Medical Director, Global Health and Well-Being Initiative, International Centre for Missing and Exploited Children; Adjunct Assistant Professor, Department of Pediatrics, Emory School of Medicine; Staff Physician, Institute on Healthcare and Human Trafficking, Stephanie V. Blank Center for Safe and Healthy Children, Children’s Healthcare of Atlanta
Education: MD, Yale School of Medicine; BA, Smith College
Public Health Law News (PHLN):Please describe your career path.
Greenbaum:I am trained as a forensic pathologist. I worked as an assistant medical examiner for a few years before deciding that I wanted to shift my career focus. I wanted to use my forensic training and was fortunate to meet a child abuse pediatrician, who mentored me in the medical evaluation of child maltreatment. Eventually, I became medical director of a child advocacy center, and for the last several years, I have been focusing more and more heavily on human trafficking and exploitation.
PHLN:What is human trafficking?
Greenbaum:Broadly speaking, human trafficking involves the exploitation of another person, typically for sex or labor, using force, fraud, or coercion—or in the case of a person less than 18 years of age, involving that person in a commercial sex act. The latter refers to any sex act in which there is the exchange of something of perceived value, such as food, clothing, or money.
PHLN:Who is vulnerable to human trafficking?
Greenbaum:While human trafficking may involve persons of any age and socioeconomic, religious, racial, ethnic, or cultural background, most trafficked persons have one or more vulnerabilities. These can occur at the individual level (e.g., homelessness, substance misuse, untreated mental health disorder), relationship level (e.g., intimate partner violence, family dysfunction), community level (marginalized population, limited community awareness of trafficking) or societal level (homophobia, gender bias/discrimination, ethnocentricity). For example, a transgender female runs away from home due to physical abuse and parental intolerance of her gender identity. She lives in a community where there is considerable violence, as well as many adult sex venues. She is befriended by a man on the street who offers to “take care of her.” He gives her a place to stay, and in exchange, she is expected to have sex with men he brings to the apartment.
PHLN:Is human trafficking, and child sex trafficking in particular, a public health issue? If so, why?
Greenbaum:I am so glad you asked! Yes, it is a major public health issue. That is, it is a preventable condition that significantly impacts the health of individuals and communities, and it can be addressed through public health measures such as systematic risk assessment, evidence-based primary prevention efforts, and early intervention programs that are subjected to rigorous scientific evaluation. Adequately addressing human trafficking will require us to address vulnerabilities at all of the levels mentioned above. Public health strategies do just that: they aim to positively impact individual, relationship, community, and societal factors that can make persons vulnerable to trafficking and exploitation.
PHLN:What role does law play in child sex trafficking prevention?
Greenbaum:Alongside a public health approach, our efforts to combat human trafficking require a strong legal intervention, including comprehensive laws that clearly define human trafficking, hold offenders accountable, and protect and serve all trafficked persons. We need training of law enforcement officers, attorneys, and the judiciary. Our legal response needs to strongly address not only sex trafficking, but labor trafficking and exploitation, as well.
PHLN:What barriers are there to enforcing human trafficking laws and identifying victims?
Greenbaum:I think some of the challenges to enforcing laws and identifying victims involve variations in state laws on human trafficking, inadequate training of professionals encountering trafficked persons (e.g., workers in law enforcement, social services, medical and mental health, public health, other child-serving professions), bias/discrimination, and a lack of adequate resources to respond to suspected trafficking. People may be very reluctant to screen for trafficking if they know there is little they can do to help a person who is being exploited. In addition, many trafficked persons may be very hesitant to disclose their exploitation to others, due to fear of retaliation from traffickers, fear of arrest and/or deportation, shame, guilt, or simply an inability to recognize their exploited status.
PHLN:Are any local or state jurisdictions taking innovative legal approaches to combat child sex trafficking?
