Human Trafficking Prevention Needs A Public Health Approach

January 11^th is recognized as National Human Trafficking Awareness Day and January is Human Trafficking Prevention Month. #WearBlueDay is the largest event among the Blue Campaign educational activities. A pervasive global problem, the United Way reports that 50 million people are in forced labor, forced marriages or are commercial sex workers. It’s highly profitable, too: traffickers rake in $150 billion in profits each year and they exploit society’s most vulnerable: 32% of victims are children. Human trafficking is both a criminal offense and a violation of rights happening on a global scale. It needs to be stopped.

The Magnitude Of The Problem

The World Health Organization defines human trafficking as a lucrative crime and human rights violation that exploits women, children and men. It includes trafficking for forced labor, sexual exploitation, forced begging and military conscription. No country or sector alone can address the ongoing challenges of trafficking. The United Nations Office on Drugs and Crime (UNODC) describes human trafficking as the recruitment, transportation, transfer, harboring or receipt of people through force, fraud or deception, with the aim of exploiting them for profit. Traffickers often use violence or fraudulent employment agencies and fake promises of education and job opportunities to trick and coerce their victims. It is a multi-dimensional problem that disproportionately impacts marginalized communities.

Human trafficking occurs in every region of the world. UNODC reports that in 2020, about 50,000 human trafficking victims were reported by 141 countries. 58% of people convicted of human trafficking offences in 2020 were male, although more women participate in trafficking compared to other crimes. 79% of trafficking involves sexual exploitation. 38.8% of survivors were exploited for forced labor, 10.2% were subjected to forced criminal activity, 0.9% were trafficked for forced marriage while others were coerced into begging, organ removal and other activities.

The scope of this problem has garnered attention from many celebrities including Angelina Jolie, Blake Lively, Mariska Hargitay, Ashley Judd, Kevin Kline, Ashton Kutcher, Demi Moore and Emma Thompson who are all actively advocating for an end to human trafficking and support for survivors.

The Role Of Healthcare Professionals And Systems

As a physician, why do I care about this issue? Human trafficking is clearly a major public health problem. Healthcare professionals (HCPs) play a critical role in responding to the injuries and intersectional trauma experienced by human trafficking and exploitation. Because frontline HCPs may be the only public servants to meet trafficked individuals while they are trafficked, healthcare systems have a responsibility AND an opportunity to promote and protect the health and safety of survivors.

“Every day, trafficking victims are coming through hospitals and clinics,” describes Hanni Stoklosa, MD, MPH, co-founder and Chief Medical Officer of HEAL Trafficking which has trained over 20,000 HCPs. ”Exploitation is being missed. We need every nurse and doctor to be trained on human trafficking and every system to have a plan.” Dr. Stoklosa, an emergency medicine physician, underscores the urgency of the crisis: “The time to act is now.”

Physical Health Effects

Survivors of trafficking experience a wide array of physical health issues resulting from inadequate nutrition, poor sanitation, physical and sexual assaults, inhumane living conditions, poor personal hygiene and lack of access to health services. Preventive healthcare is practically non-existent. By the time a health issue is addressed, it can become critical and even life-threatening. A trauma-informed approach in caring for survivors is key.

Physical ailments include sexually transmitted illnesses (e.g. syphilis, gonorrhea, HIV), pelvic pain, genital lacerations, rectal trauma and urinary problems caused by forced sex work. Pregnancy is common as a result of rape or prostitution. Infertility can stem from chronic, untreated STIs or botched abortions. Chronic back pain, hearing and visual impairment as well as cardiovascular and respiratory problems commonly emerge from dangerous sweatshop, construction or agricultural workplaces. Malnourishment and major dental issues are frequently seen in child trafficking victims who suffer from stunted growth and rotted teeth. Substance use and addiction often result from being coerced into drug use or to help survivors cope with their traumatizing circumstances.

“Health care professionals need formal training and protocols in order to recognize possible signs of human trafficking in patients of all ages, and conduct an interdisciplinary intervention that is person-centered, trauma-informed and culturally responsive,” urges Wendy Macias-Konstantopoulos, MD, MPH, MBA, director of the Center for Social Justice and Health Equity at Massachusetts General Hospital.

Sunny Slaughter, a vulnerability and global human trafficking expert, published a guide for medical healthcare professionals on how to respond to trafficking, exploitation, violence and vulnerability.

