1. 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)

2. 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

3. 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

4. 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

5. 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

7. 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

8. 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.

9. 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 …

10. 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

11. 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

12. 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

13. Acknowledgements and contact
Funding: Medical Research Council’s Proximity to Discovery scheme; NIHR CLAHRC Yorkshire and Humber Support: Anh Tran, Knowledge and Library Services, PHE; Karen Saunders of PHE West Midlands; Dr Hannah Lewis, University of Sheffield. Contact: Liz Such

15. 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