235 – Human Trafficking and Public Health

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Dr. Sandie Morgan and Dr. Susie Baldwin discuss the position of healthcare in preventing and battling against human trafficking. Dr. Baldwin describes the role healthcare takes in protecting and serving the community. Both of these experts, look at the reason prevention is such an important part of anti-human trafficking. As Dr. Morgan puts it,”…an ounce of prevention is worth a pound of cure.”

Susie Baldwin

Dr. Susie Baldwin is a preventive medicine physician whose career focuses on public health, women’s health, sexual and reproductive health, and advancing health equity. She has worked as a clinician, researcher, advocate, epidemiologist, and trainer. Dr. Baldwin serves as the Medical Director for the Office of Women’s Health at the Los Angeles County Department of Public Health and is co-founder and Board President of HEAL Trafficking, where she also leads work on developing protocols to respond to trafficked people in health care settings.

Key Points

  • The root of the problems of sex trafficking and labor trafficking is very similar.
  • When we focus on primary prevention, we have the ability to stop the problem before it presents itself.
  • Looking at human trafficking from a healthcare perspective is a fairly new concept; however, it has changed the way we approach and deal with human trafficking.
  • Viewing human trafficking as a healthcare issue, allows us to take a holistic approach to solve this issue. Meaning, it allows us to focus on the roots of the problem within our community, rather than making it an individualistic issue.


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Dave [00:00:00] You’re listening to the Ending Human Trafficking podcast; this is episode number 235: Human Trafficking and Public Health.


Production Credits [00:00:09] Produced by Innovate Learning, Maximizing Human Potential.


Dave [00:00:29] Welcome to the Ending Human Trafficking podcast. My name is Dave Stachowiak.


Sandie [00:00:35] And my name is Sandie Morgan.


Dave [00:00:38] And this is the show where we empower you to study the issues, be a voice, and make a difference in ending human trafficking. Today, we’re so glad to welcome an expert with us to really help us look at the complex and important intersection around human trafficking and public health. I’m so glad to welcome Susie Baldwin to the show today. Susie is a preventative medicine physician whose career focuses on public health, women’s health, sexual and reproductive health, and advancing health equity. She has worked as a clinician, researcher, advocate, epidemiologist, and trainer. Dr. Baldwin serves as the medical director for the Office of Women’s Health at the Los Angeles County Department of Public Health and is the co-founder and board president of Heal Trafficking, where she also leads work on developing protocols to respond to trafficked people in health care settings. Susie, we’re so glad to welcome you to the show.


Susie [00:01:32] Thank you, Dave. I’m very excited to be here. And good morning, Sandie.


Sandie [00:01:36] Good morning. I’m just reading your bio out loud. I could imagine five podcasts could go in this direction. But first, I really want people to understand the scope of public health. And then we’ll dive into where that really intersects in human trafficking. Can you address that?


Susie [00:02:00] Of course. Public health is a big field and the goal of public health, in general, is to allow people to be healthy and to live in communities that are healthy and that optimize conditions for them to have lives where they can enjoy safety and well-being. So public health is a field that’s extremely broad and it’s almost humorous when you think about the American Public Health Association, which is the U.S. body that brings together public health professionals, the conferences have so many different topics going on at every given moment. You might want to be attending five different sessions. So public health incorporates things ranging from health behaviors and health education that the very individual level all the way to transforming communities and societies through policies and laws that can advance wellness for people and health equity. So many things under the sun can fall under the realm of public health. But I think some of the key things about the field and the aspects of it which are important to human trafficking or approaching human trafficking are that, number one, it is grounded in science and evidence. Number two, that it takes a population-level approach. So while health care delivery is a very important part of public health, particularly when systems are publicly funded, but also because the health of all people in a community, whether it’s a county or state or town or tribe or a country or the world, the health care that people receive is an important factor contributing to the overall health of people. But the realm of public health goes beyond your health care and getting your vaccination or getting your mammogram to creating the conditions in which people live. So inclusive of the first public health effort, which was getting people clean water, which saved more lives than many of the interventions we have today that we rely on. So, it goes to very fundamental issues of sanitation and safety and life. So, it’s research-based or evidence-based. It’s inclusive of health and health care. And it’s also focused on prevention. So whereas health care, particularly in the United States, given our system, which is rather unique in the world, sometimes in wonderful ways and sometimes in terrible ways, public health aims to prevent disease, disability, and death. So, we really take what’s known as an upstream approach where you go back to try to look at where things start, where the problems start, and correct them at their roots, which is often very challenging. But that’s also part of what makes it exciting, because when you can really change the origins of where problems come from, then you have the opportunity to impact millions of lives in a good way.


