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A Bridge between Human Trafficking and Sex Work

...human trafficking activists want nothing to do with a sex worker’s rights based approach as they believe the existence of prostitution is to blame for the plight of forced labor, and sex worker’s want nothing to do with trafficking activists out of a need to distance themselves from anti-trafficking activists (at times) very punitive movement....these two realities are often dealt with by policy makers and activists alike as being mutually exclusive, when they are in fact, not

Laura LeMoon

by Laura LeMoon*

Disease Research & Intervention Specialist at King Co. Public Health Seattle USA

A Bridge between Human Trafficking and Sex Work


Why are human trafficking activists and sex worker’s rights activists at such odds with each other?  Spend any good amount of time in the United States …watch our news stories…read our newspapers… and it might appear that all prostitution is human trafficking and all human trafficking is prostitution. Therefore human trafficking activists want nothing to do with a sex worker’s rights based approach as they believe the existence of prostitution is to blame for the plight of forced labor, and sex worker’s want nothing to do with trafficking activists out of a need to distance themselves from anti-trafficking activists (at times) very punitive movement.  As a former Sex Worker AND human trafficking survivor, I can tell you that these two realities are often dealt with by policy makers and activists alike as being mutually exclusive, when they are in fact, not.

To give some background on the difference between these two movements, it is important to understand the political movement behind “sex work.” The Sex Workers rights movement began in the 1970’s, inspired by the women’s liberation movement , gay rights movement and the civil rights movement of the 1960’s. The term “Sex Worker” was created at this time as a unifying moniker for individuals engaged in the sex industry, and as a distinct marker of “choice” for ones participation in erotic services. The term “Sex Worker” today, is still a highly politicized term and one used to highlight ones agency and freedom of choice to participate in the sex industry. The sex worker’s rights movement is based on a kind of Marxist worker’s rights approach founded on the concept that sex work is legitimate work and like fishing in the Bering Sea or farming, those harms must be directly addressed and mitigated by tools such as national and local policy making.

Nonprofit organizations in the United States that are rooted in the Sex Worker rights movement have traditionally focused on harm-reduction methods to address issues like sexually transmitted infections, HIV prevention/intervention and primary and gynecological health care. However what these organizations have been woefully behind the eight ball on is the issue of violence in sex work and the management of trauma as a result. Many rights-based nonprofits feel that to focus on the issue of violence (whether professional or personal) is to give unfair air-time to an overpublicized issue in the world of erotic servicer work. Therefore, many pro-rights nonprofits shy away from directly addressing the issues of force, fraud and coercion or overt violence in their programming due to a kind of knee-jerk response to protect the community from further “bad press”. The lack of desire in the Sex Worker community to talk about violence comes from an understandable place; that the community is tired of defending itself against constant attacks from perceived outsiders that seek to blame the problem of forced labor on the existence of prostitution itself. Sex Workers’ rights organizations and activists are also tired of having the focus on them be singular in nature. Of course there are more issues facing people in the sex industry than violence, just as there are more issues facing this community than the need for STI  screening and access to free condoms. However, rights activists are not reacting to this in a way that is helpful to the sex working community at large. By not wanting to directly address the issues of force, fraud and coercion and overt violence from the perspective of a rights-based approach, sex worker rights activists are only acknowledging a partial reality of sex work as well as a partial need for services.

Likewise, the many activists involved in human trafficking awareness- often people or organizations with religious affiliations- are not serving trafficking survivors by placing the blame of all the potential harms/risks of sex work on sex work itself and ignoring the complex continuum of choice that can exist in the sex industry for many. In their narrow view of sex work at large, they are cutting themselves off at the knees in their abilities to truly tap into the full spectrum of violence and coercion that can exist for people in the industry, as well as their ability to connect with community members who may have a more complex relationship to sex work than just good or bad, victim or whore, black or white.

What needs to be done is a bridge built between these two activist communities. In actuality, we are not working at cross purposes. As an activist working within the Sex Worker rights community, I see the first steps as both endogenous and exogenous. Sex Worker’s rights organizations must begin to recalibrate programming according to the direct needs reported by communities being served. Not based on providence, or what is most comfortable for activists to address based on our own fears of misinterpretation by “outsiders.” Additionally, Sex Worker activists need to get comfortable reaching across the table to anti- trafficking activists and abolitionists alike who may not share a similar purview on prostitution.  Agreement certainly will not always happen, however the schism currently existing between these two ideologies has only proved to impede much needed innovative change in approaches to violence and coercion in sexual economies. We must stop fighting against each other and look to the ways that we can build upon common interest and create bridges based on the mutually held ideal of self-determination and bodily integrity for all those who come to the sex industry.



