Shifting Discourses on “Health Inequality” and Policy Frames in South Korea: A Text-Mining, Sentiment Analysis, and System Dynamics Approach

Abstract

This study empirically examines how discourses on “health inequality” have evolved over time in South Korean newspaper coverage, using articles collected with the query “health AND inequality” between January 1, 2000 and December 31, 2024 (N = 14,392). We distinguish responsibility attribution in the discourse by differentiating a public-responsibility frame (centered on government, institutions, and public services) from an individual-responsibility frame (centered on lifestyle and self-management). Using the “feature extraction (top 50 weighted terms)” text included in newspaper metadata as standardized analytical input, we construct indices for responsibility framing (keyword frequencies per 1,000 tokens), affect (anxiety, anger, and hope), and policy discourse (based on a policy-action lexicon). Period-based summaries show that language associated with the public-responsibility frame was relatively prominent during 2005–2014, and that both the public-responsibility index and the policy-action index increased again in 2020–2024. In terms of affect, anxiety and hope increased simultaneously in 2020–2024, suggesting that crisis recognition and solution-oriented narratives intensified in parallel. In addition, LDA topic modeling indicates that multiple sub-discourses—such as “national health insurance/medical costs/vulnerable groups,” “labor and employment,” and “infectious disease (COVID-19) and crisis”—shifted in prominence across periods. Fixed-effects regression models (controlling for year and media outlet) show that the public-responsibility index is positively associated with the policy-action index, whereas the individual-responsibility index is negatively associated. Finally, from a system dynamics perspective, we present a causal loop diagram (CLD) of the feedback structure linking framing, affect, and policy discourse, and discuss the potential coexistence of a balancing loop in which public-responsibility framing strengthens policy-alternative discourse and a reinforcing loop in which individual-responsibility framing weakens structural policy pressure.