health care costs.
A 2012 American Journal of Public Health study based on Fenway Health data found that in the 12-month period after marriage equality was enacted in Massachusetts, gay and bisexual men experienced a 13 percent drop in medical care visits and a 13 percent drop in appointments related to mental health. In particular, visits related to general medical care, hypertension, and sexually transmitted infections decreased, and diagnoses of depressive, anxiety, and adjustments disorders decreased. As a result, general medical health care costs in the 12-month period after same-sex marriages became legal in Massachusetts were 10 percent lower than what they were in the 12-month period before the advent of marriage equality. Costs related to mental health care were 14 percent lower.
It is commonly understood that social factors such as one’s race, socioeconomic status, and the environment in which one lives have major impacts on health. Generally speaking, people with higher incomes are healthier than people who live in poverty. Many of the policy interventions to deal with such health disparities have focused on increasing access to health care. Yet evidence is rapidly accumulating that legislative and public policy changes that reduce inequality can also positively impact health in significant ways.
It’s incredibly difficult to track the health impact of such policy changes. Major changes in law, such as what happened here in Massachusetts 10 years ago, are relatively rare events. It’s also important to remember that the 2012 study was observational, so one must be cautious about inferences. Yet, as we wrote in our 2012 study, “Because this was a fateful event that occurred outside the control of the individual, it … allowed for a relatively strong empirical test of the influence of policy-level changes on health care use and expenditures among sexual minority men.”
The ripple effects of improved health and lower costs related to medical care positively impact not just these men, their extended families, and the community at large. As we move into a second decade of marriage equality, we can do so with the confidence that the legal recognition of the marriages of same-sex couples strengthen those families―and the communities in which they live―in myriad ways. When this effect is multiplied across the 16 other states plus the District of Columbia which also now recognize the legal marriages of same-sex couples, you can see just how powerful equality can be.
KENNETH MAYER, MD, is the founder, cochair, and medical research director of the Fenway Institute, the research, training, and health policy division of Fenway Health.
STEVEN SAFREN, Ph.D., is an affiliated investigator at the Fenway Institute and director of behavioral medicine in the Department of Psychiatry at Massachusetts General Hospital. Both Mayer and Safren were researchers on the 2012 American Journal of Public Health study.