Sandie [00:05:21] And I think you may remember that my background’s pediatric nursing. So, prevention has always been really high on my list of priorities, and when I try to work with people doing prevention in our schools, they often have sort of a little card with red flags. And these are things you shouldn’t do. And we end up really on the verge of victim-blaming when kids get into difficult circumstances. So, a couple of weeks ago, we interviewed Rebecca Bender, who talked about choices, and those choices that aren’t really choices might fall into the same category of something we can imagine. If you didn’t have clean water and you drank from a contaminated creek, it was a poor choice. And so how do we begin to understand that in our prevention landscape from a public health model?


Susie [00:06:28] That’s a really good analogy there. So, thinking specifically about the issue of commercially sexually exploited children, which is the trafficking topic that schools are exploring more now and thinking about and thank goodness are now working to address in the places where children spend so much of their time. For one thing, the red flags. That’s not exactly prevention. If you’re seeing red flags, I mean, it could be a form of prevention because prevention itself has different tiers. But I am when I talk about prevention, I meaning more primary prevention, which is going back to how do we keep these children safe before these risks develop as signs to the teachers, the aides, the guidance counselors, the coaches that something is going wrong with this child. So for me, that looks like investing in systems that allow for families to be healthy in general, even before these children are born. We know from science now that the stresses that a fetus experiences in the womb can impact that person’s life moving forward and even beyond that, that the experiences of intergenerational trauma are actually manifested in our DNA. And that field is called epigenetics and it’s rapidly evolving. And it’s very exciting, but also somewhat terrifying because it explains how something that happened in your ancestors’ lives could actually be passed to you genetically through modifications in the way your genes are manifested and the way your body operates. So the issue of prevention of child trafficking, I would say this focus specifically for a moment on child sex trafficking, although I have a tendency of never talking about sex trafficking exclusively, because I think it’s extremely important to also look at labor trafficking hand-in-hand with sex trafficking, because, again, the roots of these issues are very similar.


Sandie [00:08:45] And I just want to affirm that here in Orange County, where you’ve actually started a working group to help us identify child victims of labor trafficking, which happens so much more frequently than the average person understands.


Susie [00:08:59] Yes, and we are finally also working on that in Los Angeles County as well. After seven years or so now of really focusing on child sex trafficking, our county is now also expanding to child labor. So hopefully this is one of those trends where California is starting out and others will follow the state, preventing and addressing child trafficking program is also broadening its technical assistance and training to help other counties around the state of California address child labor trafficking. But going back to the prevention aspects and it really does work for both to some degree, is that when families are healthy and when children are living in a society that cares for them, we can avoid some of these very damaging outcomes that kids experience and kids experience harms along a spectrum. And I’d say experiencing human trafficking is one of the most terrible things a person can live through, even when it is supposedly their choice, as is perceived by people who don’t quite understand the psychological coercion involved in trafficking but is framing our society so that families have the support they need to raise their children, that they have enough food to eat, that their housing is stable, that their job pays them enough so that they can eat and have a roof over their head and pay for transportation and clothing, without having to work three jobs preventing them from ever spending time with the children that they’ve had or acquired, ensuring that the school system teaches all children the skills they need to become productive adults. And that is this education is equitably available to children, regardless of the income of their parents or their race or ethnicity or their immigration status or whether they live in a rural remote setting or a big city. The fundamental inequities that are built into our society are impacting the vulnerability that children have to trafficking all the way up to the spectrum of the vulnerabilities that adults have that leave them vulnerable to exploitation and trauma.


