Understanding Healthcare Utilization and Occupational Exposures of Labor-Trafficked People

Understanding Healthcare Utilization and Occupational Exposures of Labor-Trafficked People

Understanding Healthcare Utilization and Occupational Exposures of Labor-Trafficked People

Guest blog authors: Maya Land, Philip DeCicco, Kate Berson, Ho’oani Cuadrado, Jaya Prakash, Hanni Stoklosa of HEAL  Trafficking and Justice at Work

A recent study published by medical and legal researchers at HEAL Trafficking and Justice at Work is the first of its kind, exploring healthcare utilization trends and occupational exposures among survivors of labor trafficking.  Health systems represent a safe, trusted place for labor trafficking victims, while being exploited, to access help. But prior to this study, little was known about the ways in which labor trafficking victims sought health care and for what reasons. 

The public perception of human trafficking has fixated on sex trafficking via the “perfect victim” trope, which perpetuates the heteronormative narrative of a young, White, female sex-trafficked victim. However, this view is based on stereotypes that do not reflect the realities of the human trafficking demographic landscape, nor the actual relationship between labor and sex trafficking under the broad human trafficking umbrella. While an estimated 4.8 million people globally are subjected to forced sexual exploitation, almost three times as many—up to 14.2 million– experience forced labor exploitation. Despite these numbers, legal prosecutions of and existing academic research on labor trafficking are disproportionately low. For example, in 2021 only 3% of U.S. federal trafficking prosecutions focused on labor trafficking, and only 10% literature on human trafficking focuses on labor trafficking specifically. Due to this lack of reliable information, understanding how and where interventions can be implemented to contact and help victims of labor trafficking remains challenging. 

This study published in the Journal of Healthcare for the Poor and Underserved is integral in beginning to better describe labor trafficking and identify potential health care intervention mechanisms. The authors of the study investigated the experiences of over one hundred victims of labor trafficking in the state of Pennsylvania. Researchers analyzed de-identified narratives from legal documents. The team found that 82% of the subjects studied were male and up to 78% worked in the agricultural sector. Among the charts reviewed, 92% were from Latin America, mostly from Mexico, and 97% had limited English proficiency. 

Just under half of the studied population suffered injuries while experiencing labor exploitation. Importantly, in all cases involving injuries, the traffickers interfered with access to medical care. This interference took many forms, such as through threats of deportation or wage deductions or worse conditions. In some cases, traffickers would even pose as friends or relatives during medical appointments and would be asked by medical professionals to act as interpreters. This would allow the trafficker access to confidential medical information from victims, and place the victims in a position to lie about how the injury occurred, who was liable, and who would have to foot the medical bill. These findings underscore that medical professionals should always use professional interpreters, and communicate sensitive information one-on-one, including assessing patients for violence exposures.

In terms of other health sector findings, 38% of subjects studied mentioned accessing medical services at least once, mostly via hospitals (73%-81%), while they were being trafficked. Over half of the study population developed a medical condition while experiencing labor exploitation and the majority were forced to prematurely return to work while still injured, sick, or even before the end of a doctor-recommended medical leave. Furthermore, victims struggled with inadequate sleep, unsanitary living conditions, and harmful chemicals without protective equipment, leaving many with long-lasting medical conditions that continued even after their escape. 

The study also revealed that 43% of survivors had children who were US citizens, which indicates that victims’ children likely were interacting with social and medical systems, like schools and pediatric doctors during their parents’ labor trafficking exploitation. Fifty percent (50%) also had family members who were ill.

This research lays the foundation for more research on intervention points for labor trafficking victims. Recognizing the healthcare needs, utilization patterns of victims during their trafficking experiences and the opportunities these create in the medical system to better identify and interact with labor trafficked individuals are crucial as legal and medical professionals begin to address the issue more holistically. Expanding medico-legal research partnerships to include larger geographies and survivor populations will help improve evidence-based approach to address human trafficking globally. Concerted resources must be dedicated to comprehensively characterize the risk factors, health needs, and clinical touchpoints for labor- trafficked people.

HEAL Trafficking leads innovative health solutions to eradicate human trafficking in our communities worldwide. 

Justice at Work, formerly known as Friends of Farmworkers, has been advancing the rights of workers in Pennsylvania for more than 45 years. While originally focused on agricultural workers, we now provide legal aid, community education, and advocacy to immigrant and low-wage workers across industries.

