Responding to human trafficking among refugees: prevalence and test accuracy of a modified version of the adult human trafficking screening tool.

BACKGROUND: Human trafficking is a human rights violation and urgent public health challenge. It involves the exploitation of a person by means of force, intimidation or deceit and causes severe health risks. Though it occurs all over the world, its true extent is still unknown. Refugees are especially vulnerable to human trafficking due to language barriers and difficult living conditions. Therefore, the purpose of this study was to estimate the prevalence and design a screening tool to identify survivors of all forms of human trafficking among refugees in a German state registration and reception centre. METHODS: In cooperation with the local authorities and the Ministry of Justice and for Migration Baden-Württemberg, we interviewed newly arrived refugees at an initial reception centre in Southern Germany to assess the prevalence of human trafficking. We used both a combination of the Adult Human Trafficking Screening Tool and a publication by Mumma et al. to assess all forms of human trafficking. RESULTS: In total, 13 of the 176 refugees had experienced trafficking, which corresponded to a prevalence of 7.3% (95%-CI = [3.5%, 11.3%]). Across all languages the questionnaire had a sensitivity of 76.9% and a specificity of 84.0% at a recommended cut-off of six positive responses. The recommended cut-off differed slightly for the Arabic, Farsi, Turkish, and English version. In an exploratory descriptive analysis on subregions, refugees from West Africa had a substantially higher prevalence (33.3%, 8 out of 24) for human trafficking within our sample, especially women. However, when we excluded this region from our analysis, we found no significant gender difference for the rest of the sample. CONCLUSIONS: The high prevalence of trafficking in most regions, regardless of gender, suggests that more effort is needed to identify and protect all trafficked persons. The designed screening tool seems to be a promising tool to detect an especially vulnerable group of refugees and provides assistance in identifying survivors of human trafficking.

Dental disease in a 15th-17th centuries skeletal sample of enslaved Africans (Lagos, Portugal).

OBJECTIVE: Dental disease is frequently used as a proxy for diet and overall health of individuals of past populations. The aim of this study is to investigate dental disease in a sample of enslaved African individuals recovered from an urban dump (15th-17th centuries) in Lagos, Portugal. DESIGN: In all, 81 African individuals (>12 years old) were analysed (19 males, 49 females, and 13 of unknown sex), in a total of 2283 alveoli, 2061 teeth, and 2213 interdental septa. Analysed oral pathologies include dental caries, periodontal disease, and ante-mortem tooth loss. Dental wear was also recorded. RESULTS: Dental caries affected 52.0 % of the teeth, although only 31.9 % were cavitated lesions. In all, 96.3 % of the individuals presented at least one cariogenic lesion. Gingivitis and periodontitis were recorded in 56.7 % and 19.0 % of the septa, respectively. Only one male individual had all septal areas healthy. Ante-mortem tooth loss was recorded in 38.3 % of the individuals, in a total of 96 teeth lost (4.2 %). Regarding occlusal wear, 70.8 % of the surfaces were recorded with grades 1-3. CONCLUSIONS: The frequencies of the oral pathological conditions observed may not only reflect a cariogenic diet (rich in starches and with a high frequency of meals) but also the conditions during the maritime voyage of the first victims of the North Atlantic slave trade (xerostomia due to lack of water, sea sickness and vomiting, vitamin C deficiency, poor hygiene), and also the impact intentional dental modifications had on the dentitions.

Tools for the identification of victims of domestic abuse and modern slavery in remote services: A systematic review.

OBJECTIVE: To explore the technology-based tools available for supporting the identification of victims of domestic abuse and modern slavery in remote services and consider the benefits and challenges posed by the existing tools. METHODS: We searched six academic databases. Studies were considered for inclusion if they were published in English between 2000 and 2023. The QuADS quality appraisal tool was used to assess the methodological quality of included studies. A narrative synthesis was conducted using the convergent integrated approach. RESULTS: Twenty-four studies were included, of which two were professional guidelines; each reported on a distinct technology-based tool for remote services. All tools related to domestic abuse and 21 focused on screening for intimate partner violence among young and mid-life women (18-65) in high-income countries. The review did not identify tools that support the identification of victims of modern slavery. We identified eight common themes of tool strengths, highlighting that the remote approach to screening was practical, acceptable to victims, and, in some circumstances, elicited better outcomes than face-to-face approaches. Five themes pointed to tool challenges, such as concerns around privacy and safety, and the inability of computerised tools to provide empathy and emotional support. CONCLUSIONS: Available technology-based tools may support the identification of victims of domestic abuse by health and social care practitioners in remote services. However, it is important to be mindful of the limitations of such tools and the effects individuals' screening preferences can have on outcomes. Future research should focus on developing tools to support the identification of victims of modern slavery, as well as empirically validating tools for screening during remote consultations.

