Cathy Zimmerman

• PhD
• Lecturer at London School of Hygiene and Tropical Medicine

Migration and displacement are pivotal determinants of urban health, influencing both direct and indirect health outcomes. Migrants may face unique health risks, often exacerbated by economic, social, and environmental factors encountered during transit or upon resettlement. As migration patterns shift due to geopolitical, climatic, and economic pr...

Background Migrant workers, a population of 170 million, often work in dangerous or unhealthy working environments and are likely to suffer workplace injuries and labour abuses. However, the risk of mortality in migrant workers compared with local workers is unknown. We aim to synthesise global evidence on migrant worker mortality risk and identif...

Background Globally, 170 million individuals migrate for work. Yet, evidence on their mortality risk remains unclear. Our aim was to synthesize global evidence on migrant worker mortality risk compared to local workers and to identify the multiple intersecting social determinants of mortality. Methods We conducted a systematic review of peer-revie...

Low-wage labour migrants often face health-damaging living and working conditions, but are frequently excluded from healthcare. The othering of migrants, bordering of healthcare and simple oversight and negligence create widening health inequalities for a society's essential workers. This review aimed to identify the forms and effectiveness of heal...

This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d’Ivoire. To address differences bet...

Background The growth of labour migration and associated risks of human trafficking and exploitation remain significant global human rights and health challenges. There is increasing policy interest in addressing structural determinants of adverse migration outcomes such as migrants’ use of informal employment recruiters. In Ethiopia, “safe migrati...

Background The growth of labour migration and associated risks of human trafficking and exploitation remain significant global human rights and health challenges. There is increasing policy interest in addressing structural determinants of adverse migration outcomes such as migrants’ use of informal employment recruiters. In Ethiopia, “safe migrati...

More than 50 million people globally are subjected to modern slavery and human trafficking. Adverse mental health consequences of extreme exploitation are prevalent and often severe. We conducted a systematic and realist review on evaluations of psychosocial interventions for survivors of human trafficking. The review aimed to identify the influenc...

Child labour is a common financial coping strategy in poor households, especially in low-and middle-income countries with many children working under hazardous conditions. Little is known about the linkages between hazardous work conditions and psycho-social and educational outcomes. We analysed the Bangladesh Multiple Indicator Cluster Survey (BMI...

This paper reflects on the development process (2015–2020) of the Learning Initiative for Norms, Exploitation, and Abuse (LINEA) Intervention. The LINEA Intervention is a multi-component social norms intervention to prevent age-disparate transactional sex in Tanzania. This paper aims to: (1) critically reflect on the LINEA Intervention development...

[This corrects the article DOI: 10.3389/fpubh.2021.645059.].

Over the past decade, third-party labor recruiters who facilitate employment for migrant workers across low- and middle-income countries have often been considered by the counter-trafficking community as one of the main entry points into human trafficking. In response, anti-trafficking prevention programs have increasingly focused on addressing exp...

Background: Low-wage labour migration is an increasing determinant of global health, associated with risks of exploitation, abuse, and unsafe conditions. Despite efforts to prevent irregular migration and initiatives to warn individuals of the risks of trafficking, many migrants still opt for irregular channels, particularly women seeking jobs as...

This study evaluates how World Vision's (WV) Anti-Trafficking in Persons (A/TIP) programming aimed to strengthen protection and reintegration services for survivors of trafficking in Myanmar. It employs a realist evaluation approach to examine A/TIP activities between 2019-2021. We analysed WV's administrative data and conducted interviews with sur...

Growing evidence suggests that community-based interventions in low- and middle-income countries (LMICs) can effectively address harmful social norms that promote or sustain gender inequality and drive violence against women (VAW). However, understanding what actions communities are already taking to address harmful social norms and prevent VAW is...

Violence against women (VAW) and violence against children (VAC) are public health issues of global concern. Intimate partner violence (IPV) is a commonly occurring form of VAW and there is evidence to suggest that IPV and VAC frequently co-occur within the same families. This systematic literature review searched for studies published in any langu...

The health and safety of LGBTQI+ migrants or migrants who are of diverse sexual orientation, gender identity or expression (SOGIE) remains an under-studied area, particularly for the period during transit from their place of origin to destination. This systematic review aims to describe the literature on the health risks and consequences among SOGI...

This rapid systematic review describes violence and health outcomes among child domestic workers (CDWs) taken from 17 studies conducted in low- and middle-income countries. Our analysis estimated the median reported rates of violence in CDWs aged 5–17-year-olds to be 56.2% (emotional; range: 13–92%), 18.9% (physical; range: 1.7–71.4%), and 2.2% (se...

