The global matrix of colonialism has emerged as a crucial framework for understanding health inequities worldwide. Yet, how comprehensively do we grasp colonialism's diverse manifestations? While Western colonial narratives are extensively documented, we risk perpetuating epistemological inequities by constraining health discourse within Western academic paradigms. South Korea's recent political turmoil exemplifies these postcolonial dynamics.
On December 3, 2024, South Korea faced a stark reminder of its turbulent democratic past when President Yoon Suk Yeol declared martial law—the first such proclamation in 45 years. Yoon's presidency, already tainted by scandals involving his wife Kim Keon Hee, and allegations of misusing prosecutorial power, reached a crisis point with this attempt at a self-coup in response to growing political opposition. Though South Korea's vigorous civil society and parliament managed to overturn martial law within two-and-a-half hours, followed by a successful impeachment vote against President Yoon, the incident cast a long shadow over the nation's democratic institutions.This troubling episode marked a significant moment in South Korea's democratic journey, particularly given its successful emergence from military dictatorship following Japanese colonial rule (1910-1945). Modern South Korea still grapples with the enduring effects of colonial oppression, manifesting in the militarization of society, weak grassroots social movements, and profound invisible inequalities, particularly affecting marginalized groups. It represents not merely an isolated incident but rather a consequence of the elitism stemming from colonial legacies that have steered South Korea's development.
The idea of associating Korea with colonialism raises several distinct questions. First, is it appropriate to discuss colonialism in a country like South Korea, which has achieved high-income status? More generally, will colonial discourse remain relevant when many formerly colonized nations achieve substantial economic development? Second, while South Koreans have called for the 'liquidation of Japan's legacy' in response to colonization, to what extent does colonial legacy persist in society and how can it be addressed? More broadly, what does decolonization mean for a country or region that has experienced colonization? Third, are colonized countries solely victims? The existence of South Korea's anachronistic elites—who are conceptual descendants of colonial elites who benefited from colonization—challenges this binary understanding.
These questions also lead us to ask whether colonialism is being appropriately addressed in public health discourse. Does the academic discourse on colonialism truly reflect the experiences of those living in formerly colonized nations? Or does it remain trapped within Western-centric epistemological frameworks? While the increased criticism of colonialism in public health is welcome, we must question whether this newfound awareness genuinely catalyzes meaningful change in our health systems and institutions.
It may appear paradoxical that academic critics highlight how global health's colonial legacy remains embedded in the colonial matrix of power that governs people's lives. However, the colonial matrix of power is precisely the 'spider' that social epidemiologist Nancy Krieger sought when she asked, 'Where is the spider when everyone talks about the spider's web?' Her metaphor brilliantly illustrates how focusing on individual risk factors and specific marginalized groups obscures the broader power structures that determine population health.
Despite growing mainstream recognition that contemporary health inequalities stem from the colonial world order, actual changes remain elusive. Meaningful transformation requires more than simply invoking 'decolonization' as a buzzword in academic discourse and policy documents. Achieving this transformation demands a fundamental shift in every dimension of power structures, including the democratization of knowledge production and liberation from Western-centric epistemologies.
The way forward requires more than reinforcing existing power dynamics through charitable giving from high-income countries to low- and middle-income ones. Rather, it demands a comprehensive restructuring of global health governance to ensure all voices are meaningfully heard and all communities have genuine agency in decisions affecting their health systems and outcomes. This goes beyond merely endorsing marginalized areas and indigenous peoples. Instead, it involves empowering the voiceless to understand, demand, and ultimately define their own standards of living with dignity and autonomy. Only through such a radical redistribution of power, money, and resources can we begin to dismantle the historically imposed colonial structures that continue to shape global health outcomes and progress toward a more equitable and just global health system that truly serves all communities.
About the authors
Dr Jin-Hwan Kim is a health system researcher based in South Korea, where he has pursued both his medical and academic training. Dr Kim completed his MSc in Health Policy and Management and later earned a PhD in Health Policy at the same institution. His research primarily examines health policy and system evaluation with a strong emphasis on equity and implementation. By drawing on South Korea's experiences, Dr Kim seeks to inform the development of health systems globally.
This blog post was written with Park Seohwa, who co-authored the manuscript that served as the basis for this article.
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