Gendered anti-blackness, maternal health & chattel slavery: OB/Gyn knowledge as a determinant of death of black women.

This archival investigation of the Southern Medical and Surgical Journal (SMSJ) focuses on the construction of the American Ob/Gyn profession's medical knowledge system alongside chattel slavery, between 1834 and 1860. I find that language, methods of clinical management of bodies and decision-making processes illustrate the pathways that obstetrical knowledge served as a determinant of death for Black women under chattel slavery. These are byproducts of the condition of possibility, my theoretical framework. The condition, or use of gendered anti-Black logic/practice, specifically the social death and biological indispensability of Black women in the context of chattel slavery, shapes the subjective nature of medical knowledge into a determinant of maternal death for Black women. Using the condition of possibility as a theoretical framework, I will lay the groundwork to reframe the Ob/Gyn knowledge system as a current and ever-present threat to Black women and girls' health. This study's sociological contribution lies in examining medical knowledge construction as a series of social interactions, informed by gendered and racial ideologies, that determine health outcomes for Black women.

A public health approach to modern slavery in the United Kingdom: a codeveloped framework.

OBJECTIVES: Modern slavery is a public health challenge. The objective of this research was to build and refine a public health approach to addressing it. STUDY DESIGN: This was a participatory qualitative study with a proof-of-concept exercise. METHODS: Nine deliberative workshops with 65 people working across the antislavery sector. Thematic analysis of qualitative data. Of the nine workshops, two were proof of concept. These explored and tested the public health framework devised. RESULTS: Participants contributed to the development of a public health framework to modern slavery that included multiple elements across national, local, and service levels. There were six 'C's to national components: policy that was coherent, co-ordinated, consistent, comprehensive, co-operative and compliant with international law. Local components centred on effective local multiagency partnerships and service design and delivery focussed on trauma-informed, flexible, person-centred care. CONCLUSIONS: A public health approach to modern slavery is a promising development in the antislavery field in the United Kingdom and globally. It was well supported by workshop participants and appeared to be operable. Barriers to its implementation exist, however, including the challenge of intersectoral working and an incongruent policy environment.

Spatiotemporal Changes in the Slavery-Inequality Relationship: The Diffusion of the Legacy of Slavery.

Despite the persistence of relationships between historical racist violence and contemporary Black-White inequality, research indicates, in broad strokes, that the slavery-inequality relationship in the United States has changed over time. Identifying the timing of such change across states can offer insights into the underlying processes that generate Black-White inequality. In this study, we use integrated nested Laplace approximation models to simultaneously account for spatial and temporal features of panel data for Southern counties during the period spanning 1900 to 2018, in combination with data on the concentration of enslaved people from the 1860 census. Results provide the first evidence on the timing of changes in the slavery-economic inequality relationship and how changes differ across states. We find a region-wide decline in the magnitude of the slavery-inequality relationship by 1930, with declines traversing the South in a northeasterly-to-southwesterly pattern over the study period. Different paces in declines in the relationship across states suggest the expansion of institutionalized racism first in places with the longest-standing overt systems of slavery. Results provide guidance for further identifying intervening mechanisms-most centrally, the maturity of racial hierarchies and the associated diffusion of racial oppression across institutions, and how they affect the legacy of slavery in the United States.

Professors of racial medicine: imperialism and race in nineteenth-century United States medical schools.

