Running head: HUMAN TRAFFICKING AND THE HEALTH IMPACT PYRAMID

Human Trafficking and the Health Impact Pyramid

Nicole M. Toohey

Delaware Technical Community College

HUMAN TRAFFICKING AND THE HEALTH IMPACT PYRAMID

Abstract

Human trafficking is a form of modern slavery. It is a profitable yet illegal business across the

world. The numbers involved with human trafficking are astounding and hard to come by.

Looking at the health impact pyramid developed by Dr. Frieden can give governments and

healthcare workers a starting point to help tackle human trafficking.

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Human Trafficking and the Health Impact Pyramid:

On September 25, 2012 President Barack Obama spoke these words, “It ought to concern

every person, because it is a debasement of our common humanity. It ought to concern every

community, because it tears at our social fabric. It ought to concern every business, because it

distorts markets. It ought to concern every nation, because it endangers public health and fuels

violence and organized crime. I’m talking about the injustice, the outrage, of human trafficking,

which must be called by its true name - - modern slavery” (Human trafficking, 2017). Human

trafficking is indeed modern slavery. As the former United States President so eloquently stated,

it is an issue that concerns everyone, not just in one area but on this entire planet. Human

trafficking truly is a global health issue.

In an issue of American Journal of Public Health, Dr. Thomas R. Frieden discusses the

health impact pyramid he developed. The pyramid is a “framework for public health action”

(2010) and is hierarchal in nature, consisting of five tiers. Jonathan Purtle (2013) does a

wonderful job describing each tier of the pyramid and their relation and impact upon public

health. According to him “the most impactful types of public health interventions are at the

bottom, the least impactful are at the top” (2013). As you descend the pyramid the impact moves

from the individual to the population as a whole. This explains how the bottom tiers of the

pyramid are more impactful, because they reach a broader area of people rather than just a few

individuals, as the top tiers would do. Even though the original idea of the pyramid was to

provide an outline to improve physical health it can also be used to look at human trafficking.

In this paper, we will discuss human trafficking by the numbers and figures. We will

touch upon the physical and mental health issues that occur because of modern day slavery.

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Finally, we will take a deeper look at the health impact pyramid and how it can have an effect on

human trafficking.

The United Nations Office on Drugs and Crime (UNODC) defines human trafficking as

“recruitment, transportation, transfer, harboring or receipt of persons, by means of the threat or

use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of

power or of a position of vulnerability or of the giving or receiving of payments or benefits to

achieve the consent of a person having control over another person, for the purpose of

exploitation” (UNODC, n.d.). In other words, if a person is unable to move about freely or to

make decisions on their own, and is forced to do manual work or sex work, they are a human

slave. UNICEF (n.d.) uses an infographic to show numbers in relation to human trafficking. It

estimates there are 21 million people that are trafficked around the world, and that human

trafficking is a $32 billion dollar a year industry. The numbers behind human slavery can be

shocking but they can also be very difficult to obtain.

Human trafficking is a crime and due to this it is hard to get reliable numbers and figures

about victims and profits gained. Multiple projects and non-profit organizations have been

formed to help combat the problem but as Dr. Welch writes, “’NO DATA, NO PROBLEM’,

highlights the difficulties in securing funding for research, which is important for evidence-based

health care as well as for addressing public health issues. 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” (2013). Therefore, it makes sense that data collection, in order to improve funding, falls

in to the bottom tier (tier 1) of the health impact pyramid because it would have the greatest

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impact overall. Public health is evidence-based in nature. Gathering the evidence about human

trafficking and the numbers will aid in further research and funding of programs.

The second tier of the health impact pyramid according to Dr. Friedman (2010), involves

changing the context of the situation so that ultimately the default decision for a person or group

is a healthy one. Applying this tier to human trafficking can be difficult, but there is a way. The

United Nations (UN) consists of 193 countries. In December of 2003 the UN developed The

Protocol to Prevent, Suppress and Punish Trafficking in Persons (n.d.). This protocol was

intended to help countries develop a “comprehensive international approach” to human

trafficking (n.d.). Since the time the protocol was put in to place 124 countries have established

rules and laws to help combat human trafficking. According to the Global Report on Trafficking

in Persons by the UNODC “63%...had passed laws against trafficking in persons addressing the

major forms of trafficking. Another 16% had passed anti-trafficking laws that cover only certain

elements of the Protocol definition” (2009). These numbers are a great start but more needs to

be done. Laws must be comprehensive in nature. They must be written to include every form of

human trafficking. This is where another problem lies with this form of slavery. Not every

country is on board with creating laws to stop it. If human slavery is a $32 billion dollar a year

industry, it is easy to see why some countries would be hesitant to create and enforce such laws.

As we move up the health impact pyramid, we start to see less population impact but

more of an individual impact. Tier 3 involves long-lasting protective interventions. Regarding

human trafficking, tier 3 would involve training healthcare workers to know and spot the signs of

a victim of human slavery. Massachusetts General Hospital talks about a 2014, a study of 100

human trafficking survivors was done. Of those 100 survivors, 88% came in to contact with a

healthcare worker at some point during their imprisonment (n.d.). Imagine if any of those

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healthcare workers were aware they were treating a human slave. Educating healthcare workers

on the signs is imperative to help slow the rate of human trafficking. The U.S. Department of

State has helped to develop a list of warning signs to watch out for (n.d.). This list includes a

person that lives with their employer, the inability for the healthcare workers to speak to the

individual alone without their employer present, lack of documentation or inability to give vital

information to healthcare workers such as their place of residence. If a nurse or doctor is

speaking to a slavery victim it is possible that their answers may appear scripted or rehearsed.

