Thank you for visiting the Human Trafficking Health Alliance of Canada!
The Human Trafficking Health Alliance of Canada brings together physicians, nurse practitioners, registered nurses, forensic nurse examiners, social workers, paramedics, dentists, psychologists, counselors, public health workers, health educators, researchers, administrators, and other allied professionals who work with and advocate for those affected by human trafficking.
Together, we are a united group of health care and allied professionals dedicated to increasing the recognition and response about human trafficking and the intersection of health care in Canada. The Human Trafficking Health Alliance of Canada sees education as a key intervention in both preventing and responding to human trafficking.
As an alliance, we want all persons with lived experience of human trafficking who access healthcare, to receive care that is trauma and violence informed.
Through our collective experience, The Human Trafficking Health Alliance of Canada works to be a resource for all professionals regarding the health care needs of those affected by human trafficking. We also strive to equip health care professionals within community and institutional health care settings with accessible tools to help meet the needs of those affected by labour and/or sex trafficking.
THE PURPOSE OF THIS TOOL IS TO:
This tool is an adaptation of “The Health Care Provider Human Trafficking Training Assessment Tool” for the use of the Human Trafficking Health Alliance of Canada. The original organization and development of this tool is from the collaborative work of the Laboratory to Combat Human Trafficking (combathumantrafficking.org) and HEAL Trafficking (HEALtrafficking.org). This tool builds on the HEAL Trafficking Training and Education Committees’ “Introductory Training on Human Trafficking for U.S. Health Care Professionals: Essential Content, April 2018.”
Public Safety Canada states:
“The extent of human trafficking, both in Canada and internationally, is difficult to assess due to the hidden nature of the crime, the reluctance of victims and witnesses to come forward to law enforcement, and the difficulty of identifying victims. Men, women, and children fall victim to this crime, although women represent the majority of victims in Canada.
Those who are likely to be at-risk include:
(Public Safety Canada 2020, About Human Trafficking)
Due to health consequences, survivors are likely to have contact with health care providers during their exploitation. One study, in particular, reported that 88% of women and adolescents made contact with a healthcare provider while being trafficked. (Lederer/Wetzel 2015, Health Consequences of Sex Trafficking) Persons who are trafficked may access any areas of health care, particular areas indicated may be emergency rooms/hospitals, primary care practices, public health, and reproductive health clinics. Health care providers may be the only person a trafficked person comes in contact with outside of the trafficking process, highlighting education of health care providers is essential to aid in prevention, identification, and response to human trafficking, and ultimately prevent missed opportunities.
The spectrum of health consequences of trafficking is vast and can include neurological, gastrointestinal, cardiovascular, reproductive, sexual, musculoskeletal, dermatological, dental, and mental health problems. Persons presenting with health concerns may look like any patient we see on any given day in healthcare. These injuries and illnesses can also result in advanced stage presentations that have become critical, and even life-threatening due to a delay in care, accessibility, and the nature of the violence.
(Lederer/Wetzel 2015, Health Consequences of Sex Trafficking)
Persons who are trafficked experience a plethora of psychological distress as a result of their traumatic experiences. This can include behavioral health problems like anxiety, depression, dissociation, post-traumatic stress disorder (PTSD), and complex PTSD. Trauma can also manifest as maladaptive behaviors, such as aggression toward others trying to help, lying as means to protect a trafficker, or a patient who minimizes, conceals, or denies injuries.
Taking a trauma and violence-informed approach means looking beneath the surface and recognizing the impacts of violence and trauma on health outcomes and behaviours. While behaviours may appear maladaptive or counterproductive, these behaviors serve as essential tools in the patient’s toolbox of survival skills. When used correctly, the trauma and violence-informed approach will help positively reframe these behaviors and allow providers to build trust with their patients, identify suspected and/or confirmed cases of trafficking, and suggest the most appropriate service referrals upon discharge.
