A new study published in the Journal of Medical Internet Research Formative Research, reveals stark disparities in research related to prisoner health, both across countries of varying income levels and within the divide between academic researchers and the incarcerated population of prisoners and offenders.

Led by Dr George Karystianis and Professor Tony Butler from UNSW School of Population Health at UNSW Medicine & Health with research support from Mr Wilson Lukmanjaya and Dr Natasha Ginnivan, the investigation was a collaborative effort by UNSW, which was recently ranked second in the world in terms of research outputs in epidemiological criminology.

The researchers examined outputs across seven decades related to epidemiological criminology, the discipline that applies epidemiological concepts to the realm of criminal justice. Their analysis revealed that significant variations in the income status among countries, ranging from lower income nations like Pakistan and Malawi to higher income nations such as Switzerland and Australia, exerted a notable influence on the study’s findings.

Employing the advanced technique of natural language processing, the team automatically analysed over 20,000 published abstracts relating to offender health, exploring diverse research areas within the field.

“Having undertaken research in this field for over 20 years, it is great to step back and reflect on what has been researched and how," said Prof. Butler.

"Text mining enables us to rapidly process large volumes of data that would be impossible for a human to examine in a reasonable time."

The study also contrasted the research with the priorities identified by prisoners, and found that only mental health, infectious diseases and substance use emerged as significant subjects of investigation.

Topics such as cognitive and intellectual disability, transitioning from prison to the community and post-release health maintenance, health care services, education, and women’s/maternal health were perceived as important concerns, yet they remained relatively underrepresented in terms of research themes.

 Mapping the identified researched themes from 11,814 PubMed epidemiological criminology abstracts from 1946 to 2020 to the research priority rankings of stakeholders (ie. prisoners and prison medical service directors). *Extracted themes that could not be mapped to any of the research priority categories identified by stakeholder groups.


The study highlighted an upward trend in research from the mid-1980s, yet the reasons driving this increase are unclear. Most research focused on investigating substance use (12.9%) and HIV (12.6%), although the proportion of published outputs related to HIV declined from 1990 to 2020. Tuberculosis also attracted significant attention, while hepatitis C emerged as a notable research focus from the mid 2000s.

“Our findings show that over the past 30 years, epidemiological criminology has consistently maintained its emphasis on infectious diseases, accounting for a quarter of the total research activity in the field,” said Dr Karystianis.

While the investigator team anticipated most research in this area to be driven by high income countries, their findings revealed that low income countries contributed to less than 1% of the published output. This discrepancy emphasises how socioeconomic conditions, local health concerns, and immediate health threats shape research priorities.

“High income countries primarily concentrate their research on mental health, while low income countries allocate nearly half of their research efforts to infectious diseases and the provision of healthcare services, a proportion more than twice as high as that observed in wealthier nations,” said Dr Paul Simpson, the project’s other UNSW primary researcher.


Number of published articles (n=23,722) in PubMed related to epidemiological criminology from 1946 to 2020. The results from 2021 (n=182) are not displayed.


In respect to the rise of mental health research in this setting, “The frequency of investigated themes is possible to reflect historical developments concerning disease prevalence, treatment advances, and social understandings of illness and incarcerated populations,” said Dr Karystianis.


Most frequent research priority categories by classification of country income for the period 1946 to 2020 from 11,814 PubMed epidemiological criminology abstracts.