Prompted by reports of ‘sea slavery’ in the fishing industry and threats of sanctions, Thailand has faced pressure to eradicate human trafficking the fishing sector. Although the Thai government has responded with anti-trafficking policies, there remains little understanding about their implementation. Specifically, little is known about how govern...

Background : Human trafficking is a recognized human rights violation, and a public health and global development issue. Violence is often a hallmark of human trafficking. This study aims to describe documented cases of violence among persons identified as victims of trafficking, examine associated factors throughout the trafficking cycle and explo...

Little is known about interventions to support the education, skills training, and health of female child domestic workers (CDWs). This rapid systematic literature review followed PRISMA guidelines (PROSPERO registration: CRD42019148702) and summarises peer-reviewed and grey literature on health, education, and economic interventions for CDWs and i...

Background International labour migration has become a crucial livelihood strategy, especially in countries where decently paid employment opportunities are limited. Such opportunities come with many potential benefits but also many stressors that challenge migrants’ coping skills, especially when they are in a foreign environment away from their n...

Preventing modern slavery is of global interest, but evidence on interventions remains weak. This paper presents findings from a 5-year theory-based evaluation of an empowerment and knowledge-building intervention to prevent the exploitation of South Asian female migrant workers. The evaluation used realist evaluation techniques to examine the inte...

Complex systems and realist evaluation offer promising approaches for evaluating social interventions. These approaches take into account the complex interplay among factors to produce outcomes, instead of attempting to isolate single causes of observed effects. This paper explores the use of Bayesian networks (BNs) in realist evaluation of interve...

This systematic review aims to synthesize how agent-based modeling (ABM) has been used in migration and modern slavery research and provide the basis to model development for social science researchers exploring the use of ABM. We searched five bibliographic databases using two terminology categories: (1) migration or modern slavery terminology; (2...

Labour migration is an important livelihood strategy for individuals in low- and middle-income countries, and involve potential benefits and challenges. This paper reviews the coping strategies used by migrants to manage migration-related stressors. A systematic review and narrative analysis was conducted. Study quality was appraised using Critical...

Labour migration has become a crucial livelihood strategy in settings where employment options are limited. Such opportunities come with potential benefits but also introduce stressors. This study explores migration-related stressors among returnee male Nepali international labour migrants. We conducted a qualitative study in Kathmandu among 42 ret...

Child domestic work (CDW) is a hidden form of child labour. Globally, there were an estimated 17.2 million CDWs aged 5–17 in 2012, but there has been little critical analysis of methods and survey instruments used to capture prevalence of CDW. This rapid systematic review identified and critically reviewed the measurement tools used to estimate CDW...

Background Awareness-raising and pre-migration training are popular strategies to prevent human trafficking. Programmatic theories assume that when prospective migrants are equipped with information about risks, they will make more-informed choices, ultimately resulting in safe migration. In 2016, India was estimated to have 8 million people in mod...

The migration of Nepalese women for work is a growing phenomenon. For these women, migration for work can facilitate empowerment, but can also challenge social and cultural gender norms, which can stigmatise women migrants. This article explores the concepts of stigma and empowerment through the perceptions and experiences of fifty-five prospective...

The experiences and needs of trafficking victims have received increasing attention. However, variation in the experiences and needs of people trafficked for different types of labor have been poorly explored. People trafficked for domestic servitude may represent a particularly vulnerable group but are typically subsumed within labor exploitation....

Abstract Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental he...

This briefing note describes available CDW prevalence estimates for selected Southeast Asian countries with a focus on Myanmar, defines the questions used to ascertain prevalence and highlights the limitations of current tools to obtain accurate prevalence figures for child domestic workers.

With the increase in female migration, especially in the domestic sector, and accompanying reports of worker exploitation and abuse, labour-sending countries are grappling with the question of how to protect these workers. Drawing on a critical feminist policy analysis framework, this article analyses the policy and regulatory frameworks of Nepal r...

Trafficked people require timely and ongoing access to healthcare services. Yet, many encounter difficulties accessing and utilising healthcare services, both while in situations of exploitation and after their escape. This research investigated barriers that hinder healthcare providers from identifying, providing care and making necessary referral...

Background Human trafficking and labor exploitation are prevalent in Southeast Asia and have substantial health consequences for children and adolescents. Research on pre-departure circumstances and trafficking experiences show that gender plays a key role in shaping the experience of exploited children and adolescents. Objective This study estima...