These are just a few of the signs that may be noticed.

Massachusetts General Hospital developed the Human Trafficking Initiative (HTI) in

2008 (n.d.). Its aim is to “frame human trafficking as a public health issue and advance anti-

trafficking efforts in research, education, policy, and clinical care within the health sector” (n.d.).

This is just one hospital in a world filled with hospitals and clinics. There are plenty of nursing

opportunities involved when it comes to human trafficking. Nurses and doctors are needed to

help create and implement quality education for other healthcare workers in relation to modern

slavery. As more people are aware of the signs, more victims may be pulled from their bonds of

slavery.

As we come upon tiers 4 and 5 in the health impact pyramid we are now dealing with

interventions that concentrate on the individual victim rather than entire communities or

governments. That is why these tiers are considered to have less of a social impact. However,

they still have an impact. Human slavery is a degradation of human rights and getting to one

victim helps to change them which is impactful in itself.

Tier 4 specifically relates to clinical interventions while tier 5 is about counseling and

education. Many of the victims of human trafficking experience health issues such as

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HIV/AIDS, TB, malnourishment and severe dental problems, as well as many others. The

United States Department of Health and Human Services devised a pamphlet that describes the

health issues a victim of trafficking can experience (n.d.). Some of the other issues they touch

upon are infertility related to STD’s, chronic back pain from forced manual labor, and

psychological trauma including depression, anxiety, confusion, and disorientation. Helping the

victims of trafficking become physically and mentally healthy is a major step but can sometimes

be a difficult one due to lack of trust in the victim. Healthcare workers must work very hard to

develop that trust with victims so that proper healthcare can be given to them.

Another critical issue with trafficking victims is their mental health. Helping a victim

escape their slavery is not the final step. In fact, it is just the first step. These men, women, and

children will have gone through a number of atrocities that many of us cannot even imagine.

Getting the victims enrolled in counseling and support groups will be key in making lasting

changes so that they can again become active members of society.

Human trafficking, also referred to as modern day slavery, is a big business across

the world. Sex trafficking brings in a lot of money while labor trafficking helps companies to

save money by paying the slaves next to nothing. Having people indentured to others creates all

around problems, some of which are directly related to the health of the victims and the health of

the public. When looking at the problem of human trafficking and trying to solve the complex

issue, it is a good idea to start with Dr. Frieden’s help impact pyramid. This pyramid gives ideas

and ways in which to tackle this issue. The pyramid framework can deal with individual victims

and their physical and mental health when looking at tiers 4 and 5, or it can look at communities

as a whole when considering tiers 1 or 2. Dr. Frieden did a wonderful job when coming up with

the health impact pyramid. It is time we look at this pyramid and use it to help with the problem

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of human trafficking. Human trafficking is a social, global health issue and everyone in the

healthcare field must become informed so that we can help put an end to this horrendous abuse

of human rights.

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References

Dept. of Health and Human Services. (n.d.). Common Health Issues Seen in Victims of Human

Trafficking. Retrieved April 25, 2017, from

https://www.acf.hhs.gov/sites/default/files/orr/health_problems_seen_in_traffick_victims.

pdf

Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact Pyramid.

American Journal of Public Health, 100(4), 590-595. doi:10.2105/ajph.2009.185652

Human Trafficking by the Numbers. (2017, January 7). Retrieved April 24, 2017, from

http://www.humanrightsfirst.org/resource/human-trafficking-numbers

Infographic: A Global Look at Human Trafficking. (n.d.). Retrieved April 25, 2017, from

https://www.unicefusa.org/stories/infographic-global-human-trafficking-statistics

Massachusetts General Hospital. (n.d.). Human Trafficking Initiative. Retrieved April 25, 2017,

from http://www.massgeneral.org/emergencymedicineglobalhealth/initiatives/Human-

Trafficking-Initiative.aspx

Purtle, J. (2013, December 02). How I explained public health to my relatives. Retrieved April

24, 2017, from http://www.philly.com/philly/blogs/public_health/How-I-explained-

public-health-to-my-relatives.html

UNODC. (2009, February). Global Report on Trafficking in Persons. Retrieved April 25, 2017,

from https://www.unodc.org/documents/human-

trafficking/Executive_summary_english.pdf

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UNODC. (n.d.). Human Trafficking. Retrieved April 25, 2017, from

https://www.unodc.org/unodc/en/human-trafficking/what-is-human-trafficking.html

United Nations. (n.d.). Retrieved April 25, 2017, from

http://www.ohchr.org/EN/ProfessionalInterest/Pages/ProtocolTraffickingInPersons.aspx

U.S. Department of State. (n.d.). Identify and Assist a Trafficking Victim. Retrieved April 25,

2017, from https://www.state.gov/j/tip/id/index.htm

Welch, K., M.D. (2013, February 20). Human Trafficking is a Public Health Problem. Retrieved

April 25, 2017, from http://cancerincytes.scienceblog.com/2013/02/21/human-

trafficking-is-a-public-health-problem/

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