If vodka doesn't kill the Russians, anti-gay bias might

A gay rights activist is detained in a September protest outside the Winter Olympics' organizing committee office in Moscow.

The Olympics have brought attention and scrutiny to Russia’s policies on homosexuality for infringing upon the human rights of its citizens and visitors. But could the the country's position on gays and lesbians also pose a hazard to the health of its citizens?

As we’ve written about in the past, prejudice harms the health of targeted minority populations (sexual and otherwise) through multiple pathways. The results of a recent study in the American Journal of Public Health, however, suggest that anti-gay prejudice might harm those who harbor it—not just its targets.

The study’s authors, from Columbia and the University of Nebraska, used data from the General Social Survey and National Death Index to test the hypothesis that heterosexuals with high levels of anti-gay prejudice have greater mortality risk than people with low levels. The General Social Survey has asked questions of nationally representative samples of adults in the United States since 1972 and is considered a primary source of data on social trends. Respondents have been asked questions about their sexual orientation and opinions on homosexuality since 1988. The researchers used the following four questions to categorize the 20,226 respondents as having “high” or ”low” levels of anti-gay prejudice.

  1. “If some people in your community suggested that a book in favor of homosexuality should be taken out of your public library, would you favor removing this book, or not?”
  2. “Should a man who admits that he is a homosexual be allowed to teach in a college or university, or not?”
  3. “Suppose a man who admits that he is a homosexual wanted to make a speech in your community. Should he be allowed to speak, or not?” 
  4. “Do you think that sexual relations between two adults of the same sex is always wrong, almost always wrong, wrong only sometimes, or not wrong at all?”

The National Death Index was then used to determine if each survey respondent was alive or dead in 2008, as well as when they died and from what cause. With these data, the researchers tested their hypothesis—statistically controlling for confounding variables that might be associated with both anti-gay prejudice and mortality (such as age, gender, race, ethnicity, level of education, household income, and self-rated health status).

People with high levels of homosexual prejudice were 25% more likely to have died than people with low levels—translating into a difference in life expectancy of 2.5 years. In secondary analysis, the researchers also controlled for racial prejudice and religiosity (as measured by other questions asked on the General Social Survey); there was no significant change in the findings.

So how could anti-gay attitudes be a hazard to the health of those who hold them? We don't really know. But the repeated activation of bodily stress response systems offers a possible explanation.

People with high racial prejudice have been found to produce elevated levels of cortisol when interacting with other races; the same dynamics could be at play when anti-gay people interact with people they perceive as being gay. Chronic stress increases disease risk, regardless of the nature of the stressor. Anger is also a possible mechanism. Anger has been found to be a key component of anti-gay prejudice, and it increases cardiac response, subsequently raising the risk for hypertension and coronary heart disease.

The findings published in the American Journal of Public Health support the anger theory: people with high levels of anti-gay prejudice were found to be more likely to die from cardiovascular causes (e.g., heart attacks) than people with low levels, but there was no difference with cancer.

The results also are consistent with an earlier study that found attitudes of racial prejudice to be associated with mortality. And the findings also suggest that practices and policies that foster acceptance of sexual minorities (legalizing same sex marriage, for example) might benefit everyone's health. Although Russia has been emblematic of anti-gay prejudice of late, with the Olympics in Sochi drawing more coverage of the issue than it might have gotten, there is immense room for improvement here in the U.S., not to mention places like Africa.

Policymakers on both sides of the Atlantic should consider the results of this study within the context Martin Luther King’s famous thoughts about people who harbor hate: “Every time I see it I know that it does something to their faces and their personality, and I say to myself that hate is too great a burden to bear. I have decided to love.”

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