This article examines some of the racist features of nineteenth-century medical school curricula in the United States and the imperial networks necessary to acquire the data and specimens that underpinned this part of medical education, which established hierarchies between human races and their relationship to the natural environment. It shows how, in a world increasingly linked by trade and colonialism, medical schools were founded in the United States and grew as the country developed its own imperial ambitions. Taking advantage of the global reach of empires, a number of medical professors in different states, such as Daniel Drake, Josiah Nott and John Collins Warren, who donated his anatomical collection to Harvard Medical School on his retirement in 1847, began to develop racial theories that naturalised slavery and emerging imperialism as part of their medical teaching.

Scoping review on the link between economic growth, decent work, and early childhood caries.

BACKGROUND: Early Childhood Caries (ECC) is a prevalent chronic non-communicable disease that affects millions of young children globally, with profound implications for their well-being and oral health. This paper explores the associations between ECC and the targets of the Sustainable Development Goal 8 (SDG 8). METHODS: The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to economic growth, decent work sustained economic growth, higher levels of productivity and technological innovation, entrepreneurship, job creation, and efforts to eradicate forced labor, slavery, and human trafficking and ECC all of which are the targets of the SDG8. Only English language publications, and publications that were analytical in design were included. Studies that solely examined ECC prevalence without reference to SDG8 goals were excluded. RESULTS: The initial search yielded 761 articles. After removing duplicates and ineligible manuscripts, 84 were screened. However, none of the identified studies provided data on the association between decent work, economic growth-related factors, and ECC. CONCLUSIONS: This scoping review found no English publication on the associations between SDG8 and ECC despite the plausibility for this link. This data gap can hinder policymaking and resource allocation for oral health programs. Further research should explore the complex relationship between economic growth, decent work and ECC to provide additional evidence for better policy formulation and ECC control globally.

Science and the 'emancipation of the mind': dreams, the mind, and slavery.

Dreams were a subject of interest to philosophers thinking about the connection between the mind and the body in the nineteenth century. Many scholars have pointed out that the mind and the body were intimately linked and affected each other. Although science was on its way to becoming more technical and numbers focused in its investigatory practices, medical students and other physician-philosophers investigated the nature of sleep and dreams. Medical students and advanced researchers speculated on the nature of consciousness and mused on where the mind travels to during the sleep processes. Other romantic figures like Dr Polydori speculated on the nature of sleep walking in their medical dissertations. Dreams also had a powerful moral and motivational component, as dreams and activities in dreams, drove people like Benjamin Rush to embrace abolition. Other promoters of abolition used the nature of dreams to discusses the dreadfulness and suffering of slavery.

The Legacy of Slavery and the Socialization of Black Female Health and Human Services Workforce Members in Addressing Social Determinants of Health.

BACKGROUND: One legacy of slavery and colonialist structures is that minority populations, particularly the Black populations, experience higher rates of poverty, disease, job insecurity, and housing instability today - all indicators of poor health or negative social determinants of health (SDOH). While the historical legacy of slavery may explain why certain populations currently experience social determinants, they may also embody Post Traumatic Slave Syndrome (PTSS) through manifestations of negative health outcomes. MATERIAL AND METHODS: Black female health and human services (HHS) workforce members, who have taken SDOH trainings through a medical-legal partnership (MLP), were recruited for an ethnographic study to determine how historical context, specifically PTSS, can help Black female HHS workforce members understand and advocate for their patients as well as challenge the medial and legal institutions. RESULTS: Themes emerged around how Black women in HHS have persisted and resisted, struggled, and strived to protect and raise a resistant community that is perpetually threatened. Black women constantly exist in the past, present, and future, negotiating their identities and reproducing the modeled behavior of the parents, particularly their Black mothers, who taught them how to exist in the world as Black women. CONCLUSIONS: As sufferers of negative social determinants, Black women, especially those working in HHS, use their lived experiences and historical trauma to challenge the systems within which they work. They use their intersectional identities and their reimagined definitions of SDOH to rethink how the HHS workforce can move forward in working in the best interests of their patients. Future SDOH trainings may consider integrating historical legacies to challenge medical-legal institutions.

(Un)safe Spaces: The Relationship Between Slavery and Sexual Victimization of Black Women.

