Modern slavery as a public health concern in the UK Elizabeth Such (Health Equity and Inclusion Group, University of Sheffield) Claire Laurent (formerly PHE, currently NHS England) Ravi Jaipaul (PHE) Sarah Salway (Health Equity and Inclusion Group, University of Sheffield)

What is modern slavery? The recruitment, movement, harbouring or receiving of children, women or men through the use of force, coercion, abuse of vulnerability, deception or other means for the purpose of exploitation. It includes holding a person in a position of slavery, servitude forced or compulsory labour, or facilitating their travel with the intention of exploiting them soon after (National Crime Agency n.d.) Not ‘modern’; persisted over time, space, economies and societies Image: Home Office Modern Slavery collection https://www.gov.uk/government/publications/modern-slavery-closer-than-you-think

Key facts and figures Global Slavery Index 2017: 40.3 million people worldwide UK estimate: 10-13,000 in 2013 estimates; very poor quality data Image: Home Office Modern Slavery collection https://www.gov.uk/government/publications/modern-slavery-closer-than-you-think

Modern slavery and public health Questions Modern slavery and public health What is the case for public health engagement in addressing modern slavery? What are the components of a ‘public health approach’ to modern slavery? What are the gaps in understanding, approach and practical action in public health on the issue of modern slavery? PHE and ourselves worked in partnership to examine the field and begin to articulate the case for modern slavery as a concern for public health

Methods Rapid evidence assessment Abbreviated systematic review Consultation with stakeholders Bounded practice-based documentary review Consulted with 32 individuals across mutliple organisations including the police, the London Mayor’s office, policy officials at DH, public health professionals in the English regions, third sector organisations and the Office of the Independent Anti-Slavery Commissioner

The case Approach Gaps Findings Scale & reach Health consequences Human rights & equity The case Added value 3 Ps Partnership Approach Policy Practice and capacity Gaps

Health consequences: physical, mental The case Health consequences: physical, mental Human rights violation. The ethical case Epidemiological analysis reveals very poor health among trafficked and exploited people with high incidence of physical health problems related to their exploitation such as injury, mismanaged LTCs, STIs; mental health problems such as depression, anxiety and PTSD. Similar to the characteristics of those who have experienced torture. Ethical case – in the light of such horrendous abuses of human rights with such catastrophic health consequences; we are ethically bound to respond.

Approach Preventative focus of PH Predominance of ‘spotting the signs’ Prevention Preventative focus of PH Predominance of ‘spotting the signs’ Need to move upstream Protection Appropriate care Safety and security Victim-centred support e.g. trauma informed care Partnership Coordination of services Advocates for survivors Public health intelligence What would an approach look like? These fit within globally adopted approaches to addressing modern slavery known as the 3 or 4 Ps Much commentary spoke to the disciplinary strengths of PH – its preventative focus, its appreciation of an action in the upstream determinants of health; its experience in developed, designing and testing interventions in similar areas such as domestic violence, substance abuse and homelessness PH also could also have an important influencing role – on health services; as advocates; in local policy and practice; in raising public awareness. Finally – partnerships …

Added value of PH Better meeting the needs of survivors Training Public and practitioner awareness Learning from other fields e.g. domestic violence Rebalancing law enforcement Holistic approach Influencing the health and local government sectors

An emergent approach Upstream components GLOBAL Advocacy for political and economic system change Cross-national coordination Prevention at source e.g. community resilience and education   NATIONAL Legislative protection e.g. victim immunity from prosecution Health system engagement Training Resources Survivor-centred, rights-based policy Coherence and consistency across policy (e.g. foreign, migration, anti-trafficking) Data and intelligence Public awareness/education Operational infrastructure for effective referral, assessment and support Downstream components REGIONAL/LOCAL Multi-agency partnerships Public awareness/education/readiness Community resilience   SERVICES Culturally sensitive care Coordinated, wrap-around, long-term survivor care Survivor empowerment e.g. enabled decision making Development and testing of tools and interventions Clear responsibilities, operational procedures and allocation of personnel across health services Development of specialist services Adequately trained health professionals A public health approach to modern slavery

Conclusion Modern slavery can be seen as public health issue A case has been articulated: health impacts, equity, human rights PH brings added value Approach helps rebalance the Ps – Prosecution dominates Strategic prioritisation, coordination and development now required at multiple levels in multiple systems: global, national, regional, local

Acknowledgements and contact Funding: Medical Research Council’s Proximity to Discovery scheme; NIHR CLAHRC Yorkshire and Humber www.clahrc-yh.nihr.ac.uk. Support: Anh Tran, Knowledge and Library Services, PHE; Karen Saunders of PHE West Midlands; Dr Hannah Lewis, University of Sheffield. Contact: Liz Such e.such@sheffield.ac.uk

https://www.gov.uk/government/publications/modern-slavery-and-public-health/modern-slavery-and-public-health

Gaps Coordination – services; ad-hocery Data, intelligence Awareness and professional training (cf. Craig 2017) Research: e.g. men exploited for labour; transitions in/out/in-between exploitation Area-level ‘red flags’ Framing: slavery as a criminal justice issue