Health inequalities and health equity challenges for victims of modern slavery.

BACKGROUND: Modern slavery is a serious organized crime, with severe consequences for the physical and mental health of victims, and so has public health implications. Anecdotally many victims of sex slavery experience difficulties accessing healthcare. Public Health England recently articulated the importance of health engagement to address modern slavery but little is known about the experiences of the survivors. METHODS: We conducted in depth interviews with Albanian female survivors of sex slavery who all displayed significant and complex health needs. Interviews were conducted between July 2017 and January 2018. Thematic analysis identified four primary themes: (i) barriers to access, (ii) negotiating access, (iii) health needs and care received and (iv) overall experience of primary care. RESULTS: Survivors experienced repeated challenges accessing healthcare, for themselves and their children, and initially could not access GP services. When accompanied by an advocate they reported qualitatively and quantitatively improved experiences resulting in improved permeability. Confusion surrounding eligibility criteria and a lack of understanding of modern slavery emerged as the primary barriers, fueling biased adjudications. CONCLUSIONS: The importance of advocates, enabling rights-based approaches, improving understanding about access to health services for vulnerable groups, and a need for education across health service settings are discussed.

Perceptions of Psychological Coercion and Human Trafficking in the West Midlands of England: Beginning to Know the Unknown.

Modern slavery is less overt than historical state-sanctioned slavery because psychological abuse is typically used to recruit and then control victims. The recent UK Draft Modern Slavery Bill, and current UK government anti-slavery strategy relies heavily on a shared understanding and public cooperation to tackle this crime. Yet, UK research investigating public understanding of modern slavery is elusive. We report community survey data from 682 residents of the Midlands of England, where modern slavery is known to occur, concerning their understanding of nonphysical coercion and human trafficking (one particular form of modern slavery). Analysis of quantitative data and themed categorization of qualitative data revealed a mismatch between theoretical frameworks and understanding of psychological coercion, and misconceptions concerning the nature of human trafficking. Many respondents did not understand psychological coercion, believed that human trafficking did not affect them, and confused trafficking with immigration. The public are one of the most influential interest groups, but only if well informed and motivated towards positive action. Our findings suggest the need for strategically targeted public knowledge exchange concerning this crime.