Research exploring the correlates of sexual victimization has found sexual victimization to be associated with both individual- and contextual-level factors, including age, gender, poverty, and size of the female population. However, to date, research has been limited in exploring how historical factors, such as slavery, may be associated with the contemporary prevalence of sexual victimization of women. Historical accounts have often suggested that enslaved women often experienced sexual victimization during their enslavement. Despite these accounts, research has been limited in empirically exploring the relationship between slavery and the sexual victimization of Black women. Using the 1860 U.S. Census and the 2019 National Incidence-Based Reporting System, multilevel logistic regression analyses are employed to explore whether slavery is consequential for contemporary instances of Black female sexual victimization. In line with the "legacy effect" framework, the findings from the current study suggest that Black women are significantly more likely to be sexually victimized in counties characterized by larger enslaved populations in 1860. These findings illuminate how historical institutions, despite being outlawed, have contemporary consequences, particularly for Black women. These findings, discussions, avenues for future research, and policy implications are discussed below.

The Self-Fulfilling Process of Clinical Race Correction: The Case of Eighth Joint National Committee Recommendations.

There is growing attention to how unfounded beliefs about biological differences between racial groups affect biomedical research and health care, in part, through race adjustment in clinical tools. We develop a case study of the Eighth Joint National Committee (JNC 8)'s 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, which recommends a distinct initial hypertension treatment for Black versus nonblack patients. We analyze the historical context, study design, and racialized findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) that informed development of the guideline. We argue that ALLHAT's racialized outcomes emanated from a poor and artificial study design and analysis weakened by implicit assumptions about race as biological. We show that the acceptance and utilization of ALLHAT for race correction arises from its historical context within the "inclusion-and-difference paradigm" and its indication of the inefficacy of angiotensin-converting-enzyme inhibitors for Black patients, which follows from the enduring, yet, refuted slavery hypertension hypothesis. We demonstrate that the JNC 8 guideline displays the self-fulfilling process of racial reasoning: presuppositions about racial differences inform the design and interpretation of research, which then conceptually reinforce ideas about racial differences leading to differential medical treatment. We advocate for the abolition of race adjustment and the integration of structural competency, biocritical inquiry, and race-conscious medicine into biomedical research and clinical medicine to disrupt the use of race as a proxy for ancestry, environment, and social treatment and to address the genuine determinants of racialized disparities in hypertension.

Unnamed, not unskilled: Toward a new labor history of pharmacy.

By recovering the dependent, often enslaved, laborers who helped to make European medicines commercially available in the New England colonies, this article offers a new history of early American pharmaceutical knowledge and production. It does so by considering the life and labor of an unnamed, enslaved assistant who was said to make tinctures, elixirs, and other common remedies in a 1758 letter between two business partners, Silvester Gardiner, a successful surgeon and apothecary in Boston, Massachusetts, and William Jepson, his former apprentice, in Hartford, Connecticut. Using strategies from slavery and critical archive studies, as well as from social history and the history of medicine, this article emphasizes the materiality and embodiment of pharmaceutical production and follows fragmentary evidence beyond the business archive to reverse the systemic erasure of enslaved and indentured laborers from the records of eighteenth-century manufacturers of medicines. The medicine trades of men like Gardiner and Jepson appear more reliant upon dependent laborers - named and unnamed - who not only performed rote tasks but brought their experience and judgment to their labors as well. Their contributions could be obviously medical (preparing remedies) or more ambiguous (stoking fires, shipping goods), but these actions together constituted early modern pharmacy, enabled the expansion of the transatlantic medicine trade, and laid the foundations for the more self-sufficient and industrialized pharmacy that developed in the nineteenth century. Centering the skill and knowledge among subordinated laborers in one facet of an emergent transatlantic care economy affirms the entanglement of slavery and science and underscores the necessity of asking new questions of old sources.

Honoring the enslaved African American foremothers of modern women's health: Meditations on 40 years of Black feminist praxis.

This article analyzes 40 years of Black feminist scholarship, art, and grassroots activism dedicated to the lives and legacies of the "foremothers of American gynecology." Infamously, in Montgomery, Alabama, between 1845 and 1849, up to 16 enslaved women were exploited at a backyard hospital, some subjected to surgical experimentation by Dr James Marion Sims. He was a famous and world-renowned surgeon who died in 1883, with a reputation as "the father of modern gynecology." Sims achieved the medical knowledge that catapulted him into American and European fame, using skills gained from the exploitation of the enslaved women in his early career. Famously, three of these women are referenced by their first names: Anarcha, Lucy, and Betsey. This research asks: how have these important figures been remembered in 20th and 21st-century Black feminist scholarship, art, and grassroots community activism? Further, what are the broader impacts of this pathbreaking truth, reckoning, and reconciliation work?

