The Power of Framing Human Trafficking as a Public Health Issue

October 2015 marked the fifteen year anniversary of the Trafficking Victims Protection Act, the landmark legislation that catalyzed the modern day fight against human trafficking.  Before we consider where we can go in the next fifteen years, we can take stock in how far we have come in the last fifteen years. 

Today, we know that human trafficking is not an isolated issue on the fringes of our understanding of global human rights.  We know that human trafficking is diverse – impacting foreign nationals and citizens, adults and children, men and women, across all socio-economic, religious, and cultural backgrounds.  The markets and venues for victimization run the spectrum from familial trafficking to exploitation in online and offline commercial sex markets, from criminal enterprises to integration into the global supply chains that produce the goods and services impacting our daily lives. 

Not only has our understanding about the nature of human trafficking evolved, but communities across the United States have fundamentally strengthened their responses to the problem in the last fifteen years.  The initial federal law on human trafficking has been reauthorized four times, with expansion of victim protections and accountability for human traffickers.  What started with only three states with local laws on human trafficking have scaled out to all fifty states and many U.S. territories passing and implementing anti-trafficking legislation. 

There are dozens of task forces where law enforcement and community organizations are working together to assist victims and bring cases to justice.  Local leaders and faith-based organizations have stood up new victim assistance programs and housing to enable survivors to rebuild their lives.  Community members are more alert and taking action when they see potential trafficking, leading to more than 21,000 cases of human trafficking identified by the National Human Trafficking Resource Center – including 5,000 cases in fiscal year 2014, alone.  Survivors of human trafficking are increasingly seeking support directly and taking on leadership positions as advocates, policy makers, and service providers in community-based and government organizations across the country.

These types of responses recognize human trafficking as a violent crime that requires strong rule of law and extensive social safety nets to establish a foundation to protect victims and bring traffickers to justice.  However, human trafficking is also a public health issue that impacts individuals, families, and entire communities across generations. 

As we look ahead, there are at least three ways a public health framework of human trafficking can help us build on the foundation of the last fifteen years.

Public Health Framework

1. A public health lens informs who intervenes and engages in the fight against human trafficking.  While there is still much for us to do to strengthen training for law enforcement, social service providers, health care providers, and other first responders, we recognize that we cannot arrest our way out of human trafficking alone.  Nor can we eradicate human trafficking through victim services alone.
   
   A public health framework expands the constituents that need to be engaged in anti-trafficking efforts.  Survivors of human trafficking are critical voices to inform the development of community-based programs and government policies to prevent and end human trafficking.  Identifying opportunities to enable survivors of human trafficking to meaningfully engage in participating and leading anti-trafficking efforts can contribute to more effective intervention strategies.  Empowering educators and parents can improve prevention of human trafficking.  Investing in research to understand the social and public health implications of human trafficking can help us to better target ways to fundamentally disrupt the dynamics that enable human trafficking to flourish.
    
2. A public health lens informs how we intervene.  In addition to addressing the immediate human trafficking victimization, a public health framework recognizes the social and economic determinants of health and well-being that may lead to the crisis moment of trafficking.  Interventions would go beyond the criminal justice and social service response and incorporate prevention strategies based on needs of specific populations.  While human trafficking can impact anyone, some populations are more vulnerable to human trafficking due to experience of prior violence, stigma, and disconnection.
    

   For example, research shows that victims of violence early in life are likely to experience violence later in life.  The California Child Welfare Council found that anywhere from 50 percent to 80 percent of victims of commercial sexual exploitation, including child sex trafficking, are or were formerly involved with the child welfare system.  Runaway and homeless youth, including unaccompanied minors, not only have disproportionately experienced interpersonal trauma and family instability, but they are also disproportionately at higher risk for human trafficking.  LGBT youth are disproportionately runaway and homeless and can be up to five times more likely than their heterosexual peers to be victims of human trafficking.  Native American youth have disproportionately been victims of sexual assault and impacted by generational trauma that also puts them at higher risk for human trafficking. 

   A public health approach can target anti-trafficking efforts to reduce risk of the highest risk populations instead of relying on a one-size-fits-all approach.  A public health approach recognizes human trafficking along a spectrum of inter-related violence, understands the ripple effects of trauma, and encourages cultural-specific prevention and intervention efforts. 

   In the fight against cancer, there are certain types of treatment interventions that are universal for any type of cancer.  However, not all cancers are alike and each unique form requires a level of targeted response that fits particular molecular and biological structures.  We don’t treat lung cancer in the exact same way as skin cancer.  Similarly, there are certain types of services and prevention tactics that may be universal to any form of human trafficking.  However, if we can better segment out the unique driving factors and impact of specific types of trafficking markets, we can also develop more targeted anti-trafficking strategies.

3. A public health lens informs what must be at stake to truly change the dynamics that enable human trafficking.  The existence of human trafficking is an indication that we live in an unsustainable world that has normalized and commercialized violence.  Deep rooted cultural norms around power, equity, gender, and consumer behavior shape the social and economic dynamics that have enabled human trafficking.  A public health framework is more likely to confront entrenched interests and highlight barriers to reducing slavery.

Just as abolition of chattel slavery in the historical development of the United States required a restructuring of society, long-term solutions to prevent and eradicate human trafficking will require changes in social norms and other deeply-rooted structures that may be hardest to change – including what (and how much) we choose to purchase when the price of goods and services are produced by non-forced labor,  how we choose to address the reality of demand dynamics that drive sex trafficking and gender-based violence, and how we choose to invest our resources as government agencies, philanthropic organizations, and research institutions to eradicate and prevent human trafficking. 

We need to energize public health’s role in the fight against human trafficking because the field has a fundamental belief that life can be improved and societies can change even in the midst of seemingly entrenched interests.  Public health will invest in rigorous research to gather the data to change public understanding and behavior that enable human trafficking.  Public health approaches will inform policies that recognize human trafficking as an inter-connected issue to other forms of violence and systemic inequities.  And public health has a history of addressing issues with urgency – like preventing car accidents and reducing tobacco use - even if they occur to a relative minority of our population because we can see the broader societal and multi-generational consequences. 

In the upcoming year, the Office on Trafficking in Persons commits to exploring partnerships to better leverage the public health framework to strengthen data collection, better target public awareness and prevention campaigns, expand training to address the root causes of human trafficking, and empower survivors of trafficking. 

Adapted from October 7, 2015 remarks at the “Paths to Equity” Women’s Funding Network Conference by Katherine Chon, Director of the Office on Trafficking in Persons, Administration for Children and Families, U.S. Department of Health and Human Services.