The Intersection of Human Trafficking and Public Health
Tackling the profound problem of human trafficking requires a comprehensive understanding of its multifaceted nature. Labor trafficking is “the recruitment, harboring, transportation, provision or obtaining of a person for labor or services through the use of force, fraud or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery”, and sex trafficking is “...a situation in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age”. Public health is intricately linked to human trafficking, as the health of victims is compromised, and addressing this issue requires comprehensive public health strategies—both labor and sex trafficking demand nuanced approaches to prevent and decrease human trafficking.
Labor and Sex Trafficking
Labor trafficking is linked to pre-existing vulnerabilities like poverty, immigration status, and seasonal work, and is distinguished from human smuggling and exploitation. To address labor trafficking effectively, recognizing distinctions and identifying prevalent settings is paramount.
Conversely, sex trafficking, while related to domestic violence (DV), has unique aspects we must consider. Sex trafficking and domestic violence have shared elements like secrecy, rules, and the involvement of children, along with trauma bonding and grooming. However, sex trafficking introduces distinctive factors, including a subculture with specific terminology, victimization by external individuals, and engagement in sexual activity beyond primary relationships. Encompassing risk recognition (e.g special education students) and protective factors (e.g family stability, social support networks, positive peer support, and healthy relationship boundaries), understanding victim warning signs, and addressing means of control (e.g drug dependence, psychological abuse, documentation withholding, debt bonding, threats of deportation, and branding) are necessary in sex trafficking intervention.
Public health strategies for both labor and sex trafficking share commonalities in engagement and survivor empowerment, data-driven research and insights, addressing determinants of health, tailored interventions, healthcare access and education, policy development and collaboration, and trauma-informed healthcare. However, distinguished interventions are necessary, with labor trafficking strategies emphasizing workers rights education, industry-focused intervention and fair employment practices, while sex trafficking interventions may prioritize prevention through education, demand-reduction strategies, exit programs and rehabilitation, and targeted outreach in recruitment settings, whether in schools or on social media platforms. This comprehensive approach aims to address the unique challenges posed by each type of trafficking.
Public Health Strategies to End Human Trafficking
Human trafficking is a public health issue and intersects with various social, economic, and health-related systems. Vulnerable populations, often targeted by traffickers, often rely on essential social safety nets such as SNAP (Supplemental Nutrition Assistance Program), WIC (Women, Infants, and Children), and housing assistance programs. Public health clinics can be crucial spaces for identifying and assisting trafficking victims, including ensuring that healthcare providers are trained to recognize signs of exploitation.
Collaboration between public health and law enforcement can be pivotal— police officers can be trained to recognize trafficking indicators and respond effectively. Education systems contribute to prevention by training teachers and school staff to identify signs among students. Social services, including counseling and mental health support, are integral in assisting trafficking survivors, emphasizing the need for a network of services that address the complex trauma experienced by victims. Community engagement is key, including awareness programs and outreach to empower communities to combat trafficking. Recognizing human trafficking is a global issue that transcends national boundaries, a public health approach should involve global collaboration to share best practices and address root causes contributing to trafficking. A comprehensive public health perspective to human trafficking addresses the intersecting factors within social services, public health clinics, law enforcement, education, and community engagement, leading to effective trafficking prevention, identification/intervention, and support for survivors.
Human trafficking relates to public and population health work through its profound impacts on mental and physical health, healthcare systems, infectious disease risks, social determinants, community support, data collection, and the need for policy and legislative changes.
Mental and Physical Health Impacts: Human trafficking survivors commonly experience severe physical (e.g self-harm, multiple STIs/STDs, frequent pregnancies, reproductive health complications, signs of sexual trauma, fractures, bruises, scars, malnutrition, dehydration, chronic pain) and psychological trauma (e.g PTSD, depression, anxiety, suicidal ideation, substance use disorder, dissociative disorder). Public health efforts must address the unique healthcare needs of survivors, including mental health support, medical care, and rehabilitation services.
Healthcare System Overload: Healthcare systems may struggle to provide specialized care and support for trafficking victims who often have complex trauma-related disorders. In addition, survivors often require long-term physical and mental health services, stretching the capacity of healthcare resources.
