Health care systems working together in the fight against human trafficking

Q&A

Hanni Stoklosa, MD, MPH

Emergency medicine physician, Brigham and Women’s Hospital, Boston, and
Co-founder and Executive Director of HEAL Trafficking

The AHA’s Hospitals Against Violence (HAV) initiative has a partnership with HEAL Trafficking (Health, Education, Advocacy and Linkage), which is a multidisciplinary group of more than 3,100 survivors and professionals in 35 countries dedicated to ending human trafficking and supporting its survivors. From a public health perspective, HEAL Trafficking equips providers and health systems with toolkits and other resources to aid in creating policies and procedures to implement response programs. Melinda Hatton, AHA general counsel and executive sponsor for HAV, interviewed Hanni Stoklosa, MD, MPH, emergency medicine physician at Brigham and Women’s Hospital and co-founder, Executive Director of HEAL Trafficking, to discuss the state of anti-trafficking efforts and how health systems play a role in reducing health disparities among victims of sex and labor trafficking.

Hatton: Tell us more about HEAL Trafficking and how your work supports hospitals and health systems.

Stoklosa: Research shows that the majority of people who have experienced human trafficking access health care at some point while they are being trafficked. Every day, trafficked persons come through the doors of emergency departments, orthopedic clinics, community health centers and inpatient psychiatric units. When I first learned of the intersection between health care and trafficking, I was reminded of two quotes by abolitionist William Wilberforce, “You may choose to look the other way but you can never say again that you did not know” and “Great indeed are our opportunities; great also is our responsibility.” It was this drive that compelled me to co-found HEAL (health, education, advocacy, linkage) Trafficking in the fall of 2013. I believe that there should be no “wrong door” for a trafficked person to enter the health care system.

"Every day, trafficked persons come through the doors of emergency departments, orthopedic clinics, community health centers, and inpatient psychiatric units."

I believe that every hospital and health system must be ready and prepared to care for the trafficked persons who come through our doors. HEAL Trafficking provides training and capacity building for health systems to respond to trafficking, from a public health and racial justice lens. Our website hosts compendia of the latest in evidenced-based, open-access resources. We have helped to create regional health care response frameworks for trafficking in states such as Maine, Minnesota, Alaska, Delaware, California, Tennessee, Ohio, and Massachusetts. Our HEAL Protocol Toolkit is being used by health systems in 35 countries to create their policies and procedures. Our standard-setting educational assessment tool was recently featured in the U.S. State Department’s 20th Anniversary Global Trafficking in Person’s Report, and has been used by the state of Texas in implementing their recent trafficking education law for health professionals. Where we see gaps in health care’s response to trafficking, we step in with advocacy, tools and education.

Hatton: What are some of the trends you’ve identified on how hospitals and health systems are combating human trafficking?

Stoklosa: Over the last 10 years, it has been amazing to see the awareness of and response to trafficking among health organizations grow. Some community health centers have dedicated resources to create medical homes for trafficked persons. Some health systems have trained their entire staff on trafficking, including reception staff and security personnel. Rural hospitals have focused on trafficking prevention work, addressing the social determinants of health that make their patients more vulnerable to trafficking. It is becoming a norm to have anti-trafficking response protocols as part of hospital anti-violence initiatives.

COVID-19 has brought its own challenges and highlighted existing inequities in our systems, particularly for people of color. Through a series of recent HEAL COVID listening sessions, we have heard from health systems in our community about how COVID-19 also opened doors to new opportunities, as we reimagine what health care looks like. For example, telemedicine has broken down access barriers previously thought to be insurmountable, which is vital for hard to reach populations most vulnerable to trafficking.

Hatton: 3. Racial inequities play a significant role in the experience of a trafficked individual, can you please share some considerations to ensure trauma-informed and survivor-centered care?

"Health systems should see racial justice work as integral to their anti-trafficking efforts"

Stoklosa: I am so glad you asked this question. Despite portrayals in media, people of color are more likely to be trafficked, and less likely to be able to access resources to help prevent them from being re-trafficked even after their exploitation is identified. Also, people of color are often criminalized rather than seen as victims for their trafficking experience. Furthermore, we know that they face baseline existing inequities in our health system. What this means is that health systems should see racial justice work as integral to their anti-trafficking efforts.

Hatton: Can you share some key resources to help health care leaders get started?

Stoklosa:The American Hospital Association has compiled a great list of resources for health professionals to get started, including a podcast on which I provide updates on national efforts and resources in the fight against human trafficking. For hospital administrators, I recommend the HEAL Protocol Toolkit which is an A-Z roadmap for creation of anti-trafficking policies and procedures. We have also developed a COVID resource guide for health professionals.

Hatton: What is the next phase of this work?

Stoklosa:As I mentioned earlier, where HEAL sees gaps in health care’s response to trafficking, we step in with advocacy, tools and education. We are excited to be collaborating with the U.S. Department of Health and Human Services and National Association of Pediatric Nurse Practitioners (NAPNAP) on developing core competencies for human trafficking for health professionals. Also, we take a racial equity lens to our work, it is important to highlight and mitigate a disparity we have seen in health system responses to trafficking. A lion share of those efforts focus exclusively on sex trafficking. Yet globally we know labor trafficking is more common. As health system administrators increasingly take up the banner of anti-trafficking efforts as part of their anti-violence initiatives, labor trafficking education and victim care must be as resourced as sex trafficking efforts.