Health is about freedom; creating and enhancing our physical, mental and social liberties to live the lives we choose to live, peacefully and harmoniously. To be a health professional is to be an agent of resistance for justice, rights and equity
– Richard Horton, The Lancet, November 16, 2015 (1)
The groundswell of support from health organisations for Australia’s marriage equality campaign has been nothing short of remarkable, and the breadth of it is perhaps unprecedented in our public life (2). I’ve never seen such uniformity on a progressive cause from the medical colleges and peak health groups. Unfairly or not, we have a reputation as a largely conservative profession, and some of that necessarily has root in the work itself, which must by its nature consider and where possible mitigate risks. Risk management is a constant dimension of our job.
Public health has long understood that our wellbeing has many dimensions, drivers and determinants. We are not mere products of our physiology – it may be more correct to say that our physiology is the product of us. It’s commonly accepted that the air we breathe, the water we drink, the food we eat can make us sick. So too, can the interactions of our daily life.
As medical professionals we see the power of words every day. As important as our prescription pad is our capacity to explain, to listen, to reassure. We see first-hand the way loneliness and isolation, frustration or powerlessness can exact or exacerbate a toll on our patients. Inequality can and does make us sick.
Public health looks at the bigger picture where the rest of us can tend to get bogged down in our biomedical silos, so it was no surprise to see the PHAA come out strongly in support of marriage equality and to declare it a health issue (3). What was unexpected, for me, was to see the AMA (4) and, eventually, the RACGP, add their voice to the campaign (5). These are broad churches where views on issues like marriage, abortion, and as we have seen recently, euthanasia, diverge considerably.
The RACGP in particular has been reluctant to weigh into such debates (6) on the basis that its membership, and indeed the public it serves, may not all agree with the position taken. What’s missing from this equation is that silence is itself a position, and it almost always sides with a status quo benefiting the loudest majority.
If we care about evidence then we must be committed to equality, because the facts speak for themselves. Australians of diverse sexualities and genders have poorer health outcomes.
We suffer minority stress which can manifest in a host of ways – anxiety, depression, alcohol and drug use, fractured relationships with our families, discrimination in the workplace from patients and colleagues. All too often at the moment, hate speech in the press, on billboards and our televisions, even in the skies.
We experience psychological distress at higher levels than the rest of the population, we are at greater risk of self-harm and suicide. Behind every statistic is a story of harassment, abuse, of ostracism and prejudice. Of being told there is something wrong with us, that we are a danger to people including our own kids. It’s not enough for us as health professionals to know the statistics and go through the motions – we must hear and honour these stories if we as a community are ever to heal (7).
Marriage equality isn’t just a health issue for our patients, it’s important for doctors and med students too. The standard we walk past is the standard we accept, and we must live our values if we ever hope for a society where they are the norm. We also owe it to our gay and lesbian, trans, bi, intersex and queer colleagues to advocate for their health just as loudly as we would for our patients.
As a gay medical student, seeing staff wearing equality badges and sticking up posters has been a liferaft when I have felt at my lowest ebb. Walking through the doors of Sydney Children’s Hospital and seeing a huge sign saying I was accepted, welcomed and valued and should be proud of who I am was a gift that is difficult to put into words. When I didn’t know how much more I could take, it was an AMA rally of doctors and students that kept me going.
When you’re gay you feel constantly visible, but quite often unseen. You’re an abstraction to be reviled or championed, a cause or a cipher, and this is amplified when your life is turned into a political football. As in medicine, you’re constantly adjusting your risk calculations whenever you go out in public, weighing up whether it’s safe to hold your partner’s hand or wear a certain t-shirt, whether when a patient asks you if you’re married or have children it’s easier just to lie or brush them off.
My default, after living through the campaigns to ban and now legalise marriage equality, is that people disapprove of me and my family. I have regarded every poll to the contrary with disbelief, and even now I expect the postal survey to return a no. This is the result of decades of social conditioning and derisive rhetoric from our elected leaders. It is difficult to believe the debate is shifting until you see it for yourself – tens upon tens of thousands of Australians decked out in proud rainbows marching through our capital cities saying Yes, you matter; Yes, we see you; Yes, we will walk with you. For a rare instant feeling that you are a part, not other.
These moments have the power to change lives, and regardless of the political outcome of this process, this is why advocacy matters. By calling for equality, we speak for those who may not have a voice amongst the clamour of those who are accustomed to being heard. We demand better health for our patients and for our profession – including for LGBTQI doctors and students. We do no harm, and we remember the words of Virchow: Medicine is a social science and politics is nothing else but medicine on a large scale.
No matter what happens on November 15, this debate has been a galvanising moment for our profession. As doctors we have been called to account, and we have responded Yes. In solidarity, we have been true to our oath, that warmth, sympathy and understanding may outweigh the surgeon’s knife or drug, that there is art to medicine as well as science, and that above all, we too are human beings. The more often we are reminded of our humanity, the better doctors we will be.
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