Same-sex marriage is being framed as a health issue in the upcoming Australian plebiscite.
Opposition health spokeswoman Catherine King recently stated that a vote said against gay marriage would lead to worse health for same-sex couples. "The Health Minister might not be prepared to say it, but I am - marriage equality is an issue of health," she said.
This was backed up by the leader of the Greens, Richard Di Natale , who is a doctor.
"I can state without any reservation that achieving marriage equality is a public health issue with a broad impact on the LGBTIQ community and the people who know and love them. Achieving marriage equality will have a profound impact on the physical and mental health of LGBTIQ Australians."
Politicians are not wholly to blame for transforming a robust moral and political debate between two experienced brawlers into a match between a schoolyard bully and his sickly and defenceless victim. The Australian Medical Association strongly backed same-sex marriage (without consulting its members) earlier this year with the thinnest of evidence. One of its critics, Dr Chris Middleton , a former president of the AMA's Tasmanian branch, pointed out that
"The only evidence the AMA provides for the alleged health benefits of changing our marriage law is a single study from a clinic in the US 14 years ago. In that study, annual mental health visits by LGBTI people dropped from 3.35 to 2.93 after the marriage law changed, a finding confounded by lack of a control group of straight patients and therefore of questionable significance. That is no basis for public policy."
Given the short time frame for the debate, it's likely that an article published yesterday in The Conversation by three researchers from the University of Melbourne will be widely cited: "Legalising same-sex marriage will help reduce high rates of suicide among young people in Australia".
This is a topic with lots of conflicting evidence, but you wouldn't know it from reading the article. The researchers state confidently (albeit choosing their words very carefully):
Research shows that in countries and jurisdictions that have legalised same-sex marriage, there is a much smaller gap between the rates of poor mental health among same-sex attracted and heterosexual people. This is particularly the case with young people, for whom suicide rates have a been a significant national concern for decades.
In some cases statistics for overall mental health might improve. But what if the suicide rate rises? If politicians are sincerely about reducing the suicide rate amongst young gays, shouldn't they be told about research which shows that suicide risk increases in countries where same-sex marriage has been legalised?
It's not as though this is hidden. The Melbourne Uni researchers even cited one of these studies.
And there are not one, but four, at least, research articles which suggest that male same-sex couples, especially, could be at risk of premature death or suicide, even in countries where same-sex marriage has been legalised and is relatively uncontroversial.
The first of these was published in 2009 in the American Journal of Public Health . Two Danish researchers found that:
Despite recent marked reduction in mortality among gay men, Danish men and women in same-sex marriages still have mortality rates that exceed those of the general population. The excess mortality is restricted to the first few years after a marriage, presumably reflecting preexisting illness at the time of marriage.
Even though their study was inconclusive, it still suggests that same-sex marriage may not bring health benefits to young gays and lesbians. However, the authors stressed that their study did not support conservative groups in the US: "Although further study is needed, the claims of drastically increased overall mortality in gay men and lesbians appear unjustified."
A second study published in 2011 in Social Psychiatry and Psychiatric Epidemiology examined suicides in Denmark in the 12 years after the legalization of same-sex registered domestic partnerships (RDP) - which is not the same as marriage, but did give more social status to same-sex couples. The results were appalling: "The estimated age-adjusted suicide mortality risk for RDP men was nearly eight times greater than for men with positive histories of heterosexual marriage and nearly twice as high for men who had never married."
The third study was the one cited in the article in The Conversation. Another Danish team reported its somewhat puzzling results in the International Journal of Epidemiology four years later, in 2013:
Between 2000 and 2011, same-sex married Danish women emerged as a group with particularly increased mortality; in contrast, same-sex married Danish men now have mortality rates that are lower than those of unmarried and divorced men. (Ed. emphasis added)
In The Conversation , however, only the decreased mortality amongst gay couples was mentioned - not the increased mortality amongst lesbians. But there was even more obfuscation than this. Although the overall mortality fell for gay couples, there was a four-fold increase in the risk for suicide. How could the Australian authors have missed this?
The fourth article, published last year in the European Journal of Epidemiology , was based on data from Sweden. Its message ought to put a big dent in glib claims of the health benefits of same-sex marriage: "Among same-sex married men the suicide risk was nearly three-fold greater as compared to different-sex married".
Denmark and Sweden are gay-friendly countries. Sweden legalised same-sex marriage in 2009; Denmark in 2012. Domestic partnerships had been recognised years before that. They are not hotbeds of simmering homophobia. But men, especially, in same-sex marriage, are still committing suicide.
Why haven't young gays and lesbians been informed of these figures from these gay-friendly countries where same-sex marriage has already been road-tested? Are they definitive? No. Are they ominous? You bet they are.