Infectious Disease and Risk: Trafficked individuals are often subjected to deplorable living conditions, increasing vulnerability to infectious diseases. Public health initiatives must consider this when developing strategies to prevent and manage disease outbreaks within these populations.
Social Determinants of Health: Human trafficking is often intertwined with social determinants of health, including poverty, lack of access to education, unstable housing, and violence. Human trafficking is closely linked to violence and crime, creating a cycle of victimization (e.g. forced criminality) and public safety concerns. Addressing trafficking involves tackling these root causes to improve overall population health.
Community Resilience and Support: Communities play a crucial role in identifying and supporting trafficking victims. Public health interventions can promote community awareness, education, and social services (e.g child welfare system, housing, employment support, and legal aid) to strengthen the safety net for potential victims.
Data and Surveillance: Effective public health responses require accurate data and surveillance systems to identify trafficking patterns and prevalence. Collaboration with law enforcement, NGOs, healthcare facilities, juvenile and adult justice facilities, and legal aid organizations is essential in gathering this information.
Policy and Legislation: Public health experts can advocate for stronger anti-trafficking policies and legislation at the systemic level, which can lead to better protection for victims and the prosecution of traffickers (e.g vacatur laws).
The intricate web of the impact of human trafficking on mental and physical health, healthcare systems, infectious disease risks, social determinants, community support, data collection, and the need for policy changes, equity, and legacy considerations highlights the complexity of this pervasive issue.
Equity and Legacy Considerations
Human trafficking is intertwined with historical legacies of inequity we face in the U.S. today, particularly the deep racial and social disparities stemming from slavery, colonialism, and indentured servitude. Acknowledging and rectifying these inequities is paramount in addressing the persisting challenges. A comprehensive two-year review of suspected human trafficking incidents revealed that 40% of sex trafficking victims were Black women. Furthermore, a 2015 report surveying four sites in the US and Canada found that, on average, 40% of women involved in sex trafficking identified as AI/AN or First Nations. Systemic discrimination, rooted in the long-lasting effects of discrimination and racism, can significantly limit survivors' access to education, healthcare, employment, and justice.
Global economic inequity serves as a catalyst for trafficking, with individuals enticed by the promise of a better life in economically developed regions. Notably, over half of labor trafficking victims reported to the Trafficking Hotline from 2018 to 2020, whose immigration status was identified, held legal visas, including temporary work visas. The legacy of historical injustices, exemplified by the transatlantic slave trade, underscores the need to address modern human trafficking as a means to confront these historical wrongs. Additionally, up to 40% of homeless youth identify as LGBTQ, and within this group, individuals are 3-7 times more likely to engage in survival sex to meet basic needs like shelter, food, drugs, and toiletries.
Recognizing the role of past social justice movements, such as the civil rights movement and the fight against colonialism, provides inspiration and valuable lessons for contemporary efforts to combat human trafficking and promote equity.
Below, we’ve provided a comprehensive guide to navigate the intricacies of human trafficking, including efforts at the system, community, and individual level
Systemic and Societal Level:
Collaborate with government entities at all levels for policy reforms and funding.
Engage internationally to address cross-border trafficking and support survivors.
Prioritize economic and social empowerment to tackle underlying vulnerabilities.
Discourage demand for trafficked goods and services through cross-sectoral collaboration.
Community and Local Level:
Conduct training programs for diverse stakeholders, including public health agencies.
Forge partnerships between healthcare institutions and anti-trafficking organizations.
Enhance health screening efforts (e.g ACEs) for early detection and intervention.
Facilitate collaborative data sharing among various organizations.
Collaborate with legal aid organizations and drive joint research initiatives.
Promote toll-free hotlines, prevention programs (e.g and private sector engagement: agriculture, construction, food service, adult entertainment, hospitality, and massage), and survivor engagement in policy development.
Promote awareness of trafficking myths and facts.
Encourage active engagement, volunteering, and support for anti-trafficking efforts.
Explore supply chains responsibly.
Emphasize the importance of individual commitment to learning, understanding, and taking action against human trafficking.
If you are in the United States and believe someone may be a victim of human trafficking, call the 24-hour National Human Trafficking Hotline at 1-888-373-7888 or report an emergency to law enforcement by calling 911. Trafficking victims, whether or not U.S. citizens, are eligible for services and immigration assistance.