Abstract

Health inequities in South Korea persist despite overall gains in life expectancy and a universal health insurance system. This perspective applies scholarship on the structural determinants of health to analyze how societal rules and power dynamics produce and maintain health inequities in South Korea. Moving beyond depoliticized approaches to the social determinants of health, structural determinants were recently defined as written and unwritten rules—values and norms, governance arrangements, laws and budgets, and institutional practices—shaped by those with power and reciprocally reinforcing existing power hierarchies. Drawing on national and international evidence, we examine three interrelated forms of structural oppression that underlie contemporary health inequities in South Korea: structural economic exploitation, structural regional inequity, and structural sexism. We illustrate how growth-first economic norms, concentrated corporate power, weak labor protections, market-oriented healthcare governance, metropolitan-centered resource allocation, and gendered labor and care regimes translate into unequal health outcomes by income, employment status, region, and gender. We argue that these inequities persist not due to a lack of technical solutions, but because prevailing power dynamics limit meaningful changes to the rules that shape health-relevant conditions. To demonstrate how power can be contested and reshaped, we present a brief case study of healthcare policymaking in South Korea, highlighting the role of civil society organizations, labor movements, and community-based initiatives in challenging healthcare commodification and seeking to expand democratic control over health governance, while also revealing the limits of reforms that fail to redistribute decision-making power. Advancing health equity therefore requires strategies that intentionally build community power, democratize governance, and reconfigure institutional rules alongside improvements in community conditions. Repositioning public health as a project of political and structural transformation is essential to achieving sustainable equity in South Korea.