Professional Documents
Culture Documents
Human Trafficking
Melissa H. Towe
4/10/2018
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Abstract
Human trafficking at the most simplistic definition consists of the transport/trade of human
beings for sexual exploitation. Human sex trafficking continues to be a growing international
problem that violates the most basic human rights of its victims despite the extensive
international attempts to bring it to an end. The following explores the various forms of human
trafficking and the multifaceted factors that may perpetuate its continued existence across the
globe with a direct focus on the regions of Nepal and India. The following also applies Frieden’s
Health Impact Pyramid on public health action to the issue of human sex trafficking and briefly
examines the role of the nurse in these interventions. Finally, it explores additional implications,
gives suggestions for needed changes, and explores some of the many opportunities for careers
Human Trafficking
Human trafficking is the third largest organized crime in the world (Deane, 2010).
Approximately “800,000 people are trafficked across international borders; 80% are female and
half of them are minors” (Rijal, Adhikari, & Aro, 2016, p. 3). There are different types of human
trafficking however, all forms share the exploitation of the victim and the use of some type of
force/coercion by the trafficker for the exchange of some type of profit (Deane, 2010). Sex
trafficking for the victims can result in debilitating and lifelong health consequences such HIV,
abuse, trauma, and stigma (Deane, 2010). The following will focus specifically on sex trafficking
in the regions of Nepal and India. Nepal and India share the largest burden of child/female
trafficking in South Asia, with India being the single largest foreign destination for victims of sex
trafficking (Deane, 2010). It is estimated that “10,000-15,000 Nepali women and girls” are sold
to brothels in India every year (Deane, 2010, p. 493). Nepal and India share an open border and
despite the current laws and protocols in place to prevent human trafficking, it still occurs
significantly. The following will explore these laws/interventions, give suggestions for
improvement, and explore career opportunities related to the global health field. It will focus on
addressing public health action in regards to human sex trafficking via Frieden’s Health Impact
Pyramid.
Frieden’s Health Impact Pyramid addresses public health action and the effectiveness of
its interventions. The pyramid has five tiers of which the impact on the population is greater in
the bottom tiers than it is at the top, and the amount of effort required on the individual’s part is
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greater in the top tiers than it is in the bottom tiers. The pyramid identifies socioeconomic
determinants as the base of the pyramid, followed by public health interventions, protective
interventions (long-term), clinical care, and finally counseling and education (Frieden, 2010).
Socioeconomic Factors
determinants are an extremely influential factor in health and wellness. Socioeconomic factors
include but are not limited to poverty, educational/employment status, cultural/family beliefs,
gender equality, sanitation, and access to healthcare (Frieden, 2010). In Nepal, the status of
women is “subordinate to men in the context of their access to knowledge, economic resources,
and political power, as well as their personal autonomy in the process of decision making”
(Deane, 2010, p. 495). This means that women and female children receive little to no education,
they have limited or no access to healthcare, and are severely limited in regards to employment
opportunities. Without education, women are seldom aware of the laws and their rights. “Only
66% of adolescent girls from one of the most vulnerable areas in Nepal were aware of sex
trafficking” (Rijal et al., 2016, p.5). This is problematic as women/girls in these areas may not
know their rights and may think what is happening to them/around them is acceptable. Poverty
and lack of employment opportunities in Nepal and India has increased women’s vulnerability to
sex trafficking by placing them in positions where they feel they have no other option than to
exchange sex for survival and basic needs such as food/water/shelter (Deane, 2010). Traffickers
use these gender disparities to their advantages to tempt women/girls with what appears to be a
better life, higher wages, or more suitable working conditions but in reality, they have just
The second tier of the pyramid refers to public health interventions that change the
context to make individual’s default decisions healthy. These interventions “…change the
environmental context to make healthy options the default choice, regardless of education,
income, service provision, or other societal factors” (Frieden, 2010, p. 591). In layman’s terms
this means that interventions on this level yield results that individuals would have to go out of
their way to avoid benefiting from. In the context of human trafficking, these interventions
would include international laws, or at a minimum, stricter laws and enforcement of those laws.
Take for example, harsh border patrol between Nepal and India. If international laws against
human trafficking could be implemented and enforced via border control between the two
countries, individuals would have to go out of their way to avoid receiving that protection. Nepal
and India both currently have laws against human trafficking, however these laws are unspecific
and seldom enforced. These countries share an open border and have differences in what
activities are considered illegal. For example, prostitution is legal in India but it is not legal in
Nepal. According to Deane (2010), “Such legal incongruities will hinder a smooth
implementation of any strategy to combat trafficking” (p. 497). An international law could help
to solve this problem and enable these countries to work together against human sex trafficking
(Deane, 2010).