*Laura LeMoon was born in Washington State, USA in 1985. She earned her Bachelor of Arts degree in Women’s studies at Mills College in California and began her career in research authoring a pilot study on violence in the lives of Sex Workers of all genders at a nonprofit peer-based medical clinic for Sex Workers in San Francisco, California. Laura has continued her Sex Worker advocacy in the red-light district of Kolkata, India at the Sex Workers’ union Durbar Mahila Samanwaya Committee, has worked with famous Sex Workers rights pioneer Carol Leigh, assisted in forming human-trafficking focus groups at the International Rescue Committee and has worked as an ethnographer for the National HIV Behavioral Surveillance run nationally in the U.S. via the Centers for Disease Control, which is focused around HIV and high risk populations. Currently she is working as a Disease Research & Intervention Specialist on the National HIV Behavioral Surveillance (NHBS), which this year focuses on HIV risk and women who exchange sex. She is also the co-founder of a Sex Workers’ collective in Seattle that works to provide harm reduction services to street-based Sex Workers on one of Seattle’s last remaining “strolls.” She lives in Washington State, USA.

Why do Some American Citizens not support Universal Health Care?

This paper is an exploration of some possible answers to this confounding question, including some misconceptions and interesting opinions. As such, it will not explore health care as a right or pros and cons of universal health care. Rather, its scope is limited to expressing reasons given by a few people for not supporting universal health care in the United States of America

Corie Leifer2

by Corie Leifer*

Project and Department Assistant at Phillips-Medisize

Why do Some American Citizens not support Universal Health Care?


The universal health care debate in America is not a new one. The discussion has already lasted more than 100 years and shows no signs of coming to an end. This is despite the fact that, for more than a century, other democratic countries have had universal health care systems in place. As an American living in the Netherlands I have been asked more than once why all Americans are not in favor of universal health care. As an American also does not understand this viewpoint, I find this a hard question to answer. Additionally, as a nurse and public health specialist, I have a special interest in this topic.

I feel it necessary to state my bias and purpose upfront and clearly express that this article is not scientific. It is an exploration of some possible answers to this confounding question, including some misconceptions and interesting opinions. This paper will not explore health care as a right or pros and cons of universal health care. The scope of this article is limited to expressing reasons given by a few people for not supporting universal health care in the United States of America.

The question of universal health care is clearly much more complex than can be answered with a simple, “yes, we provide it” or “no, we don’t”. The variations are endless. There is a history behind this debate. There are philosophical, moral, ethical, and personal issues that need to be explored and considered. There are many perspectives from which to see this complex subject as well, due to the various stakeholders involved in health care delivery. This paper explores concerns from the perspective of a patient regarding their support of universal health care.

Here are a few of the reasons that American citizens have expressed to me for why they do not support universal health care:

Government is ineffective and inefficient 

This reason was given by more than one respondent. There are regular problems with government-run programs in America, such as Veterans Affairs (VA), social security, and Medicaid/Medicare. It was expressed that there is too much overhead without oversight in current government programs. There is a fear that, even if these systems are funded, there is no guarantee that it is sustainable. One respondent specifically did not like the idea of contributing to a universal healthcare fund, when there was no guarantee that as she aged that fund would still be around to take care of her when she needs it most. There is a common misconception that there are only two options: government provided health care or privatized health care. Furthermore, it was expressed that people value things less when they do not have to pay for them. The assumption is that government provided health care is free to the patient. Americans are often unaware of a third option available in many other countries; government subsidized private health care.

Don’t like being told what to do 

Another reason given for not supporting universal health care is the idea that something is mandatory. When I pointed out that car insurance is also mandatory, the respondent argued that she could choose not to drive. Americans often reference their individual rights and seem to resent being told that they must do something. In addition, the individualistic culture leads people to feel that they are not sick, why should they care if someone else is? The strange thing is that other services are forced on Americans such as schooling, but the same resentment does not seem to apply.

Overburdened system

It was expressed that if everyone were to have access to health care, then the already overburdened system will collapse. Worries included increased wait times due to increased patient load and the ability to receive appropriate, quality, timely care and treatment. One possible solution to this problem is to educate and create more healthcare professionals. Unfortunately, that also includes a financial investment from an industry that is already having to make austere decisions and take cost-cutting measures. Rising costs were also a major concern for all parties. However, that is a subject about which entire books are written, and, thus, will not be addressed in this brief opinion editorial.


