National Advisory Council on Migrant Health: Recommendations on Labor Trafficking

Two men landscaping; supervisor watches in backgroundContent from the National Advisory Council on Migrant Health's Report, December 24, 2018

About the Council 
The National Advisory Council on Migrant Health (NACMH/Council) advises, consults with, and makes recommendations to the Secretary of the U.S. Department of Health and Human Services (HHS) and the Administrator, Health Resources and Services Administration (HRSA). The Council is charged with reviewing the health care concerns of migrant and seasonal agricultural workers (MSAW), and the organization, operation, selection, and funding of migrant health centers (MHC) and other entities assisted under section 330(g) of the Public Health Service (PHS) Act, as amended, 42 USC 254(b), with the goal of improving health services and conditions for MSAWs and their families.

Recommendation 2
The United States (US) is heavily reliant on MSAWs in the agricultural sector to plant and harvest crops. The dependence of large agricultural companies on seasonal labor creates many employment opportunities for MSAWS in the agricultural sector, but also presents opportunities for exploitation of labor. The Council recognizes the important role that the HCP, with its network of health centers located across the US, can play in advancing the three key strategies set forth by the HHS Strategic Plan. The anti-trafficking mission for the plan includes raising awareness to help identify victims; getting victims connected to restorative services; and equipping community organizations to help victims become survivors. The Council recommends that in alignment with the HHS Strategic Plan, HRSA support HCP grantees to:

  1. Raise awareness of labor trafficking by increasing health center capacity to better identify victims of labor trafficking. This may include:
    • Training staff (front office and clinical) to appropriately screen, identify and refer people who are or have been trafficked.
    • Training should include but not be limited to:
      • Knowledge that trafficking is a reportable offense by all clinic staff.
      • Ongoing training on the intersection of mental health and trafficking, to increase staff capacity to support MSAWs in socially determined circumstances (lost wages, false promises, long hours, exploitation, etc.)
      • Equipping staff and providers with resources and tools such as those created by the National Human Trafficking Center.
      • Supporting provider capacity building and practice improvement by providing continuing medical credits for trafficking victim identification.
    • Expand outreach services to better identify MSAWs and provide information about medical, mental health and other support services available. Outreach must necessarily include going to farms and offering point-of-contact services, which are often the only option for establishing contact with MSAWs due to lack of transportation, inability to miss work and other barriers to care.
    • Provide victims primary care and mental health services.
  2. Link MSAWs who have been trafficked/exploited to restorative services by:
    • Expanding the number of health center medical-legal partnerships by providing grantees technical assistance on how to create or leverage partnerships and establish referral pathways.
  3. Establish collaborations with federal and non-federal partners engaged in anti-trafficking efforts to increase capacity of all agencies/organizations to better serve MSAWs and ensure consistent access to health and enabling services by:
    • Utilizing and disseminating the vast array of resources and trainings made available by the Office on Trafficking in Persons within the HHS Administration for Children and Families.
    • Working with community based organizations such as Justice at Work; HEAL Trafficking and Alliance to End Slavery in their endeavors to help victims become survivors.
    • Collaborate with local workforce programs, Migrant Head Start and Migrant Education to cross train staff in screening, identification and referral for victims of trafficking.

Background
The HHS 2018-2022 Strategic Plan, under Strategic Objective 3.2 to safeguard the public against preventable injuries and violence or their results, includes the charge to: “Assess and increase the capacity of medical and behavioral health practitioners, nonprofits, faith-based and community organizations, licensed social workers, child welfare professionals, housing authorities, and public health agencies to provide comprehensive and survivor-informed services for victims of human trafficking.”

Persons who are trafficked in agriculture are unlikely to report violations because of the fear of dismissal, threats to notify the police or IRS, isolated housing and other forms of exploitation. The Typology of Modern Slavery: Defining Sex and Labor Trafficking in the United States, by Polaris gives the most complete listing of the many forms of human trafficking in the United States. Although most attention is paid to trafficking related to the sex trade, there are over two dozen types of modern slavery. Of particular interest to this Council are forms of trafficking related to agriculture in the broadest definition of that term. These include agriculture and animal husbandry, landscaping, forestry and logging. Trafficked agricultural workers are subjected to abuses including: underpayment, longer work shifts, limited or no breaks, lack of restroom facilities located in close proximity to work, no shelter from the sun, pesticide and heat exposure, limited access to water, etc. Other examples of exploitation include sexual harassment, including demands for sex and assault. 

While trafficking is a reportable offense, there are challenges with identifying cases of labor trafficking. Labor trafficking victims are harder to identify than sex trafficking victims, given that international victims may be mistaken for smuggled immigrants. Further, the victimization of labor trafficking victims (many of whom are male) may be seen as less compelling than that of sex trafficking victims (many of whom are young women). A study conducted by the National Institute of Justice to examine labor trafficking among MSAWs in North Carolina found that at least 25 percent of the workers experience labor trafficking, and approximately 30 percent workers experience other abuses, including restrictions of movement, passport confiscations, threats and verbal abuse.

MSAWs who are victims of labor trafficking may lack access to health care, (including immediate medical attention, sexual assault evaluations, substance use disorder counseling), emergency housing, food, and clothing. Commonly overlooked medical problems that agricultural laborers sustain include chemical burns from pesticides, resulting respiratory problems, infertility and birth defects. If access to health services is not consistent or reliable, individuals may face dire health and mental health consequences.

Access the entire report from the National Advisory Council on Migrant Health.

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