Protective Interventions
The third level of the pyramid discusses the infrequent but long-lasting protective
interventions. These interventions are thought to “…have less impact than interventions
represented by the bottom 2 tiers because they necessitate reaching people as individuals rather
than collectively” (Frieden, 2010, p. 592). This level of intervention can apply to sex trafficking
in a few different ways. In the medical aspect, vaccinating women and young children for
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hepatitis A, hepatitis B, and the human papillomavirus (HPV) would yield fewer transmissions
of these preventable diseases. Though vaccinations would yield long lasting protective benefits,
they do not actually have any direct effect on the incidence of sex trafficking. A protective
intervention could put precedence on educating women and young girls on their rights, and the
risk of human trafficking. According to Rijal et al., (2016) “Many people are simply not aware of
their rights, and the law against such crimes is poorly understood” (p. 5). An example of this type
of intervention can be seen in Nepal: “134,718 migrants were informed about possible trafficking
events at borders, 183 victims were rescued, and 2,904 were intercepted in 2014 alone” (Rijal et
al., 2016, p.5). It will take the involvement of institutions such as the Human Rights Watch
(HRW) and eventually the governments of both countries to curtail human trafficking, however
attempting to implement protective actions such as education and vaccinations for sexually
Clinical Interventions
The fourth level of the pyramid refers to clinical interventions that are ongoing and
largely individual (Frieden, 2010). This aspect applies largely to human sex trafficking in the
aspect of health screenings. This level of intervention is often thought to be limited in its
effectiveness as access to healthcare differs for everyone. Thorough screening should still be in
place and capable of reaching every victim possible. As previously mentioned, human trafficking
increases the risk for “acquiring sexually transmitted diseases, including human
pregnancies, and miscarriages” (Rijal et al., 2016, p.4). Victims are also at an increased risk for
physical injuries from abuse, and mental disorders related to the trauma they have experienced
(Rijal et al., 2016, p.4). It is important that health clinics in these locations have sex trafficking
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questionnaires/screenings and provide education to these women and young girls about their
rights. Health care professionals should be aware of potential red flags when doing physical
assessments and know what to look for. They should also attempt to separate the patients as
many victims will not be upfront about any abuse if their abuser is present. Sensitivity training
should be implemented in these areas to improve the ability to recognize these victims and
The final tier in Frieden’s Health Impact Pyramid is counseling and education. This level
of intervention “…is perceived by some as the essence of public health action but is generally the
least effective type of intervention” (Frieden, 2010, p. 592). This is because these interventions
level of care is sometimes unrealistic. In Nepal and India, integrating women and girls who have
been trafficked back into their community is another challenge entirely. Many
communities/cultures believe “that bringing a trafficked person back into the community will
the community” (Rijal et al., 2016, p. 6). This way of thinking causes a stigma towards victims
of human trafficking and causes problems for them when trying to return to their community.
The role of the nurse is essential in this stage. Victims returning to their communities require
extensive evaluation and care. Both physical and mental health screenings are needed to assess
the need for medical treatment and therapy. Rijal et al., (2016) states that it is necessary to build
and implement specialized, violence-free centers for rehabilitating these victims prior to
returning them to their communities. These centers would require trained mental health nurses
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for counseling of anxiety, depression, and post-traumatic stress disorder commonly seen in
victims of human trafficking (Rijal et al., 2016, p. 4). These centers could drastically improve
reintegration into the communities by ensuring that victims “...receive the required health care
services, social and legal support, and livelihood training” needed to be successful in returning to
their community (Rijal et al., 2016, p. 6). This type of intervention is most likely unrealistic as it
would be costly to implement and healthcare access is often limited with this population
sex trafficking.
This level of intervention also encompasses health behavior change theories. The theory
that most closely relates to human trafficking is the Stages of Change Model. This model
endorses that change is a process in which different individuals can be at different stages of
readiness for. (Skolnik, 2016). There are five stages in this theory; pre-contemplation,
considering a need for change to actively implementing and then maintaining that change. This
best applies to human trafficking on an international level as some countries have decided that
any form of human trafficking is a direct violation of human rights and therefore must be stopped
entirely. In these countries, laws, protocols, and treaties have already been put into effect and
agreed upon with the intent to end human trafficking. However, some countries continue to make
a large profit from the trafficking of human beings and thus are reluctant to even consider
making the change. This goes to show the differences in the readiness of people to change, and
Interventions
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Ending human trafficking will not happen overnight. In order to implement a change that
lasts, the majority of the world will need to believe that this change is for the better.
Unfortunately, even in this century, we have not reached that belief for human trafficking.
Despite Nepal and India both having laws against human trafficking, they both remain on the
“Tier 2 watch list for their failure to combat trafficking in persons” (Deane, 2010, p. 506). Some
of this noncompliance may be contributed to their subpar legal system, and political refusal to
make human trafficking a priority (Rijal, 2010). Another contributing factor may be the open
border between India and Nepal, “it is estimated that between 7,000 and 10,000 girls between the
ages of 9 to 16 years, are trafficked each month from Nepal to India” (Deane, 2010, p. 494).
Structuring some type of border control between these two countries could drastically improve
these numbers. Not only would some level of border control help detect human trafficking, but it
could also be a source of employment opportunities for both countries which could be a gain for
their economies. Education is also a pressing intervention. Mass education in various languages
needs to be present in public places, not just in health clinics but in schools, public
transportation, and stores. Information on human rights especially women’s rights and the
Professional Opportunities
There are a wide variety of employment options and volunteer options in the global
health field. It is even possible to obtain a major in global health. Career opportunities include
areas such as research, policy, program design and implementation, program evaluation, and
including hands-on fieldwork in developing countries providing clinical services people in need
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(Skolnik, 2010). Involvement in bilateral aid organizations and government agencies offer
the Peace Corps or international disaster relief/emergency response. These options may not be
considered careers however volunteer opportunities typically expand into quality experience for
References
Frieden, T. R. (2010). A Framework for Public Health Action: The Health Impact
Rijal, A., Adhikari, T. B., & Aro, A. R. (2016). Ethical perspectives on combating sex
Skolnik, R. (2016). Global health 101. Burlington, MA: Jones & Bartlett Learning
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