Author bios

Maya Land is a recent graduate from Tufts University, and an incoming Master of Science in Public Health student at Johns Hopkins. She is excited to pursue a career focused on creating stronger health systems to better address the needs of under-resourced populations. She volunteered for Street Safe in New Mexico for 5 years, doing outreach and providing direct service to street sex workers and victims of human trafficking. Most recently she worked with the Center for Black Maternal Health and Reproductive Justice. 

Philip DeCicco holds a Master’s Degree in Public Policy and Management from Carnegie Mellon’s Heinz College. Philip’s background includes working as a legal interpreter, outreach to immigrant worker communities, and direct services to survivors of labor trafficking.

Kate Berson is a Department of Justice Accredited Legal Representative and the Special Initiatives Coordinator at Justice at Work Pennsylvania. She represents low-wage immigrant survivors of labor trafficking and other workplace crimes, in their applications for immigration status. She has worked for over 15 years in immigration and poverty alleviation as a project coordinator, grant-writer, Spanish-English interpreter, and teacher.

Ho’oani Cuadrado, MSPAS, PA-C, is the Director of Education for HEAL Trafficking. She began working as an emergency medicine physician assistant (PA) for Lehigh Valley Health Network (LVHN) 20 years ago and began to realize the prevalence of homelessness and its close relationship to human trafficking within her own community. She has been a proud member and supporter of VAST (Valley Against Sex Trafficking) for eight years and served on the organization’s Board for four years. Seven years ago, she established a physician assistant team at a local refugee resettlement site to provide health care for unaccompanied minors primarily from Central America, many of whom were victims of human trafficking or exploitation. As an assistant professor, she taught graduate physician assistant students how to care for the community’s most vulnerable and spearheaded efforts to provide free health care to a local residential home for sex-trafficked women. In 2019, she was asked to serve on an expert work group for the Department of Health and Human Services, Office of the Assistant Secretary for Health, and the Office of Population Affairs to review the intersection of human trafficking and family planning services. In 2020, she was the first physician assistant to be selected for the Pearl Birnbaum Hurwitz Humanism in Healthcare Award as a leader and change agent in Street Medicine and prevention of human trafficking. In 2021 she was awarded American Academy of Physician Assistants’ (AAPA) Physician Assistant of the Year for demonstrating exemplary service to the community. For years, with the help of HEAL Trafficking, Ho’oani has been developing a Human Trafficking Response Protocol for LVHN (a non-profit organization of over 20,000 employees). The protocol went live April 2023 in all of LVHN Emergency Departments and will be expected to roll out to inpatient and outpatient departments over the next year with Ho’oani’s support. In August 2023, Ho’oani will be featured in Lehigh Valley Style magazine as one of the Lehigh Valley’s most influential women.

Jaya Prakash is an OBGYN resident doctor within the MGB system. Her clinical work centers around a trauma-informed approach to reproductive health as well as women’s wellness. Her scholarship focuses on the health concerns and disparities experienced by survivors of violence, specifically with regards to human trafficking and intimate partner violence.

Hanni Stoklosa, MD, MPH, is co-founder and CMO of HEAL Trafficking, an emergency physician at Brigham and Women’s Hospital (BWH) with appointments at Harvard Medical School and the Harvard Humanitarian Initiative. Dr. Stoklosa is an internationally-recognized expert, advocate, researcher, and speaker on the wellbeing of trafficking survivors in the U.S. and internationally through a public health lens. She has advised the United Nations, International Organization for Migration, U.S. Department of Health and Human Services, U.S. Department of Labor, U.S. Department of State, and the National Academy of Medicine on issues of human trafficking and testified as an expert witness multiple times before the U.S. Congress. Moreover, she has conducted research on trafficking and persons facing the most significant social, economic, and health challenges in a diversity of settings including Australia, Brazil, China, Egypt, Guatemala, India, Liberia, Nepal, Kazakhstan, the Philippines, South Sudan, Taiwan, Thailand, and Uganda. Among other accolades, Dr. Stoklosa has been honored with the U.S. Department of Health and Human Services Office of Women’s Health Emerging Leader award, the Harvard Medical School Dean’s Faculty Community Service award, has been named as an Aspen Health Innovator and National Academy of Medicine Emerging Leader. Her anti-trafficking work has been featured by CNN, the New York Times, National Public Radio, Fortune, Glamour, Canadian Broadcasting Corporation, STAT News, and Marketplace. Dr. Stoklosa published the first textbook addressing the public health response to trafficking, “Human Trafficking Is a Public Health Issue, A Paradigm Expansion in the United States.”


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