What I am able to conclude from my brief research, if it can be called that, is that this topic is as extensive as it is complicated. The intricacies and considerations involved health care services are limitless. The scope of a discussion is very hard to limit because each topic is closely linked to multiple other issues. Each question leads to another question, rather than an answer. That is why it is easy to put on the back burner. I think the true answer to why universal health care is not an idea supported by all Americans is because there is not enough comprehendible information available. There are nuances and details that confuse even those who are knowledgeable and informed. In order to persuade everyone to support universal health care, clear and concise messages about the program need to be developed based on addressing public concerns.



*Corie Leifer was born in 1981 in Connecticut, USA. After earning a bachelor degree in communications and another in nursing in the United States, she moved to the Netherlands in 2011 to earn a Master of Health Science degree with a focus on International Public Health from Vrije Universiteit in Amsterdam. During this study, Corie completed her internship at AFEW and subsequently joined AFEW as Office Manager. As a research intern, she investigated the use of SMS campaigns to reduce the spread of HIV/AIDS. Corie has international marketing and communications experience, having worked at Operation Smile, Inc. and Trader Publishing Company prior to returning to school. Corie is also a Registered Nurse licensed in the Commonwealth of Virginia, USA. Since April 2016 Corie serves as Project and Department Assistant at Phillips-Medisize.

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Global Nutrition Report 2016: una guida per l’azione

Lanciato il 14 giugno 2016, Il Global Nutrition Report è stato realizzato da un Gruppo Indipendente di Esperti sotto la supervisione e revisione di competenti di settore. Il Report  ha beneficiato del supporto finanziario della Fondazione Gates oltrechè di CGIAR Research Program on Agriculture for Nutrition & Health, the Children’s Investment Fund Foundation, la Commissione Europea, i governi di  Canadà, Germania e Olanda, Irish Aid, UK Department for International Development (DFID), US Agency for International Development (USAID), e la organizzazione 1,000 Days


by Daniele Dionisio

Membro, European Parliament Working Group on Innovation, Access to Medicines and Poverty-Related Diseases

Progetto Policies for Equitable Access to Health – PEAH

Global Nutrition Report 2016 una guida per l’azione


Poche tra le sfide odierne alla comunità globale eguagliano in grandezza quella posta dalla malnutrizione, quale condizione sofferta da almeno una persona su tre e, perciò, problema rilevante di sanità pubblica da cui nessun Paese può dirsi esente.

In termini economici, alla malnutrizione è imputabile la perdita annuale dell’11% del prodotto interno lordo in Africa e Asia, mentre è documentato che la sua efficace prevenzione ha prodotto ‘ritorni’ di $16 per ogni dollaro investito.

A livello mondiale, nonostante la condivisione sugli obiettivi da conseguire e qualche reale progresso, il traguardo finale è ancora lontano.

In effetti, slanci propulsivi in anni recenti non sono mancati: nel 2012 la World Health Assembly adottava i ‘2025 Global Targets for Maternal, Infant and Young Child Nutrition’ e l’anno seguente proseguiva con l’adozione di obiettivi per le malattie non trasmissibili (NCDs) inclusivi di targets per la nutrizione.

Nel 2013 poi, al primo  ‘Nutrition for Growth (N4G) Summit’, ci fu l’impegno dei donatori all’erogazione di 23 miliardi di dollari per il miglioramento dei livelli nutrizionali.

Con la ‘Second International Conference on Nutrition (ICN2)’ nel 2014 e con la definizione recente del periodo 2016-2025 quale ‘United Nations Decade of Action on Nutrition’, sempre più persone hanno cominciato a riconoscere l’importanza della lotta alla malnutrizione in tutti i suoi aspetti.

Nel 2015, gli ‘UN Sustainable Development Goals (SDGs)’ includevano l’obiettivo ‘ending all forms of malnutrition’ quale sfida mondiale basata su un nuovo modo di pensare e agire riguardo alla malnutrizione in tutti i sui aspetti, e con l’impegno ad eliminarla completamente e per tutti entro il 2030.

Almeno 12 dei 17 SDGs contengono indicatori relativi alla nutrizione quale riflesso del ruolo centrico della medesima sullo sviluppo sostenibile.

Il 2016 offre oggi ulteriori opportunità per traslare gli impegni in azione. Queste includono l’adozione da parte dei Paesi di propri targets correlati agli SDGs, l’inarrestato attivismo di Nutrition for Growth, e la crescente leadership sulla nutrizione assunta da un Giappone proiettato ai Giochi olimpici e paralimpici di Tokyo 2020.

Coerente con questi temi, il Global Nutrition Report è l’unica rassegna annuale, indipendente e comprensiva, dello stato della nutrizione su scala mondiale quale iniziativa multi-partner di informazione sui successi e fallimenti nel conseguimento di targets intergovernativi di settore. Il Report documenta, inoltre, il progresso degli impegni assunti e raccomanda azioni per accelerare il raggiungimento degli obiettivi. Come tale, il Global Nutrition Report funge da guida per l’individuazione di consone opportunità di azione e appropriate modifiche di percorso.

