Featured Journal Content

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 November 2017)
Policy Forum
Extreme exploitation in Southeast Asia waters: Challenges in progressing towards universal health coverage for migrant workers
Rapeepong Suphanchaimat, Nareerut Pudpong, Viroj Tangcharoensathien
| published 22 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002441
Summary points
:: Labour exploitation and enslavement of sea workers have caught significant political attention in many Southeast Asian countries in recent years. These human rights violations are complicated by human trafficking syndicates, economic disparities between countries in the region, weak rule of law, inadequate labour inspection and protections, poor access to healthcare, and corruption.
:: Although some Southeast Asian nations attempt to protect the health and well-being of “everyone” on their soil by introducing health insurance policies, there remain unsolved implementation challenges.
: Effectively combating extreme labour exploitation requires a collective effort from all concerned stakeholders, seamless collaboration across countries, and long-term comprehensive mechanisms to prevent further abusive treatments; this is particularly relevant with a highly mobile population like migrant seafarers.

Essay
Labour trafficking: Challenges and opportunities from an occupational health perspective
Elena Ronda-Pérez, Bente E. Moen
| published 22 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002440
Summary points
:: Labour trafficking is intrinsically related to occupational health; however, very little attention has been paid to the issue from an occupational health perspective.
:: The recognition of certain work-related health problems in workers in specific work sectors can help to identify victims of labour trafficking.
:: This essay identifies a series of opportunities for occupational health services to detect and address labour trafficking and increase health personnel awareness of the problem.

Essay
Child sex trafficking in the United States: Challenges for the healthcare provider
V. Jordan Greenbaum
| published 22 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002439
Summary points
:: Victims of child sex trafficking are at high risk of numerous physical and behavioral health problems and are likely to seek medical attention. This places healthcare providers (HCPs) in a position to identify high-risk youth and offer critical services.
:: Children are unlikely to disclose their victimization spontaneously to HCPs. To increase the likelihood that providers recognize victims and appropriately respond to their particular needs, training and resources are needed in the following 3 areas: understanding trauma and its impact on children, victim-centered and human rights–based approaches to care, and developmentally appropriate interview techniques.
:: Building trust and establishing the rapport needed to allow a child victim to disclose exploitation typically requires time. This may be difficult to allocate in busy medical settings. Screening tools, division of responsibilities among staff, and prioritization of assessment for trafficking may help to address this problem.
:: Trafficked children have a wide range of physical, mental health, educational, and social needs that are best met by multidisciplinary collaboration of HCPs, victim service providers, government agencies, and other stakeholders. Development of detailed hospital/clinic protocols will assist HCPs in accessing appropriate community and national resources.

Essay
Sexual exploitation of unaccompanied migrant and refugee boys in Greece: Approaches to prevention
Julie Freccero, Dan Biswas, Audrey Whiting, Khaled Alrabe, Kim Thuy Seelinger
| published 22 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002438
Summary points
:: The refugee and migrant crisis in Europe has drawn international attention to the issue of sexual exploitation of unaccompanied and separated refugee boys, requiring humanitarian actors and service providers to quickly develop responses in the absence of an established evidence base.
:: Although adolescent boys comprise a substantial majority of the population of unaccompanied and separated children, they are rarely the focus of policy discussions and are consistently left out of gender-based violence prevention and response efforts. Gender-specific research, policy guidance, and evidence of best practices related to interventions preventing the sexual exploitation of boys are extremely limited.
:: Three prevention approaches have been heavily debated in Greece among policy makers and practitioners: high-security shelter models, life skills education, and cash transfer programming. While lessons can be drawn from evidence of these interventions in other contexts or among other target populations, research on the impact of these approaches on vulnerability to sexual exploitation among unaccompanied refugee and migrant boys is urgently needed to inform policy and program design.
:: A combination of approaches, addressing risk factors at multiple levels, such as building individual-level knowledge and skills, providing community- or family-level protection in the absence of traditional support mechanisms, and structural interventions to address economic vulnerability, is likely needed in order to significantly reduce the vulnerability of unaccompanied and separated boys to sexual exploitation.
:: Rigorous evaluation of current pilot approaches is critical to building the gendered evidence base, guidance, and resources practitioners urgently require.

Collection Review
Human trafficking and exploitation: A global health concern
Cathy Zimmerman, Ligia Kiss
| published 22 Nov 2017 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1002437
Summary points
:: Labor migration is an economic and social mobility strategy that benefits millions of people around the world, yet human trafficking and the exploitation of low-wage workers is pervasive.
:: The negative health consequences of human trafficking—and labor exploitation more generally—are sufficiently prevalent and damaging that they comprise a public health problem of global magnitude.
:: Human trafficking and labor exploitation are substantial health determinants that need to be treated as preventable, drawing on public health intervention approaches that target the underlying drivers of exploitation before the harm occurs.
:: Exploitative practices are commonly sustained by business models that rely on disposable labor, labyrinthine supply chains, and usurious labor intermediaries alongside weakening labor governance and protections, and underpinned by deepening social and economic divisions.
:: Initiatives to address human trafficking require targeted actions to prevent the drivers of exploitation across each stage of the labor migration cycle to stop the types of harm that can lead to generational cycles of disability and disenfranchisement.