Objectives To assess the association of living and working conditions experienced during trafficking with mental health of female and male survivors. Methods We analyzed a cross-sectional study of 1015 survivors who received post-trafficking services in Cambodia, Thailand, and Vietnam. Modified Poisson regression models were conducted by gender to...

Aims Human trafficking is a crime and a human rights violation that involves various and simultaneous traumatic events (sexual and physical violence, coercion). Yet, it is unknown how the patterning of violence and coercion affects the mental health of female and male trafficking survivors. Methods We conducted a cross-sectional study using a samp...

Background: Globally, there are more than 150 million international migrant workers-individuals who are employed outside of their country of origin-comprising the largest international migrant group. A substantial number of migrants work in hazardous and exploitative environments, where they might be at considerable risk of injury and ill health....

In an Editorial, Ligia Kiss and Cathy Zimmerman discuss the need for research on the prevention of human trafficking and mitigation of its effects.

Background Human trafficking is a pervasive global crime with important public health implications that entail fundamental human rights violations in the form of severe exploitation, violence and coercion. Sex-specific associations between types of violence or coercion and mental illness in survivors of trafficking have not been established. Metho...

With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to...

Background: Little is known about the health of GMS commercial fishers and seafarers, many of whom are migrants and some trafficked. This systematic review summarizes evidence on occupational, physical, sexual and mental health and violence among GMS commercial fishers/seafarers. Methods: We searched 5 electronic databases and purposively searche...

Case study of ethics processes followed in the Study on Trafficking, Exploitation & Abuse in the Mekong (STEAM), a survey of post-trafficking service users in Thailand, Cambodia & Vietnam conducted by the London School of Hygiene and Tropical Medicine & the International Organization for Migration. Presented at Global Forum on Bioethics in Research...

Background Human trafficking in the fishing industry or “sea slavery” in the Greater Mekong Subregion is reported to involve some of the most extreme forms of exploitation and abuse. A largely unregulated sector, commercial fishing boats operate in international waters far from shore and outside of national jurisdiction, where workers are commonly...

As international female labour migration has increased, so too have efforts to prevent the exploitation of labour migrants. However, evidence to underpin prevention efforts remains limited, with little known about labour migrants’ migration planning processes. Using data from a survey of female prospective labour migrants from Nepal, this article c...

Background Bride-trafficking has been a growing phenomenon in Southeast Asia, particularly in China, where one-child policies have resulted in demographic imbalances favoring males. Yet, empirical evidence about women and girls sold into marriage in China remains sparse. Methods This study describes the experiences of 51 Vietnamese women and girls...

Background Although trafficked women and adolescents are at risk of unprotected or forced sex, there is little research on maternity care among trafficking survivors. We explored health care needs, service use and challenges among women who became pregnant while in the trafficking situation in the United Kingdom (UK) and clinicians’ perspectives of...

In this collection review, Cathy Zimmerman and colleague introduce the PLOS Medicine Collection on Human Trafficking, Exploitation and Health, laying out the magnitude of the global trafficking problem and offering a public health policy framework to guide responses to trafficking.

Framework analysis example. (DOCX)

Developing the codes. (DOCX)

Background International migration has become a global political priority, with growing concern about the scale of human trafficking, hazardous work conditions, and resulting psychological and physical morbidity among migrants. Ethiopia remains a significant “source” country for female domestic workers to the Middle East and Gulf States, despite wi...

Objectives Growing numbers of people are migrating outside their country for work, and many experience precarious conditions, which have been linked to poor physical and mental health. While international dialogue on human trafficking, forced labour and slavery increases, prevalence data of such experiences remain limited. Methods Men from Dolakha...

Mental health professionals have opportunities to intervene and provide care for trafficked people. Research shows that mental health problems – including depression, anxiety and post-traumatic stress disorder – are prevalent among trafficked people, and that at least some trafficked people come into contact with secondary mental health services in...

Abstract: Background Trafficked people experience high levels of physical and psychological morbidity, but little is known about trafficked people’s experiences of accessing and using healthcare services during or after their trafficking experiences. Aim To explore trafficked people’s access to and use of healthcare during and after trafficking...

Background Sex trafficking and sexual exploitation has been widely reported, especially in conflict-affected settings, which appear to increase women’s and children’s vulnerabilities to these extreme abuses. Methods We conducted a systematic search of ten databases and extensive grey literature to gather evidence of sex trafficking and sexual expl...

Background: Men comprise nearly two-thirds of trafficked and forced labourers in common low-skilled labour sectors including fishing, agriculture and factory work. Yet, most evidence on human trafficking has focused on women and girls trafficked for sex work, with scant research on trafficked men and boys. Methods: We analyse survey data from the...