Sandie [00:11:16] I think one of the things I really struggle with is building value for that kind of primary prevention that is based on building resilience and kids supporting families’ developmental assets. And our listeners can go back and listen to other podcasts about those things. But too often when people find out about human trafficking, they want to jump in at the intervention space and they actually leave what they’re doing that helped a child not become a victim. So how do we begin to communicate that primary prevention as an anti-human trafficking strategy?


Susie [00:12:03] Well, I think podcasts like this are a great way to spread that message and talk about it wherever, whenever we can. I think a lot of the portrayals of human trafficking intervention that we see in the media that some groups have gravitated toward reflect what’s known in anti-trafficking circles as a savior complex and sometimes more broadly. When we look at different troublesome issues around the planet, it can be called a white savior complex where white, more affluent, more fortunate people from Western countries will use their energies and their time to try to rescue people who are experiencing harm. Whether or not those people believe they want to be rescued or not. So, to shift our approach to anti-trafficking from a rescue, quote, rescue industry to prevention and empowerment effort is really important both to respect the autonomy and the desires of people who are being victimized. Because as you know, as many of your listeners may know from hearing your podcast, that it’s not as simple as it seems. Trafficking victims have a very complicated mental perspective on what’s happening to them. Sometimes they don’t even know that they’re trafficked and sometimes they often believe it’s their own fault. And particularly with people who are exploited at younger ages, they think they’re making the decision to do whatever they’re being exploited for, of their own free will. And it sounds like you cover this very well with Rebecca Bender. So we don’t need to focus on that. But people who are trying to help would benefit from taking a step back and thinking more broadly about the ways to eradicate trafficking in our society by not being on that tail end of the process where law enforcement operates, frankly, because there are situations where only somebody with a gun and state authority can break up or change a situation that’s happening. But all of us have the power to do a more upstream approach to work, to create a society where this doesn’t happen. And yes, it’s long term. It’s not nearly as exciting as people who decide to go out at night and bust into a motel room, which is also very traumatic for the victim, by the way. But to really think about what we do in our daily lives, that creates and perpetuates the systems of inequality that allow for the vulnerability to trafficking. And it’s built into our very economy. It’s not just that there are people who are bad and want to hurt other people. There is an economic incentive that drives this crime that has a lot to do with profiting off of the labor of other people, which, of course, is how this country was created. So it’s deep. It’s very deep.


Sandie [00:15:20] So when you’re talking about primary prevention, we could spend the whole time just right there and for me, I don’t think that the community at large really values primary prevention, say that maybe you and I do. So how do we get them to get on our boat?


