Scotland's Trafficking and Exploitation Strategy 2025

A Public Health Approach to Human Trafficking

Scotland’s second Trafficking and Exploitation Strategy takes a public health approach to trafficking. There have been growing calls for taking such an approach to trafficking and exploitation within academic literature, as outlined in the series of evidence reviews, produced by the Scottish Government’s Justice Analytical Services (JAS), but this is at an early stage of development within policy and practice^[8].

There is no one universally adopted model or definition of a public health approach to trafficking. Prevention is a central component of the public health approach, and Liz Such and colleagues developed a definition of prevention which was informed by lived experience:

“…. an on-going process of avoiding and minimising exploitation and harm. This can be achieved by intervening before harm occurs, by intervening early and by treating harms. It also includes action to prevent re-exploitation and re-trafficking.” (Such et al, 2024: 2.)

Taking a public health approach does not mean focusing only on health nor focusing only on prevention. It means taking an approach that has demonstrated improvement in the health and wellbeing of populations by delivering targeted interventions and resources aligned to their specific needs or challenges and applying it to trafficking. Other examples of taking this approach across the Scottish Government are the ‘Violence Prevention Framework’ and the ‘Equally Safe Strategy’. It aligns with the Scottish Government’s ‘Vision for Justice’ which aims to improve outcomes for individuals, focussing on prevention and early intervention.

Using a public health approach to trafficking brings with it a number of advantages including, but not limited to:

• focusing on preventing trafficking by understanding and changing the conditions that allow it to happen. This means looking at the existing situations and social conditions that put people at risk – both in local communities and on a national and international level. Prevention is already a key part of the previous strategy but is an area that requires further focus.
• using multi-agency and collaborative approaches to address interrelated causes and effects such as those outlined above. This is already the approach taken in the previous Trafficking Strategy and strengthens it.
• viewing the harm done by trafficking not only as impacting specific individuals but also their family and community.
• being evidence and data-driven with a clear focus and ambition to evaluate the outcomes of the Strategy and the processes required to achieve these. While it can be challenging to identify outcomes and indicators for some broader prevention measures, the intention to monitor and evaluate the outcomes of the Strategy leads to an improved evidence-base.
• having flexibility to respond to changing and complex circumstances, contexts and impacts. This is of particular relevance within the fast-changing national and international context in which traffickers adopt alternative strategies to avoid detection.
• a more effective use of resources at local and national levels to maximise the impact of interventions and programmes.
• an alignment with other Scottish Government approaches focused on vulnerable groups and public protection as outlined above.

Public health approaches in action

A public health approach works across three levels^[9]:

Primary prevention: prevents trafficking and exploitation before it occurs. This involves programmes and interventions designed to reduce factors that put people at risk of experiencing or perpetrating trafficking.

Secondary prevention: provides an immediate response to trafficking and exploitation after it occurs through addressing short-term consequences and effects. Programmes and interventions focus on the identification of victims and their immediate needs such as safe housing, health care (physical and mental) and other forms of support alongside the disruption and prosecution of perpetrators.

Tertiary prevention: provides long-term support after the trafficking and exploitation has occurred and prevents retrafficking from occurring. Programmes and interventions include long-term supportive services, advocacy and outcomes as well as other services aimed at mitigating long-term impacts and retrafficking, and facilitating community reintegration.

These three levels are referred to in this Strategy in the following way:

• before harm occurs – primary prevention
• intervening early – secondary prevention
• treating harms and supporting recovery – tertiary prevention

The prevention continuum below, developed by Liz Such and colleagues, illustrates these different levels across the prevention levels.

Text for graphic below:

The BETR prevention continuum. Prevent Before and Early then Treat and prevent Retrafficking. Preventing exploitation before it happens. Intervening early to prevent further harm. Treating harms and preventing retrafficking.

The public health approach enables policy makers and practitioners to adopt a prevention lens that incorporates different actions depending on the stage or phase at which trafficking is identified, disrupted and victims supported. This approach also focuses on early detection by using multi-agency working (such as specialist trafficking support services, health and legal interventions, social work involvement, and criminal justice investigations) to mitigate the effects of trafficking as soon as harm is identified.

In general, a public health approach is characterised by the following components:

• defining and understanding the problem, the extent of the problem and its root causes
• reviewing evidence to identify the best ways to solve the problem, including considering what ‘works’ and for ‘whom’
• identifying risk and protective factors for individuals, groups and communities
• developing and testing prevention strategies across primary, secondary and tertiary levels
• monitoring and evaluating their effectiveness through data and evidence collection
• adapting strategies to changing circumstances and evaluation evidence.

Most of these components were present in the previous Strategy but a public health approach places a greater emphasis on prevention as a holistic focus – a “whole systems approach”^[11] – rather than as one of three separate strands of work. This will underpin the delivery of preventative measures more consistently and the implementation of these more strategically, potentially strengthening opportunities for identification and support. In addition, the importance and centrality of data collection, information and intelligence sharing processes to build the evidence base for effective interventions is highlighted.