For the 2016 end-of-the-year editorial, the PLOS Medicine editors asked 7 global health leaders to discuss developments relevant to the equitable provision of medical care to all populations. The result is a collection of expert views on ethical trial design, research during outbreaks, high-burden infectious diseases, diversity in research and prot...

Objective: This study estimated the prevalence and correlates of self-harm among adult victims of human trafficking who accessed secondary mental health services, and it estimated the responses of mental health services to these individuals. Methods: A clinical records database was searched for self-harm, sociodemographic, clinical, and service...

Young people who have been trafficked may have experienced significant trauma and violence but little is known about their health and healthcare needs. This UK study aimed to address that gap. It included a health survey and qualitative interviews with 29 young people aged 16-21 trafficked into the UK from other countries who were recruited through...

Migration is a crucial issue for public health, with currently nearly a quarter of a billion international migrants and more than three times this number of migrants moving within their home country.1,2 Migration is not a new phenomenon, but international and internal migration seems to be increasing, triggered by displacement of large numbers of p...

There is growing demand for robust evidence to address complex social phenomena such as violence against women and girls (VAWG). Research partnerships between scientists and non-governmental or international organizations (NGO/IO) are increasingly popular, but can pose challenges, including concerns about potential conflicts of interest. Drawing on...

Background: Despite the multiple physical and psychological health consequences associated with human trafficking, there is little evidence-based guidance available for health providers on assessing and meeting the health needs of trafficked people. We aimed to review literature that provided guidance or research on care provision for people who h...

Objectives: To investigate physical and mental health and experiences of violence among male and female trafficking survivors in a high-income country. Methods: Our data were derived from a cross-sectional survey of 150 men and women in England who were in contact with posttrafficking support services. Interviews took place over 18 months, from...

To update and expand on a 2012 systematic review of the prevalence and risk of violence and the prevalence and risk of physical, mental and sexual health problems among trafficked people. Systematic review and meta-analysis. Searches of 15 electronic databases of peer-reviewed articles and doctoral theses were supplemented by reference screening,...

Non-interventionist attitudes towards domestic violence (DV) are underpinned by gendered cultural norms and roles, an arena which has only been superficially explored within the public health literature. In this study, we undertook qualitative interviews with a small number of healthcare providers and NGO staff members to obtain exploratory insigh...

Emerging evidence indicates the extreme forms of violence and acute and longer-term mental health consequences associated with trafficking and exploitation. However, there has been little research on post-trafficking mental health and psychosocial support services for survivors. This study explored the availability and accessibility of mental healt...

IMPORTANCE Human trafficking and exploitation of children have profound health consequences. To our knowledge, this study represents the largest survey on the health of child and adolescent survivors of human trafficking. OBJECTIVE Todescribeexperiencesofabuseandexploitation,mentalhealthoutcomes,and suicidal behavior among children and adolescents...

(1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals' knowledge and confidence to respond to human trafficking. A cross-sectional survey. Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary h...

Both intimate partner violence (IPV) and community violence are prevalent globally, and each is associated with serious health consequences. However, little is known about their potential links or the possible benefits of coordinated prevention strategies. Using aggregated data on community violence from the São Paulo State Security Department (INF...

Title Children and young people’s experiences of trafficking in the UK: health impacts Objectives This paper reports on an ongoing NIHR study of the effects of trafficking in persons on health, with an emphasis on children and young people. Little is known about their health issues as victims presenting to health service providers keep their iden...

Trafficking is a crime of global proportions involving extreme forms of exploitation and abuse. Yet little research has been done of the health risks and morbidity patterns for men, women, and children trafficked for various forms of forced labour. We carried out face-to-face interviews with a consecutive sample of individuals entering 15 post-traf...

Our goal was to describe the forms of persecution reported by adult refugees in the U.S. and the relationships between persecution and health status among this population. Data were derived from the 2003 New Immigrant Survey, a representative sample of new U.S. lawful permanent residents. Major depression, impairment in daily activities due to pain...

Background: Human trafficking is a crime that commonly results in acute and chronic physical and psychological harm. To foster more informed health sector responses to human trafficking, training sessions for health care providers were developed and pilot-tested in the Middle East, Central America, and the Caribbean. This study presents the results...

Global assessments suggest that a substantial proportion of labour migrants ends up in situations of extreme exploitation, some of whom are identified as victims of human trafficking. Because large numbers of migrant workers fall into a “grey area” between trafficking (as defined by international and national law) and exploitative labour situations...