Research Article: The healthcare response to human trafficking: A need for globally harmonized ICD codes

Date Published: May 2, 2019

Publisher: Public Library of Science

Author(s): Jordan Greenbaum, Hanni Stoklosa

Abstract: In a Perspective, Jordan Greenbaum and Hanni Stoklosa make the case for inclusion of codes for human trafficking in international diagnosis classification systems.

Partial Text: According to 2016 global estimates, 40.3 million people were victims of modern slavery, including HT [3]. HCPs are only recently recognizing HT as a major public health problem. Trafficked persons may experience myriad adverse health sequelae [4–6], including traumatic injury from work-related accidents and sexual and physical assault, sexually transmitted and other infections, chronic untreated medical conditions, pregnancy and related complications, malnutrition, complications of substance use disorders, post-traumatic stress disorder, major depression, and suicidality. These adverse effects have been demonstrated in survivors of HT from diverse geographic regions, reflecting the global impact of such exploitation. At present, the incidence of the sequelae for each type of exploitation, the risk factors for sequelae, and the cost of treatments are unknown. Access to this information would inform early screening and intervention strategies that could help improve physical and mental health outcomes and reduce the global healthcare burden. For example, recognizing the high risk of suicidality among sex-trafficked youth [7] may drive prompt assessment procedures that prevent fatal self-harm. There is scant anecdotal data on the relationships between the types of exploitation or how sequelae may vary based on the relationship of the trafficked person with the exploiter. For example, risk of substance use may be increased in those who experience combined labor and sexual exploitation or who are exploited by a trusted family member rather than a stranger.

Because HCPs have direct contact with survivors of sexual and labor exploitation, it is critical that health systems track the data they gather in a way that allows scientific analysis and informs global health and prevention initiatives.

Adoption of ICD codes must be done with consideration of potential unintended consequences. Trafficked persons may take umbrage at being labeled as a victim of HT, for example. HCPs may be reluctant to use the HT codes for fear of wrongly labeling a patient. In countries in which ICD codes are prominent in the medical record, cultural stigma attached to commercial sex may lead to bias and discrimination against patients by medical staff or retribution by traffickers who gain access to these documents.

While we applaud the US for adding HT diagnostic codes to their ICD-10 revisions and encourage other countries to revise their ICD-10 systems, this strategy creates the potential of variations in country-specific codes and nonstandardized data collection. Differing national coding criteria, definitions, and code subcategories will hamper our ability to conduct global-level analysis of trends in prevalence, monitor health impacts, and evaluate treatment modalities across cultures. Instead, the universal use of a single set of ICD-11 codes offers a unique opportunity for the global health community to track progress toward Sustainable Development Goal (SDG) 8.7, which involves the eradication of HT. We urge WHO to adopt diagnostic codes for HT in ICD-11 promptly.



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