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Abstract
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Human trafficking is increasingly understood as a global public health concern that harms individuals, families, and communities by directly and indirectly causing a multitude of adverse physical and mental health outcomes.1 Intersecting with a complex range of social determinants of health (eg, income, migration status, social exclusion),2 human trafficking manifests itself through various forms of commercial sexual exploitation and forced labor. Researchers, policy makers, and survivors have promoted reframing human trafficking, which is traditionally perceived as a law enforcement issue, as a public health issue.3 The US public health community has broadly responded with high levels of engagement, including delineating research priorities,4 developing prevention strategies,5 and advocating for policy changes.
Researching human trafficking is challenging because of complex legal definitions, the geographic and demographic diversity of trafficked people, and the inherently hidden nature of the population of interest. The combination of traffickers' restrictions on trafficked people's movements, the stigma of self-identification and related criminalization, and a shortage of trained frontline responders creates difficulties in risk identification and monitoring of human trafficking. In 2019, the US National Human Trafficking Hotline identified 11 500 human trafficking incidents nationwide.7 Although this hotline mechanism is considered one of the best sources of quantitative data available on human trafficking in the United States, it relies strictly on passive data collection (ie, people reporting to the hotline). As such, from a population-level perspective, the number of cases reported will likely represent a small fraction of the total number of trafficked people in the country (estimated to be 400 000 as of 2018).8 Likewise, passive data from the criminal justice system are likely to underestimate the number of trafficked people. Trafficked people may be reluctant to engage with justice systems in general because of a fear of retaliation from traffickers and a lack of institutional infrastructure to bring cases forward.9 Instead, this article suggests a shift toward a highly targeted, active surveillance approach. Conducting regular screening and monitoring within locations or organizations where trafficked people are likely to present in order to address other life issues, such as legal or health needs, could improve prospects of successfully identifying trafficked people through interactions with existing ancillary points of contact...
Language: en |