Hong Kong’s debate over same-sex relationships is often framed as a question of constitutional law, social values, or individual rights. But it is also a question of public health.

Henry Li and Edgar Ng’s wedding in 2017. Photo: Supplied.

A year after the Legislative Council rejected the Registration of Same-sex Partnerships Bill, the legal recognition of same-sex couples remains unresolved – and that uncertainty places unnecessary stress on same-sex couples.

It is plainly not in society’s interest to witness another heart-breaking situation like that faced by Henry Li, who was forced into lengthy legal proceedings after the death of his husband simply to secure protections that should never have been in doubt. The consequences deserve to be considered not only in legal terms, but also in terms of health, well-being, and social cohesion.

Mental health has become an increasingly important policy concern in Hong Kong, particularly among younger people. Yet public discussions often focus on individual interventions while paying less attention to the structural conditions that influence health, including social inclusion, protection from discrimination and legal recognition of non-traditional family relationships.

At first glance, marriage may not appear to be a public health issue. Yet public health has long recognized that health is shaped not only by healthcare services or individual choices, but also by the social conditions in which people live. Laws influence access to security, social support, and equal treatment. In other words, the law itself forms part of the environment in which one’s health is determined.

This matters because the health disparities experienced by LGBTQ+ people in Hong Kong remain significant. A 2025 survey by researchers from the Chinese University of Hong Kong and the University of Hong Kong found that 30.8 per cent of LGBTQ+ respondents reported symptoms of moderate-to-severe depression, while 24 per cent reported moderate-to-severe anxiety. These figures were virtually unchanged from a comparable survey conducted seven years earlier.

The persistence of these disparities suggests that greater visibility alone has not eliminated the structural and social factors associated with poorer mental health outcomes. The researchers described the findings as evidence of a long-neglected problem requiring broader societal and policy responses.

Beyond symbolism

One often-overlooked factor is the legal environment in which LGBTQ+ people live. The minority stress framework describes how persistent experiences of discrimination, stigma, and exclusion create chronic psychological pressures that contribute to poorer health outcomes among sexual minorities. Importantly, the problem does not arise from sexual orientation itself, but from social conditions that place additional burdens on LGBTQ+ people. When the law treats some relationships differently from others, it can reinforce the perception that certain families are less worthy of recognition and protection.

Marriage is not simply a symbolic institution: it provides a recognized legal framework governing a wide range of matters, such as inheritance, property, taxation and family responsibilities.

Despite a string of legal victories, same-sex couples in Hong Kong continue to navigate a patchwork legal landscape in which recognition in one area does not necessarily translate into another, creating uncertainty for families when clarity matters most.

Marriage is not simply a symbolic institution: it provides a recognized legal framework governing a wide range of matters, such as inheritance, property, taxation and family responsibilities. These protections can be especially important during illness, medical emergencies and bereavement, when partners often provide care, make healthcare decisions, and serve as a person’s primary source of support.

Few phrases communicate family status more clearly than “we’re married.” By contrast, alternative legal arrangements may not be immediately understood by emergency personnel, employers, police officers, or businesses. During moments of crisis, that ambiguity can carry real consequences.

The wedding rings of same-sex couple Mark and Peter, who are based in Hong Kong. Photo: Kyle Lam/HKFP.

The broader public health implications are increasingly recognized internationally. A recent Lancet editorial, “Attacks on LGBTQ+ health are a threat to all,” argues that the health of LGBTQ+ people is closely connected to wider questions of rights, inclusion and social well-being. It further warns that efforts to undermine LGBTQ+ rights can have consequences extending beyond the communities directly affected.

A growing body of research supports this view. A 2021 scoping review of 59 studies found that equal marriage was associated with a range of positive psychosocial effects, including greater social acceptance and reduced stigma.

These findings should not be interpreted to mean that marriage for same-sex couples is, by itself, a mental health intervention. Marriage equality cannot replace accessible mental health services or community support. Rather, it forms part of a broader body of evidence showing that legal and social environments are inextricably linked to health outcomes, both positive and negative.

When people see that the law values their families equally, trust in institutions deepens and the bonds that hold society together grow stronger.

The distinction is important. Public health policy already recognizes that laws can shape the conditions in which health is produced. Workplace protections, anti-discrimination laws and smoke-free environments, for example, can influence exposure to stress, social participation and physical risk. Family law is part of that same wider social environment.

For LGBTQ+ young people, the significance is especially profound. The visibility of same-sex marriage offers more than legal protection; it provides a tangible vision of a future in which their relationships and families are recognized equally. It sends a powerful message that they, too, can build lives marked by dignity, security, and belonging. When people see that the law values their families equally, trust in institutions deepens and the bonds that hold society together grow stronger.

Two-tier legal system

The government’s attempt to establish recognition through the Registration of Same-sex Partnerships Bill represented one possible response to our highest court’s ruling in favour of protecting same-sex couples. However, even if a separate partnership regime could satisfy the minimum constitutional requirement, that does not make it the strongest public policy solution.

From both public health and social inclusion perspectives, a two-tier legal system in which some couples are recognized through marriage while others are relegated to a separate legal designation would reinforce stigma, perpetuate exclusion and signal that certain relationships are less worthy of recognition than others.

While an alternative status may provide some of the practical protections associated with marriage, it preserves a distinction between relationships recognized through marriage and those recognized through another legal framework. Public health research suggests that social recognition, equal status and freedom from stigma are closely linked to psychological well-being. Marriage already provides a comprehensive and widely understood framework for family recognition without the need for parallel legal structures.

A poster designed by an LGBTQ group. File photo: Kyle Lam/HKFP.

Same-sex couples are simply seeking access to the same civil marriage framework that is available to other committed couples, and for the same mix of reasons, from affirming their love and commitment to providing security and legal protections for their family. Moreover, marriage remains the most widely understood and socially recognized framework for family formation. Extending civil marriage to same-sex couples would provide the same clarity, dignity and legal security already available to other families.

Following the legislative defeat, Hong Kong should continue building support for comprehensive statutory reform, including marriage. At the same time, the government should implement administrative measures to reduce unnecessary discrimination and uncertainty affecting same-sex couples and their families.

Marriage is about much more than whether two people are permitted to marry. It is about whether the law provides families with the security, recognition, dignity, and institutional support that help people navigate illness, ageing, bereavement, and other moments of vulnerability.

Family law is not merely a legal matter. It is part of the social environment that shapes health, security and social inclusion. If Hong Kong is serious about improving mental well-being, strengthening families and building a more cohesive society, extending civil marriage to same-sex couples should be viewed not only as a question of equality, but also as a practical investment in public health, family stability, and social cohesion.

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