Between 2020-2024, 30 states passed discriminatory laws that adversely target socially marginalized groups, including Black people and other people of color; lesbian, gay, bisexual, and queer people; transgender and nonbinary people; and women and other birthing people, according to a new analysis. These findings underscore the need for a coordinated response by policymakers, health advocates, clinicians, researchers, and more to restore and preserve protections for marginalized populations.
In recent years, the United States has experienced an unprecedented surge in state laws that limit access to critical services and resources, including gender-affirming care, abortion care, gender-congruent bathrooms, and critical race theory education in school.
In many states, multiple discriminatory laws simultaneously threaten the health of populations that are already socially marginalized, according to a new analysis by Boston University School of Public Health (BUSPH), Cornell Law School (CLS), and the University of Delaware (UD).
Published in the American Journal of Public Health, the analytic essay assessed state legislation across the nation and found that between January 2020 and January 2024, 30 states enacted laws that adversely target Black people and other people of color, lesbian, gay, bisexual, and queer people (LGBQ) people, transgender people, and/or birthing people. Moreover, 25 of these states passed laws that target more than one of these groups.
This overlapping targeting of marginalized groups underscores the intersectional nature of co-occurring discriminatory legislation and how these laws work in tandem to curtail legal protections for individuals and groups who have historically experienced the deleterious and synergistic effects of racism, sexism, and other forms of oppression—and related health consequences. For example, Black cisgender women or Latinx transgender men are likely to experience negative health impacts from laws that promote racial as well as gender discrimination.
As such, the analysis suggests that confronting these laws requires a comprehensive and coordinated effort among multiple sectors.
"Given that more than half of the US population experiences one or more of forms of marginalization by race, ethnicity, sexual orientation, or gender, the recent onslaught of discriminatory legislation targeting these groups demands a forceful response not only by policymakers and advocates, but also by healthcare professionals, institutions, researchers, and research funders," says study senior and corresponding author Dr. Kimberly Nelson, associate professor of community health sciences at BUSPH.
In the analysis, the team presents a model of public health law to illustrate how discriminatory laws burden marginalized populations. The team also identifies current legislation that targets these groups, and provides recommendations on how health experts and advocates can collaborate to counter these laws that can lead to a wide range of harmful health outcomes, from chronic conditions and substance use to suicidal ideation and death.
"Prior research is clear that discriminatory or adverse laws have downstream health consequences, particularly for people who experience multiple forms of marginalization," says study lead author Dr. Kristen Underhill, associate dean for faculty research and professor of law at CLS.
Importantly, these state laws may not only lead to harmful health outcomes, but also create or perpetuate stigma that exacerbate discriminatory beliefs and behaviors, and lead to a ripple effect of other states implementing similar legislation.
During the four-year study period, the most common pattern of concurrent discriminatory legislation—which occurred in 14 states—that the team observed targeted all four of the marginalized groups of interest. Sixteen of the 30 states passed at least one law that targeted more than one of these groups in the same bill or statute.
The researchers provide several recommendations on how clinicians and health researchers can help counter discriminatory legislation. To start, clinicians should prepare to treat potential increases in psychological and physical harms among marginalized patients. Both clinicians and healthcare institutions can also improve best practices with tailored efforts that combat discrimination, such as equity-oriented staff training and hiring, as well as use their knowledge and political influence to denounce discriminatory laws.
The team also encourages health researchers to adopt methodologies that track these laws and identify subgroups of affected populations. Furthermore, funders of this research should prioritize work that investigates the connections between state laws, stigmas, and health.
"Discriminatory laws undermine the autonomy and health of marginalized people, to the advantage of dominant social groups," Dr. Underhill says. "A coordinated threat demands a collective and intersectional response, and the clinicians, institutions, and researchers who care for marginalized patients have compelling reasons to join this work."
The analytic essay was coauthored by Dr. Valerie Earnshaw, associate professor of human development & family sciences at UD.
**
About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