The Modern Slavery Core Outcome Set: A Survivor-Driven Consensus on Priority Outcomes for Recovery, Wellbeing, and Reintegration.

There is no consensus on the outcomes needed for the recovery and reintegration of survivors of modern slavery and human trafficking. We developed the Modern Slavery Core Outcome Set (MSCOS) to address this gap. We conducted three English-language reviews on the intervention outcomes sought or experienced by adult survivors: a qualitative systematic review (4 databases, 18 eligible papers, thematic analysis), a rapid review of quantitative intervention studies (four databases, eight eligible papers, content analysis) and a gray literature review (2 databases, 21 websites, a call for evidence, 13 eligible papers, content analysis). We further extracted outcomes from 36 pre-existing interview transcripts with survivors, and seven interviews with survivors from underrepresented groups. We narrowed down outcomes via a consensus process involving: a three-stage E-Delphi survey (191 respondents); and a final consensus workshop (46 participants). We generated 398 outcomes from our 3 reviews, and 843 outcomes from interviews. By removing conceptual and literal duplicates, we reduced this to a longlist of 72 outcomes spanning 10 different domains. The E-Delphi produced a 14-outcome shortlist for the consensus workshop, where 7 final outcomes were chosen. Final outcomes were: "long-term consistent support," "secure and suitable housing," "safety from any trafficker or other abuser," "access to medical treatment," "finding purpose in life and self-actualisation," "access to education," and "compassionate, trauma-informed services." The MSCOS provides outcomes that are accepted by a wide range of stakeholders and that should be measured in intervention evaluation.

Forced labor and health-related outcomes. The case of beggar children.

BACKGROUND: Limited qualitative research indicates that beggar children might be victims of forced labor, and/or modern slavery. However, research quantifying the manifestations and health-related implications of forced child begging is missing in the literature. Because forced child begging might be physically, mentally, socially and morally harmful to children, research on the subject is needed to inform policymaking. OBJECTIVE: This study addressed the gap in the literature on child begging. The work aimed to examine whether beggar children are victims of forced labor, as well as to identify the manifestations of forced labor in beggar children, and assess whether forced child begging relates to deteriorated health-related quality of life and mental health. PARTICIPANTS AND SETTING: The study focused on the capital city of Greece, Athens, where beggar children are not a hard-to-reach group. Cross-sectional data were collected in 2011, 2014, 2018 and 2022, with 127 beggar children taking part in the study. METHODS: The study adopted the Anti-Slavery International research toolkit, which sets methodological guidelines on researching child begging. A scale was developed to quantify forced child begging based on the International Labour Organization's definition of forced labor. Multivariate regressions were performed with a view to answering the research questions. RESULTS: The study found that most beggar children were forced by others to beg, experienced threats of violence, physical and verbal harassment aimed at forcing them to beg, and difficulty in terms of being allowed by others to stop begging. Moreover, it was found that forced child begging was positively associated with living with unknown people, hunger due to food unavailability the previous week, and negatively associated with native beggar children. In addition, it was discovered that forced child begging was negatively associated with health-related quality of life and mental health for beggar children. CONCLUSION: Based on the study's findings, child begging encompasses elements of coercion and the deprivation of human freedom. These factors collectively amount to instances of forced labor and/or modern slavery. Policies should ensure that beggar children are removed from harm's way, and that those forcing children to beg are brought to justice, thus preventing forced child begging. Policies to reduce poverty, which constitutes the root of forced child begging, should also be considered. The goal is to create a protective environment where children can thrive, free from forced labor. In line with Sustainable Development Target 8.7, policy makers should take immediate and effective measures to eradicate forced labor, and end modern slavery.

Teaching the Legacy of Slavery in American Medicine and Psychiatry to Medical Students: Feasibility, Acceptability, Opportunities for Growth.