Susie [00:15:43] That’s a very good question. I think it does go back to education. I think we have to allow people to dream of a better society, a place where everybody has what they need, where people aren’t suffering needlessly. And we do have the wealth in this country. We do have the infrastructure to take care of everybody in a fundamental way. We just choose not to because we’re very focused here in the states on individualism and getting ahead and succeeding in a more narrow way than succeeding as a community and taking care of one another. And the hard thing about crime and prevention also is that it’s very hard to prove the benefit of it. And this is true even with medical preventive interventions, because when you prevent something from happening, you know, say you quit smoking when you’re twenty-eight instead of smoking until you’re 72. You have prevented a lot of damage to your own body. You prevented a tremendous amount of suffering for yourself, potentially for your loved ones who would have to take time off work to care for you if you start to have heart problems, or lung problems, or other problems related to their smoking behavior. But you can’t, I mean you can, researchers do estimate the value of these things, but it’s hard to quantify it. And that’s even with something that’s as proven as smoking. You know, we know what smoking costs us both individually and as a country and as a planet in terms of the harm done to people and the years of life, years of quality of life loss, and the years of actual lives lost. For one thing, we don’t have good estimates about trafficking, human trafficking. And it’s also part of the basis of the public health approach is that when you use a public health approach, the first thing you do is assess the problem and try to get a sense of the magnitude of what causes it. And what can be done to help it. So, in general, measuring trafficking is difficult and measuring the benefit we would get by instead of investing in what’s called tertiary prevention, which is finding that people who have been harmed by this crime and then taking care of them after so that they don’t be harmed again. That is an important form of prevention. And that’s where I started in this work for many years, was providing care, clinical care for people who had already experienced human trafficking. And we can measure that. We can measure what it costs to take care of somebody who’s broken bone or their depression or their anxiety or their PTSD. But we can’t measure as readily what would’ve happened if this person at a school that they love a great after school program and their parent’s drug addiction was treated and they grew up in a stable home and went to college and not the people who go to college don’t get traffic. But just imagining the life of a more vulnerable victim who say lacks education opportunity and winds up trafficked for labor or sex, what would your life been different if the investment in them had been made upfront vs. investing in all the criminal justice efforts that go to help them get out of this situation and prosecute the trafficker and pay for their rehabilitation and recovery after they’ve been severely harmed.


Sandie [00:19:17] And that makes me think of growing up, hearing grandma say an ounce of prevention is worth a pound of cure. Yes. I think creating a value for resourcing prevention is something we’re beginning to understand better. Survivor Council in Washington, D.C., one of their recommendations is looking at intergenerational responses of prevention as well as intervention. And I love the analogy of smoking because pretty much everybody actually believes that now. And how do we get people to believe that about prevention and labor trafficking, as well as sex trafficking? I think that’s our generation. It’s our job to make sure that happens. One of the ways that you’ve been a leader in this is the creation of Heal. Will you tell us about Heal and the amazing resources and community assessment, all of that?


Susie [00:20:21] Sure. Thank you. So, yes, Heal that October. We will have existed for seven years. Although we’ve only been a formal nonprofit with federal nonprofit status for less than one year at this point. So, we’ve been growing slowly through a lot of amazing volunteer labor by people all around the country and even the globe Heal emerged out of… There were several of us and I came to human trafficking through my clinical work, when I first moved to L.A. I was in Tucson, Arizona before that for eight years, and I was doing a fellowship at UCLA and was invited to participate in a new clinic that was starting up to care for survivors of human trafficking. And I devoted a lot of my life to that as a volunteer for eight years caring for survivors of sex and labor trafficking. They were all 18 or over, I don’t practice pediatrics, and they were from all over the world. And I eventually learned that despite the burgeoning anti-trafficking movement in the United States, nobody was really talking about the health of people who experienced trafficking. Nobody was including nurses, doctors, chiropractors, therapists, other mental health specialists at the table. In those days, this is in the mid-2000s, we were sort of on the side of what was happening with all the collaboration going on to address trafficking. So eventually there were six of us physicians who were dealing with trafficking in our work in various ways. And three of us here on the West Coast were serving patients in our clinical work who had been trafficked. And there were three others on the East Coast who were doing various research projects and policy work and to some extent clinical work to care for people who had experienced trafficking. And we came together and founded this organization. And when we reached out, when we do a lot of online outreach and everyone we talked to seemed to be hungering for the same thing, which was to come together to talk about this. So, there were people all over the country, not a lot of us back then, but there were people who were working on this in silos. And we wanted to have a resource for people to come together, to share ideas, to share information, to build the research base. When I started doing this work at the end of 2004, there was next to nothing in the medical literature about it. I mean, you could find a lot of information about sexual exploitation of teenagers, you know, people who were previously known as child or teen prostitutes, which is now a language that we understand is offensive and very unfair. But there wasn’t anyone actually studying human trafficking, per say, in terms of health after the passage of the Trafficking Victims Protection Act and the Palermo protocol, which is the UN’s process that led to the defining trafficking internationally. Aside from the anti-human trafficking group in the U.K., so we felt like there was a big gap in the United States and we came together and found a lot of committed, brilliant people around the country who wanted to participate. And together, we’ve now I think we’ve actually helped change the way that human trafficking is discussed in this country. We’ve brought the lens of health and increasingly to public health, to the field, so that it’s now even recognized in Washington, DC, and in state capitals that health is part of this picture.


