The role of health systems in combating human trafficking

In June, the CDC added ICD-10 codes to represent “suspected and confirmed forced labor and sexual exploitation” and the Joint Commission published an article on “identifying human trafficking victims.”

This reflects a growing awareness that human trafficking doesn’t just occur overseas. It happens in our midst—and trafficking victims are present in our cities, our hospitals, our clinics.

Indeed, the American Hospital Association reports that “human trafficking is an issue in nearly every corner of the country.” Another study found that 88% of U.S.-born, female sex trafficked victims had seen a healthcare professional while being trafficked. The most common treatment site was a hospital ED, though primary care and urgent care clinics both saw high numbers as well. Healthcare providers, therefore, are in a position to intervene.

Amelia Benefiel is an ED nurse at a large hospital in San Diego, California. She learned of the problem through the Junior League of San Diego and the work of Dr. Jamie Gates, professor of cultural anthropology at Point Loma Nazarene University. Troubled by the issue, she reached out to her hospital’s social work department.

“We don’t really see that here,” one social worker dismissed.

“My concern is that we do see it but don’t realize it,” said Benefiel. “A lack of knowledge and a casual attitude toward trafficking in the ED can cause us to miss opportunities to identify these victims.”

Her organization is not alone. Discussions with local clinicians and hospital leaders reveal a general lack of awareness of trafficking. Like the social worker, they believe “it couldn’t possibly happen here.”

Yet research by Gates, the PLNU professor, found that it does. Sex trafficking in San Diego County represents an estimated $810 million in annual revenue and impacts more than 1,766 commercially sexually exploited persons a year, mostly teenage girls with an average age of entry below 15 years old.

Moreover, a San Diego State University study estimates that “31% of undocumented, Spanish-speaking migrant workers interviewed in San Diego County had experienced labor trafficking.” Other metropolitan areas report similarly alarming numbers.

Presented with these data and trained on recognizing red flags, many clinicians experience a lightbulb moment. For Benefiel, one particular encounter came to mind.

“A man at the bedside claimed to be her father but seemed too young for that to be true,” she recalled. “The patient said nothing during my care for her, and his word was all we had to go on.”

Benefiel concluded: “I felt uncomfortable about the situation but was unsure of what to do for her.”

Anti-trafficking advocates are working to change that.

Founded in the fall of 2013, HEAL Trafficking unites over 2,000 professionals across the globe who are fighting human trafficking from a public health perspective. Its vision is to see “a world healed of trafficking.” HEAL's website offers open access resources for health professionals and health systems, including a human trafficking protocol toolkit. Through the not-for-profit’s work, healthcare leaders are seeing themselves and their organizations as part of the solution.

One health system leading the charge is San Francisco, California-based Dignity Health. Through an initiative led by Dr. Ron Chambers, Mercy Family Health Center developed the Human Trafficking Medical Safe Haven, which provides trauma-informed, patient-centered care to trafficked persons. Dignity Health is planning to scale the model across its facilities.

“Seeing these patients, hearing their stories, and playing a role in their care has brought me back to the roots of why I wanted to be a physician,” said Chambers. By spending extended time with victims and survivors, doctors are able to build trust and develop care plans that meet their complex needs.

“It’s so rewarding to hear from patients that this is the first time they’ve been given an opportunity to build a trusting relationship with a physician—one who knows their name and treats them with kindness and patience,” added Jennifer Cox, program manager of the Human Trafficking Medical Safe Haven.

“Healthcare has a front row seat in making a difference and supporting victims and survivors in their recovery,” she commented. “All of us can do our part.”

Health systems across the country can help combat human trafficking by:

1. Educating staff on red flags and implementing a protocol of actions to be taken.
2. Documenting suspected and confirmed trafficking using the new ICD-10 codes.
3. Investing community benefit dollars toward anti-human trafficking initiatives.
4. Become acquainted with community groups that serve trafficking survivors.

Human trafficking is a community problem and a health issue. It requires collective effort not only from law enforcement, education, and survivor services, but also from health systems. Healthcare providers have a central role to play in bringing about “a world healed of trafficking.”


Christopher Lee, Healthcare Consultant and Clinical Solutions Marketing Manager, Family Health Centers of San Diego

Christopher Lee is a healthcare consultant and Clinical Solutions Marketing Manager at Family Health Centers of San Diego. He’s convening the health services committee for the San Diego Human Trafficking Advisory Council. In addition, Chris teaches healthcare economics at National University and manages a career development blog at

Hanni Stoklosa, Executive Director, HEAL Trafficking, Emergency Physician, Brigham and Women’s Hospital, Harvard Medical School.

Dr. Stoklosa is an internationally-recognized expert, advocate, researcher, and speaker on the wellbeing of trafficking survivors in the U.S. and internationally through a public health lens. She has advised the United Nations, International Organization for Migration, U.S. Department of Health and Human Services, U.S. Department of Labor, U.S. Department of State, and the National Academy of Medicine on issues of human trafficking and testified as an expert witness multiple times before the U.S. Congress. Dr. Stoklosa published the first textbook addressing the public health response to trafficking, "Human Trafficking Is a Public Health Issue, A Paradigm Expansion in the United States."

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