Introduction: Understanding the legacy of slavery in the United States is crucial for engaging in anti-racism that challenges racial health inequities' root causes. However, few medical educational curricula exist to guide this process. We created a workshop illustrating key historical themes pertaining to this legacy and grounded in critical race theory. Methods: During a preclinical psychiatry block, a second-year medical school class, divided into three groups of 50-60, attended the workshop, which comprised a 90-minute lecture, 30-minute break, and 60-minute small-group debriefing. Afterwards, participants completed an evaluation assessing self-reported knowledge, attitudes and beliefs, and satisfaction with the workshop. Results: One hundred eighty students watched the lecture, 15 attended small-group debriefings, and 132 completed the survey. Seventy-six percent (100) reported receiving no, very little, or some prior exposure to the legacy of slavery in American medicine and psychiatry. Over 80% agreed or strongly agreed that the workshop made them more aware of this legacy and that the artwork, photographs, storytelling, and media (videos) facilitated learning. Qualitative feedback highlighted how the workshop improved students' knowledge about the legacy of slavery's presence in medicine and psychiatry. However, students criticized the lecture's scripted approach and requested more discussion, dialogue, interaction, and connection of this history to anti-racist action they could engage in now. Discussion: Though this workshop improved awareness of the legacy of slavery, students criticized its structure and approach. When teaching this legacy, medical schools should consider expanding content, ensuring opportunities for discussion in safe spaces, and connecting it to immediate anti-racist action.

Fugitivity and marronage and the study of sex work.

Campaigns against female prostitution used slavery as a rhetorical device to characterize the condition of sex workers, and sex work features prominently in contemporary campaigns against "modern slavery". In both types of campaigning, "the slave" is worked as a symbolic device to represent the abject condition of human beings objectified, controlled by violence or its threat, and stripped of agency and choice. The assumptions and generalizations about prostitution that inform this vision have been extensively critiqued. However, less attention has been paid to the fact that the analogy also rests on a very particular reading of "the slave" and a very partial appeal to histories of Atlantic World slavery. Histories of enslaved people's resistance and flight are entirely overlooked. The latter has recently prompted interest in fugitivity and marronage as analytic concepts, albeit concepts that are defined and deployed in different ways by different scholars and activists. This review asks whether and how they might potentially have theoretical purchase with regard to the contemporary experience (both positive and negative) of sex workers.

Institutional Logics in the UK Construction Industry's Response to Modern Slavery Risk: Complementarity and Conflict.

There is a growing understanding that modern slavery is a phenomenon 'hidden in plain sight' in the home countries of multinational firms. Yet, business scholarship on modern slavery has so far focussed on product supply chains. To address this, we direct attention to the various institutional pressures on the UK construction industry, and managers of firms within it, around modern slavery risk for on-site labour. Based on a unique data set of 30 in-depth interviews with construction firm managers and directors, we identify two institutional logics as being integral to explaining how these companies have responded to the Modern Slavery Act: a market logic and a state logic. While the institutional logics literature largely assumes that institutional complexity will lead to a conciliation of multiple logics, we find both complementarity and continued conflict in the logics in our study. Though we identify conciliation between aspects of the market logic and the state logic, conflict remains as engagement with actions which could potentially address modern slavery is limited by the trade-offs between the two logics.

Exacerbating Pre-Existing Vulnerabilities: an Analysis of the Effects of the COVID-19 Pandemic on Human Trafficking in Sudan.

COVID-19 has caused far-reaching humanitarian challenges. Amongst the emerging impacts of the pandemic is on the dynamics of human trafficking. This paper presents findings from a multi-methods study interrogating the impacts of COVID-19 on human trafficking in Sudan-a critical source, destination, and transit country. The analysis combines a systematic evidence review, semi-structured interviews, and a focus group with survivors, conducted between January and May of 2021. We find key risks have been exacerbated, and simultaneously, critical infrastructure for identifying victims, providing support, and ensuring accountability of perpetrators has been impeded. Centrally, the co-occurrence of the pandemic and the democratic transition undercut the institutional and governance capacity, limiting the anti-trafficking response and exposing already vulnerable groups to increased risks of human trafficking. Findings point to increased vulnerabilities for individuals with one or more of the following identities: migrants, refugees, females, and informal labourers.