Mental Health Consequences

Survivors of human trafficking experience psychological trauma from frequent mental and physical abuse and torture. They are vulnerable to many mental health conditions, most often PTSD, depression and anxiety disorders, but psychosis, dissociative and eating disorders, antisocial behaviors, self-harm and suicidality are not uncommon. Individual outcomes vary widely as pre-trafficking exposure to violence, mental health conditions and developmental vulnerabilities play a role in what symptoms the survivor experiences. Feelings of shame, humiliation, helplessness, shock and denial are commonplace among trafficking survivors.

“Diagnostic and treatment planning must start from a trauma-informed perspective, built on a foundation of care and compassion, while gathering the data necessary for making diagnoses and building a care plan,” explains Candida Fink, MD, psychiatrist, author and cohost of the podcast, Mental Health Goes to School.

Vulnerable Individuals Are Targeted

While anyone can be a victim of human trafficking, traffickers often prey upon members of marginalized communities and other vulnerable individuals. Human trafficking is considered a form of gender-based violence because traffickers often exploit women and push them into forced labor including forced commercial sex. Gender inequalities, normalization of exploitation, objectification of women and male privilege all conspire to put women and girls at increased risk of trafficking. Migrant women are particularly at risk due to their vulnerability in the labor marketplace. Abused women are more likely than non-abused women to seek medical attention, and they’re mostly likely to disclose their abuse to HCPs. This is yet another reason why healthcare systems are uniquely positioned to identify and address the needs of trafficked women and girls.

Child sex traffickers prey on children and youth in welfare and juvenile justice systems; those who are unhoused and/or experiencing poverty; those who identify as LGBTQ+; children and youth of color; and immigrant and refugees. LGBTQ homeless youth are overrepresented in victims of sex trafficking. 58.7% of homeless LGBTQ youth are victims of sex trafficking compared to 33.4% of heterosexual homeless youth. Individuals with intellectual disabilities are at risk due to the inability to understand the nature of sexual abuse and exploitation.

We Need A Public Health Approach

The U.S. Department of Health and Human Services offers multiple strategies from a public health lens to prevent human trafficking. We need to remove barriers to health and healthcare access: too many survivors face roadblocks to medical services from shame, lack of identification documentation and insufficient insurance. We also need to educate healthcare providers about the nuances of human trafficking and understand how trauma shapes a survivor’s perception of and experiences with the healthcare system. Vulnerable patients need to be offered support and services if and when risk factors are identified in healthcare settings. Often there are no obvious visible signs of trafficking thus knowing the individual’s story and accurately identifying common risk factors are critical, for example, histories of domestic violence, homelessness, maltreatment, financial insecurity. Lastly, we need local, state and federal policies that promote the health and wellbeing for all people by reducing barriers to receiving affordable, quality care, particularly for those who are considered most vulnerable.

In addition to public health, multiple sectors including legal, law enforcement, political and community-based organizations must work together to stop the egregious crime of human trafficking. Melissa Sontag Broudo, JD, MPH, legal director of Decriminalize Sex Work who has worked with survivors for over 15 years, understands the complexity and interconnectedness of human trafficking with racism, sexism, homophobia, transphobia, poverty and criminalization.

“I advocate to remove criminal penalties that are forced upon sex workers and survivors of trafficking so that they are not further harmed by criminalization (arrests, police brutality, etc.) and the burden of a lifelong criminal record,” shares Broudo. The lawyer and activist adds, “Everyone deserves a chance at obtaining employment, housing, immigration status, as well as a life free of harm, violence, and stigmatization. Hopefully human trafficking awareness will bring these issues to the forefront and allow us to pass critical legislation to ensure survivors can live a life free of harm and gender-based violence.”

What Can YOU Do?

To get help from the National Human Trafficking Hotline, call 888-373-7888. To report suspected human trafficking to U.S. federal law enforcement, call 866-347-2423. You can also follow @DHSBlueCampaign on social media to learn more about #WearBlueDay and campaign efforts throughout the year. You can also learn from, support and share multiple resources including the National Center for Missing & Exploited Children, Black & Missing Foundation, Decriminalize Sex Work, RAINN, HEAL Trafficking, Office of Trafficking in Persons, United Nations, World Health Organization, and many others.

I’ll give the final words to Alison Turkos, a sexual assault survivor and activist: “What’s most important is that people in positions of power listen to those most impacted. Survivors and victims of trafficking need to be at every table. Elected officials need to include us in policymaking; leaders of organizations need to include us in coalitions. Let us lead and tell our own stories.”