Sandie [00:24:24] And you’ve developed curriculum, the SOAR curriculum that is available for free on the Health and Human Services resource page, and Heal has a web page as well, right?


Susie [00:24:37] Yes, we do. So many of us were involved in the development of the SOAR curriculum and still are. Some of us are trainers. There are plenty of people involved in SOAR who are not affiliated with Heal, but many of us were. And yes, that’s an amazing free resource out of the National Human Trafficking Technical Assistance Center and the U.S. Office of Trafficking in Persons. And our Web site also HealTrafficking.org has many resources on it. And it’s almost it’s astounding to me. Let’s say, that when I started doing this work, I would do a search. You know, I remember I did my first search for human trafficking in the medical literature. The search turned up tens of thousands of articles about human trafficking, and all but one that I could find. You can scroll through 10000 articles. But they were all about cellular signaling, human trafficking at the most fundamental level, from cell to cell or even within cells. How cells communicate with each other. How signals travel within a cell. So now the literature about human trafficking and health is exploding. There are all kinds of new research coming out. And the field has changed. So, it’s hard to even keep up with all of the literature coming out. But Heal Trafficking is a good way to start, and our executive director, Hanni Stoklosa, keeps up with the emerging articles. And as part of our listserv, people can find out what’s happening in many fields of human trafficking, but also in the research literature.


Sandie [00:26:24] We’ll put links to all of that in our show notes. And I’m like getting the signal. I can’t believe how fast half an hour goes. So, Dr. Baldwin, can you just in one sentence, sum up, tell us why we must begin to include a public health lens if we’re going to actually beat human trafficking.


Susie [00:26:48] One sentence.


Sandie [00:26:49] I know that’s hard.


Susie [00:26:51] OK. It’ll be a long sentence. A public health approach to human trafficking allows us, No. One, to integrate health care providers into anti-trafficking work, knowing that people who are victimized by trafficking do seek health care. And we need to know how to use that opportunity to offer them help. We also need to take a step back and use the public health approach to expand the opportunities our society has to people, so that we can reduce vulnerability to trafficking and allow everybody to live healthy and productive lives.


Sandie [00:27:27] Beautiful, beautiful. Thank you so much. We’re going to have to have more conversations about this. Thank you.


Susie [00:27:33] Thank you, Sandie.


Dave [00:27:35] Thank you so much to you both. We’re inviting you to take a few moments to also dive in on the resources we’ve mentioned in this episode. If you’ll go over to Endinghumantrafficking.org, that will allow you to track down all of the things we’ve mentioned in this conversation. Also, it’ll open you up to the library of all of our past episodes. And for the last 10 years that we’ve been airing the show, you can also download a copy of Sandie’s book, The Five Things You Must Know: A Quick-Start Guide to Ending Human Trafficking. It’s absolutely free. It’ll teach you the five critical things Sandie has identified that you should note before you join the fight against human trafficking. Get access to that by going over to Endinghumantrafficking.org. That’s also a great place to find out more about the Antihuman Trafficking Certificate program here at Vanguard University of Southern California. Endinghumantrafficking.org for more details there. And if today’s conversation has generated a question in your mind, take a moment to reach out to us by e-mail feedback at Endinghumantrafficking.org. And we will see you back in two weeks. Take care everybody.

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