Prison Raises Odds of Death for Prisoners and Their Communities, Study Reveals
By Adebowale Bello. B.Tech. Microbiology, Freelance Health Writer. Reviewed by the DLHA Editorial Team
Photo of a prison wall with a banner across a small rustic barred window captioned “Prison health is public health”.
In many African countries, when someone ends up in prison, society often moves on without them and they're seen as criminals who must face the consequences. Overcrowded cells, poor sanitation, lack of clean water, inadequate healthcare and long periods of pre-trial detention have made many African prisons breeding grounds for disease and distress. For most people, once you're behind bars, your chances of good health drop sharply.
However, it’s not just the person behind bars who suffers but also their family, neighbours and community. A major study from the United States shows that imprisonment doesn’t just affect the prisoner but it can also shorten the lives of people who live in that community and have never been to jail. This could be a cause for concern especially as justice systems across Africa struggle to cope with crime and worsening prison conditions.
Researchers in the United States analysed 3.26 million adults who were part of a national survey in 2008. They followed these people for 11 years to see who died, what caused their deaths and whether being in prison or living in an area with high prison rates had anything to do with it.
The study looked at two main things:
They compared these people with others who weren’t in prison and didn’t live in areas heavily affected by imprisonment adjusting for age, income, race and other health-related factors.
People who were in prison during the survey had a nearly 4 in 10 (39%) higher risk of dying from any cause than those who weren’t. Furthermore, they were three times more likely to die from drug overdoses.
However, it didn’t end there. Even people who weren’t in jail but lived in areas with high imprisonment rates had a higher chance of dying particularly from overdoses. For every 10% increase in a county’s prison rate, there were about 5 more deaths per 100,000 people.
In simple terms, being locked up was harmful but living in a place where many people are locked up also increased the risk of early death.
At first glance, these findings may seem like a U.S issue but if you look closer, the message is deeply relevant for Africans.
Across the continent, many prisons are overcrowded, underfunded and ignored in public health discussions. Pre-trial detention is high in many countries, meaning people are kept in prison for months or even years without being sentenced. In Nigeria, for instance, 66% of inmates are awaiting trial.
If U.S prisons, which have far more resources can harm health this significantly, what does that say about African prisons, where access to medical care, clean water and mental health support is far more limited?
The study also shows that high prison rates affect entire communities, not just inmates. When a large number of young African men in a community are imprisoned, families lose income, children grow up without fathers and whole neighbourhoods suffer from stress and instability. This creates a ripple effect affecting education, economic opportunity, crime levels and long-term health.
The study only looked at imprisonment at one point in time, which means it didn’t capture whether people went in or out of prison later. It also didn’t include data on how long people were behind bars, what specific type of correctional facility they were in (e.g. jail or prison) or their underlying physical and mental health conditions.
Furthermore, the study focused only on overall deaths and overdose deaths, without exploring other possible causes of death or how outcomes may differ across racial or ethnic groups. Lastly, like many studies that rely on existing data, there may be unmeasured factors that influence the results. So, while the study shows strong associations, it doesn’t prove that incarceration directly causes early death.
Imprisonment is not just a legal issue, it’s a health issue too. For African leaders, this is a reminder that fixing the health sector also means fixing the justice system. Here are actionable steps governments and stakeholders can take:
Upgrade facilities to provide access to clean water, adequate food, basic healthcare and mental health support. Prisons should not become breeding grounds for disease and early death.
Many African prisons are filled with people who haven’t been sentenced. Governments should reform the justice process to ensure quicker trials and alternatives to incarceration, especially for non-violent offences.
Prisoners need support systems that help them reintegrate into society. Addiction treatment, mental health care and vocational training should be part of prison and post-release programmes.
Communities heavily affected by incarceration should be prioritised for social investment, in education, healthcare, employment and youth programmes in order to break cycles of poverty and crime.
Additionally, there’s a need to start collecting better data on imprisonment and health in Africa. Most African countries lack the kind of detailed, long-term records used in this study. Without good data, it’s hard to design policies that actually solve the problem.
When we lock people away, we don’t just take away their freedom, we often put their lives at risk and the damage doesn’t stop at the prison gate. It spills over into local homes, streets and the health systems. The study is a stark reminder that prison health is public health too.
Source: Khatri UG, Hakes JK, Buckler D, Zebrowski A, Winkelman T. Individual- and Area-Level Incarceration and Mortality. JAMA Netw Open. 2025;8(6):e2513537. doi:10.1001/jamanetworkopen.2025.13537. Available from here
Published: July 10, 2025
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