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The Public Health Case For Marriage Equality

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This fall Congress will have the chance to enact federal legislation protecting same-sex marriages, as well as interracial unions.

The bill being considered—the Respect for Marriage Act—sailed through the House of Representatives earlier this summer with the support of every Democrat and 47 Republicans.

Now, the fate of the proposal is up to the evenly divided Senate, where at least five Republicans have indicated they may vote for the measure. Five more would be needed to advance the bill through the chamber and send it to President Joe Biden’s desk.

The impetus for the legislation is borne out of the recent US Supreme Court decision overturning Roe v. Wade, the long-standing court case that established a federal right to abortion care in the United States.

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In a concurring opinion, Justice Clarence Thomas, outlined his view that Roe was not the only US Supreme Court precedent that should be revisited and possibly cast aside. The right to contraception, the right for consenting adults to engage in intimate relationships, and the right for same-sex couples to marry are all areas in which the conservative justice believes the Court has overstepped.

This line of thinking immediately caused an uproar among those who benefit from such protections—especially those within the LGBTQ+ community. The hard fought right for people to enter a legally recognized marriage, regardless of their gender, sexual orientation, or the state they live in, suddenly felt at risk. If Roe fell after 50 years, one could certainly imagine a scenario in which marriage equality—less than a decade old—could also unravel.

To be clear, no other justice signed on to Thomas’ views. As a result, some members of Congress have suggested that there is no urgent need to codify marriage protections for LGTBQ+ people into federal law.

But there is urgency, indeed.

The US Supreme Court may not be on the verge of overturning its decision in Obergefell v. Hodges—the court case that determined same-sex marriage was constitutionally protected. But the suggestion from Thomas that marriage equality ought to be reconsidered helps illustrate the range of threats LGBTQ+ people continue to endure at the individual, community, and societal levels.

Every day, we run the risk of verbal and physical attacks when simply walking down the street, even in diverse urban centers such as Washington, D.C., that boasts large LGBTQ+ populations. Or we face the threat of a sitting US Supreme Court Justice who seeks to eliminate a basic human right that millions of Americans currently enjoy.

Always On Edge

These constant threats contribute to the grim reality that LGBTQ+ Americans live in a country where we often do not feel safe to be ourselves. We do not feel protected by our nation’s laws or lawmakers. We live in a constant state of hypervigilance—always on edge, constantly scanning for the next threat. And it may be killing us.

Hypervigilance, and associated stress, can lead to a host of negative mental and physical health outcomes. It is no surprise, then, that research shows that LGBTQ+ adults are more likely to have worse heart health than their heterosexual peers. They are also more likely to suffer from mental and behavioral health disparities, including higher reported levels of suicide and substance use disorders. The list goes on.

Is Justice Thomas responsible for these poor health outcomes? Not exactly. But when he seeks to advance national policies that discriminate against LGBTQ+ people, he may be contributing to the perpetuation or worsening of these outcomes.

Social Safety

Writing in the journal, Neuroscience & Biobehavioral Reviews, researchers from the University of Utah’s Department of Psychology argue the health disparities often observed within LGBTQ+ communities could be attributed to a lack of social safety.

What is social safety? Lisa Diamond, PhD, and her colleagues out of Utah define it as “reliable social connectedness, inclusion, belonging, recognition, and protection.” They argue that it is only when sexual and gender diverse people feel socially safe can we let our guard down. When the threat has been eliminated or removed, stress levels can subside, and perhaps negative health outcomes can dissipate.

Diamond gives the following example to help illustrate the point. Imagine waiting alone at a dark and deserted bus stop, not knowing whether you missed the last bus and not having any other way to get safely home. Your brain and your senses will likely go into high alert for any sign of the approaching bus, temporarily hijacking all of your other thoughts and goals. Only when you detect the approaching bus (signaling that you are out of danger) will your nervous system down-regulate its threat-vigilance, flooding your brain and body with relief and allowing you to turn your attention to other things.

A new report from the Trevor Project—a national nonprofit organization that provides 24/7 crisis support services to LGBTQ young people—substantiates this theory. The report revealed nearly half of multiracial LGBTQ youths “seriously considered” suicide in 2021—a devastating statistic.

But there is good news. The same report also concluded that LGBTQ-affirming spaces and people are strong protective factors for multiracial LGBTQ youth suicide. For instance, multiracial LGBTQ youth who reported high levels of social support from family had 55 percent lower odds of attempting suicide in the past year.

Just like affirming spaces and people, affirming laws and policies can foster better health outcomes. As Diamond discusses in her paper, there is evidence that suggests states with higher levels of policy support (for example, protections for marriage or parenting rights), LGBTQ+ people are happier and healthier. They report fewer days with poor mental health, lower alcohol use, and more recent health care checkups.

Congress Can Declare

Congress has the chance to enact a law that affirms LGBTQ+ people on a national scale. Lawmakers can neutralize the health and social threat created by Justice Thomas’ opinion and dispel the uncertainty it has created about protections for same-sex marriage in the United States.

In passing a federal law that protects same-sex marriage, Congress can declare that we belong, that we are included, and that our relationships are safe. When it comes to marriage equality, LGBTQ+ Americans are currently sitting in the dark at a deserted bus stop waiting to see if Congress is coming to pick us up. They ought not to miss the opportunity. Our lives are riding on it.

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