Greenbaum:Yes. A good example involves the state of New York, which passed a law in November 2017 requiring healthcare facilities to train clinical and security staff and develop protocols for responding to suspected human trafficking. The law resulted in proposed rules that were released in December 2018. We know that many trafficked persons seek medical or mental healthcare at some point during or around the time of their exploitation. If we can train health professionals to recognize persons at risk and respond in a trauma-informed, culturally sensitive manner, we will be able to offer these persons critical resources and referrals.
PHLN:What kind of trainings should be conducted to prevent child sex trafficking?
Greenbaum:I think we need to educate parents and the lay public about human trafficking dynamics, possible indicators, an appropriate response to possible trafficking, and prevention strategies (e.g., online safety, common recruitment techniques, risk factors). We need to work with children so they understand the differences between healthy and unhealthy relationships, how to respect others, how to say “no,” and how to recognize situations that present a high risk for exploitation. Training should also be provided to healthcare professionals, law enforcement, social service workers, legal professionals, teachers, and other child-serving professionals. We need to address prevention at all levels. And this training needs to include information about labor trafficking, as well as sex trafficking, since the two types of exploitation often coexist, and labor trafficking is associated with many of the same adverse health consequences as sexual exploitation.
PHLN:What should be included in trainings about labor trafficking?
Greenbaum:The same things included in trainings about sex trafficking. With professionals, training should include the trauma-informed, rights-based, culturally sensitive approach to interacting with trafficked persons, common trauma-related stress responses and behaviors, reasons why trafficked persons may be hesitant to disclose their situation or accept help, and short/long-term needs of trafficked persons.
PHLN:How is identifying and treating adult sex trafficking victims different from child sex trafficking victims?
Greenbaum:Many adult trafficked persons were exploited as minors so both age groups may share many of the same risk factors. However, there are clear developmental differences between adolescents and adults, so sex-trafficked minors may present differently, may perceive offers to assist in a different way, and may behave differently with those around them. Because of their stage of brain development, they may have particular difficulty developing insight into their exploitation and exercising caution in high-risk situations. Their emotional needs may differ from adults, as may their ability to express those needs.
PHLN:Where can healthcare workers seek training for recognizing and treating child sex trafficking victims?
Greenbaum: Fortunately, there are a number of good resources, including—
PHLN: Where can people learn more about child sex trafficking prevention?
Greenbaum: Here are some resources:
US Department of State (For the general public.)
- Greenbaum VJ, Titchen K, Walker-Descartes I, Feifer A, Rood CJ, Fong, HF. Multi-level prevention of human trafficking: The role of health care professionals. Preventive Medicine, 2018; 114: 164–167.
- Alpert EJ, Chin SE. Human trafficking: Perspectives on prevention in human trafficking is a public health issue: A paradigm expansion in the U.S. Chisolm-Straker M, Stoklosa H, eds. 2017, Springer, Switzerland.
Girls Educational and Mentoring Services (GEMS) (Primarily secondary and tertiary prevention.)
Not A #Number (Love 146) (Primary prevention program for adolescents.)
PHLN:What other projects are you currently working on?
Greenbaum:The Institute on Healthcare and Human Trafficking is a partnership between Emory University School of Medicine, Georgia State University School of Public Health, and Children’s Healthcare of Atlanta, and provides training and technical assistance to medical and mental health professionals regarding all types of adult and child trafficking. We help write guidelines/protocols for health facilities, train staff, and offer numerous resources on our website, including research articles, templates, fact sheets, sample protocols, and prevention materials. In addition, we are continuing to validate a short screening tool designed to identify youth at high risk for child sex trafficking when they present for healthcare. The six-item tool has been evaluated in several health settings and been found to be helpful in identifying trafficked persons and those at risk for exploitation. We are continuing to evaluate it, and we are also working with an adult hospital to pilot a different screening tool for vulnerable adults who present to the emergency department.
PHLN:Do you have any hobbies?
Greenbaum:I like spending time with our dogs, walking, hiking, and goofing around.
PHLN:Do you have anything you’d like to add?
Greenbaum:I just want to thank you for taking an interest in this topic and helping to build awareness on human trafficking. I truly appreciate it.