The knowledge and awareness of human trafficking is a new concept to health providers, and as a result, health care has not been able to capture data to quantify the issue. The Canadian Institute for Health Information (CIHI) “provides comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada” (Canadian Institute for Health Information, n.d.). Currently, CIHI does not have a mechanism for coding available to capture those who are exploited or who are being trafficked in Canada. This absence of data within CIHI limits the ability to capture the health care experience of those who are trafficked and often leaves decision-makers and other allied professionals misunderstanding the relevance of health care for the person, and its contribution to other sectors addressing human trafficking. Limitations of representative data fuel the understanding that human trafficking does not happen, and creates a false understanding of the critical importance for health care providers to contribute to recognition and response to human trafficking. Limitations in data also impact the ability to quantify persons who are trafficked presenting for non-acute and acute injury and illness, health risks and consequences, and to provide supportive data to implement measures needed to address human trafficking within health care.
As health care providers, we are left with statistics that are provided by police-reported data only and anecdotal experiences. Statistics gathered through police reporting mainly represent sex trafficking and only provide a partial, restricted, and underrepresentation of the issue.
Health care professionals have work to do. We must work together and with our government to ensure that health care is accessible, and care is in keeping with the acute and chronic needs of those affected by human trafficking. We must also ensure that health care providers have the skill set to work with the priorities set out by our Canadian public health organization of trauma and violence-informed health care.
We know that human trafficking is happening across our country, but police-reported incidents show an overrepresentation in Ontario and Nova Scotia. In 2019, Ontario accounted for 62%, and Nova Scotia, account for 10% of the human trafficking incidents reported.
From 2009-2018, Police reported:
(Public Safety Canada 2020, About Human Trafficking)
The following are some reasons why statistics in Canada are hindered:
Trafficking in Canada 2019 Stats Can Report: https://www150.statcan.gc.ca/n1/pub/85-005-x/2021001/article/00001-eng.htm
National Strategy to Combat Human Trafficking 2019-2024: https://www150.statcan.gc.ca/n1/pub/85-005-x/2021001/article/00001-eng.htm
The Human Trafficking Health Alliance of Canada sees the education of health care and allied professionals as a key prevention and intervention point to highlight the role of the health care provider in addressing human trafficking. Education needs to start within our academic institutions and expand into the workplace.
Currently, in Canada, education curricula about human trafficking are inconsistent and in many academic institutions non-existent.
In one study of 262 medical students, most reported that they “were not knowledgeable (48.5%) or only somewhat knowledgeable (45.4%) about human trafficking. 88.9% of participants were not familiar with the signs and symptoms of trafficked persons. While students’ responses indicated that they prioritized other social issues, a majority of participants (76.0%) thought that trafficking was important to learn about in medical school, especially identifying trafficked persons and their health needs”. (Wong JC, Hong J, Leung P, Yin P, Stewart DE, 2011, Human trafficking: an evaluation of Canadian medical students’ awareness and attitudes. Educ Health)
“These medical students of one Canadian medical school demonstrated limited familiarity with the issue of human trafficking but largely felt that they should be taught more about this issue during their medical education. This assessment of early medical students’ awareness of human trafficking is relevant to medical educators and the organizations that could develop the required educational curricula and resources.” (Wong JC, Hong J, Leung P, Yin P, Stewart DE, 2011, Human trafficking: an evaluation of Canadian medical students’ awareness and attitudes. Educ Health)
Human trafficking education has also not been adopted as necessary education for health care providers within all health authorities in Canada.
The Human Trafficking Health Alliance of Canada’s Education Working Group focuses on educating health care providers (northern, rural, urban and remote).
We include the application of trauma informed concepts for health care; making relevant, evidenced-based training resources more accessible.
The Human Trafficking Health Alliance of Canada’s Research Working Group serves as a collaborative forum for researchers, students, and others with an interest in advancing evidence about human trafficking.
The goals of this group are to facilitate collaborative research projects and partnerships, provide support and assistance to those engaged in human trafficking-related research, and share ideas, resources, and products that may further the field.