Community Health Centers and Sentinel Surveillance of Human Trafficking in the United States

Abstract

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. 6

The Public Health Response to Human Trafficking: A Look Back and a Step Forward

“…6 Increasingly, public health strategies drive human trafficking research, 7 including investigations using sophisticated methods of prevalence estimation, 8,9 the design and validation of screening tools, [10][11][12] and the use of sentinel surveillance to detect trends in human trafficking. 13 While much research focuses on identifying risks and vulnerabilities at the individual and relationship levels, 14,15 there is an increasing focus on studying cultural factors that influence human trafficking at the societal level, including systemic racism and other beliefs and attitudes that foster the marginalization of large groups (eg, homophobia, transphobia). [16][17][18] Because human trafficking is a public health issue, intervention and prevention efforts must be founded on a strong evidence base and informed by affected populations, including those with lived experience, and by using an equity lens.…”

“…Gallo et al 13 approach the challenges of identifying people impacted by human trafficking and assessing trends in exploitation by advocating for the use of an active sentinel surveillance system in which a nonrandom sample of service sites is targeted for surveillance based on frequent use by people at risk for human trafficking. They suggest that community health centers (CHCs) in the United States serve in this capacity and that routine patient screening for risk of human trafficking, combined with the use of new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes for human trafficking, 19,20 would allow monitoring of trends in the number and characteristics of trafficked people.…”