By Katherine Welch, M.D.
“The business of public health is to take what is accepted and make it unacceptable.” – Bill Foege, former director of the Center for Disease Control
Although largely framed as a legal issue, a social issue, and sometimes a geo-political issue, human trafficking IS also a public health issue. Communicable diseases such as tuberculosis, sexually transmitted infections, and skin infestations are common. Non-communicable diseases such as asthma, dental disease, and malnutrition also contribute to the global health burden. Mental health is perhaps the most important co-morbidity among survivors of trafficking often suffering from post-traumatic stress disorder, depression, anxiety, substance abuse, and cognitive disorders, among others.
As with other global public health issues (e.g., HIV/AIDS, female genital mutilation, under- nutrition), social and cultural factors contribute to the problem as well as the solutions. Public health approaches consider all of these factors to take local information to make locally- appropriate interventions. It can also take local data to help feed our global pool of knowledge regarding this complex issue.
Human Trafficking is both an individual as well as a public health issue. While direct health care is important, health professionals and organizations need to move beyond this and get involved in prevention, research, developing appropriate treatment guidelines, monitoring and evaluation of health care interventions. Using a public health approach to counter trafficking can be quite effective in prevention and identification of victims. Jonathon Todres states it well:
“Approaching human trafficking from a public health perspective offers the prospect of addressing fundamental aspects of the problem, including its root causes. For example, public health’s focus on identifying risk factors can help identify vulnerability and facilitate earlier interventions that reach at-risk individuals before traffickers do. A public health approach also goes beyond criminal law’s narrow focus on the state-perpetrator dynamic to address community- and population-based impacts.” (1)
Estimating the number of affected people is an important in public health factor, but is quite problematic in human trafficking for several reasons. Trafficked people and survivors are hidden, and we lack access to them. Different countries have different definitions and so are not “counting” on the same scale.
An axiom, “NO DATA, NO PROBLEM”, highlights the difficulties in securing funding for research. If you have no data to prove a problem then you have no problem to address. The problem is huge, but largely defined by anecdotes and stories. No matter how terrible, these will not generate the proof many donors require to fund a project. The problem of donors in funding counter-trafficking efforts is another article altogether.
Evidence-based research is a backbone of medicine and public health. Evidence informs interventions and programs. However, few data document the nature of the health risks or the disease burden globally. Data is needed to identify the traffickers, root causes, and triggering events.
Unfortunately, there are many barriers to producing solid research. Most of the organizations addressing human trafficking are small and grass-roots. Few of them are equipped or prepared to do solid research or even basic, internally-informative data gathering. Access to survivors is limited and building rapport is time-consuming as it can be difficult to gain trust for honest responses. Lack of understanding regarding research may affect organizations’ willingness to cooperate in a study. Counter-trafficking organizations are not trained or funded to collect data; and may not know how to use the information. Uniform data collection is not used; study methods are often substandard, even among large well-funded organizations. Sometimes there is a failure among organizations to see mutual goals, and they are unwilling to collaborate or share information. Finally, there is an overall lack of funding for research, and the grant- application process is often prohibitively complex, daunting for many practitioners.
Even so, research is important as it can drive policies and generate funding. “Monitoring the health status of survivors of trafficking, the care they receive, and their access to medical services will be crucial in the future to hold signatories of the Convention [on the Rights of the Child] accountable and protect this vulnerable group.” (2) Furthermore, knowing the situation of your community, region, or nation will inform you about how to make appropriate contextual interventions. Public health approaches can help us understand what puts victims at risk: the push-pull factors such as social, cultural, economic, immigration status, and language barriers. When vulnerable populations are identified, prevention strategies can be developed. Long-term studies with follow up for evaluation and monitoring can be based on initial data-gathering strategies.
Human trafficking is a complex health issue – health problems are compounded while social and legal issues can be complicated. More than ever, we need funding, organizational support, and political will to make a global difference against slavery today. Public health is an important component of this effort.
Katherine Welch, M.D., is an American pediatrician based in Thailand. She works as a consultant in serving the health needs of abused, exploited and trafficked people. Katherine is also an Editorial Adviser for Cancer InCytes Magazine. You can learn more about her work at http://www.gorelentless.wordpress.com.