Focalizzato sul tema dell’azione e documentazione/misurazione degli impegni S.M.A.R.T. correnti, il  Report 2016 analizza il volume di attività richieste per sconfiggere definitivamente la malnutrizione entro il 2030. Targets specifici includono:

-Ridurre del 40% il numero dei bambini con rachitismo

-Ridurre e mantenere la consunzione infantile a meno del 5%

-Alt al sovrappeso nell’infanzia

-Ridurre del 50% l’anemia nelle donne in età fertile

-Aumentare almeno del 50% l’esclusivo allattamento al seno

-Ridurre del 30% il sottopeso alla nascita

-Bloccare negli adulti i trends in crescita di sovrappeso, obesità e diabete.


Il report stimola all’azione secondo linee basilari di intervento:

Attuare scelte politiche tese all’eliminazione di ogni forma di malnutrizione

Il drammatico calo della malnutrizione in Brasile, Ghana, Perù e nello stato indiano del Maharashtra sono state permesse dalla continuità di impegno in primis dei rispettivi governi. In ultima analisi, sconfiggere la malnutrizione dipende dalle scelte che leaders politici, donatori, organismi della società civile e del settore commerciale e finanziario devono operare a livello globale (internazionale, nazionale e regionale).

Investire di più e distribuire meglio

Investire nella sconfitta della malnutrizione è uno dei compiti più gratificanti che i governi possono adempiere se è vero, come anticipato, che 16 dollari hanno costituito il documentato ritorno per ogni dollaro investito in solidi programmi ad hoc.  Allo scopo governi e donatori dovranno triplicare i livelli di finanziamento nel prossimo decennio, mentre è necessaria maggiore attenzione affinchè l’allocazione multisettoriale dei budgets (agricoltura, educazione, settore alimentare, sistema sanitario, protezione sociale, approvvigionamento idrico ed igiene) contempli maggiori risorse per l’eliminazione  della malnutrizione in ogni suo aspetto.

Raccogliere informazioni appropriate per massimizzare gli investimenti

L’incompletezza dei dati è un grosso inciampo al progresso della lotta alla malnutrizione su scala mondiale. Governi, donatori e ricercatori dovrebbero impegnarsi a chiudere questo gap che sensibilmente frena l’azione.

Nello spirito degli SDGs, governi, donatori, settore industriale, commerciale, finanziario, e società civile dovrebbero monitorare e regolarmente render noti i loro volumi di spesa e di impatto su tutti gli aspetti della malnutrizione, inclusi rachitismo, deperimento, anemia, obesità, NCDs, e livelli di allattamento esclusivo al seno.

Investire nella messa in opera di prassi solide ed ‘evidence-informed’— e nell’individuazione di nuove

Identificare nuove, meno dispendiose soluzioni per l’impiego di dati subnazionali già disponibili – e raccogliere nuovi dati se necessario – aiuterà a non lasciare nessuno indietro nell’era degli SDGs.

 Affrontare la malnutrizione in tutte le sue forme

-Significa che i paesi a basso e medio reddito devono integrare la prevenzione e controllo del diabete e dell’obesità all’interno dei loro programmi nutrizionali ed implementare le politiche ed interventi dedicati.

-Significa che i paesi OECD devono apprendere dall’altrui esperienza su scala mondiale per migliorare le proprie strategie nazionali di lotta all’obesità e alle NCDs.

-Significa che i donatori devono espandere ‘il tiro’ per riconoscere la minaccia alla nutrizione globale posta da obesità e nutrizione-relate NCDs.  

-Significa che tutti gli ‘addetti’ devono elevare il rendimento dei loro investimenti e politiche attraverso l’dentificazione e implementazione di azioni in grado di affrontare simultaneamente più di una forma di malnutrizione.

-Significa, infine, che tutti gli ‘addetti’ devono familiarizzare con i nuovi concetti di lotta alla malnutrizione: in tutte le sue forme, nello stesso posto e nello stesso tempo – un problema che coinvolge quasi la metà di tutti paesi su scala planetaria.


Global Nutrition Report 2016

GNP: Independent Expert Group

GNP: Stakeholder Group

Sustainable Development Goals

What is malnutrition? – World Food Programme

Obesity boom ‘fuelling rise in malnutrition’

Malnutrition: latest research and reviews

How to make SMART commitments to nutrition action

Scaling up nutrition: global commitments to action

WHO: nutrition

1,000 Days



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