Abstract

Introduction

The relations between social movements, the field of Collective Health (CH) and the Brazilian National Health System (SUS) are an important research and practice area. The social movements actively act to build up knowledge and practices in CH and to develop the SUS, based on the institutionalized principle of social control¹1. Brasil. Presidência da República. Lei nº 8.080, de 19 de Setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da União. 19 Set 1990.,²2. Stotz EN. Movimentos sociais e saúde: notas para uma discussão. Cad Saude Publica. 1994; 10(2):264-8..

The proletarian movement, the countryside, riverine, forest population movement, the peasant movement, the negro movement, the feminist movement, the gender movement, movements of people affected by dams, environmental justice, and so many others, point out several fronts of resistance confronting unfair social processes and attacks to human rights, including the right to health. As such, the social movements produce counterhegemonic knowledge that aims to warrant the social and ecological well-being, to preserve existing biodiversity and traditional ways of life, cultures and territories, and to develop a new and more cooperative, equitable and fairer society³3. Porto MF, Finamore R. Riscos, saúde e justiça ambiental: o protagonismo das populações atingidas na produção de conhecimento. Cienc Saude Colet. 2012; 17(6):1493-501..

The social movements’ struggles for health can be performed by two modes: diffused or concentrated. The diffused mode occurs when the focus of the action addresses health determinants of a specific population or one region. For instance: the defence of territories against unequal development, the labourer struggles against overwork to reduce worktime, the campaigns to combat the widespread use of pesticide and to preserve life, the actions to keep springs alive, seeds developed by peasants and small farmers, and all types of actions to eradicate racisms and gender, colour, class, ethnic and sexual discrimination. The concentrated mode refers to specific actions to improve health services, institutions and policy, and to recognize particular illness processes, that demand precise care.

Social movements contribute to amplify the access to health services and to give visibility to contested and difficult diagnoses diseases. They are also vital forces to combat gender, race, class and ethnic inequalities⁴4. Brown P, Zavestoski S. Social movements in health: an introduction. Sociol Health Illness. 2004; 26(6):679-94. by proposing strategies to increase social and cultural resources, challenging the State, the Institutions and the cultural authorities to promote participation in social policies broadening the democracy⁴4. Brown P, Zavestoski S. Social movements in health: an introduction. Sociol Health Illness. 2004; 26(6):679-94..

They emerge before the science and technology dominance within social policies that attribute more value to the professional and technical expertise than to popular knowledge. They also present alternative understandings of health based on their experiences pointing out the limits of medical power to deal with illness and contrasting the medicalization point of view that keep inequalities³3. Porto MF, Finamore R. Riscos, saúde e justiça ambiental: o protagonismo das populações atingidas na produção de conhecimento. Cienc Saude Colet. 2012; 17(6):1493-501.,⁴4. Brown P, Zavestoski S. Social movements in health: an introduction. Sociol Health Illness. 2004; 26(6):679-94..

Amidst several social and public health problems in Brazil, modern slavery is one of the most persistent and unfair⁵5. Leão LHC. Trabalho escravo contemporâneo como um problema de saúde pública. Cienc Saude Colet. 2016; 21(12):3927-36.. Modern slavery can be defined as coercive controlling forms upon someone or a group of people to make profits by economic exploitation and violence use⁶6. Bales K. Disaposable people: new slavery in the global economy. Berkeley, Los Angeles: University of California Press; 1999.. It involves forced labour, exhausting worktime, degrading conditions and movements restrictions due to debt bondage⁵5. Leão LHC. Trabalho escravo contemporâneo como um problema de saúde pública. Cienc Saude Colet. 2016; 21(12):3927-36.,⁷7. Brasil. Presidência da República. Lei nº 10.803, de 11 de Dezembro de 2003. Altera o art. 149 do Decreto-Lei nº 2.848, de 7 de Dezembro de 1940. Diário Oficial da União. 11 Dez 2003.. According to ILO estimates, 40 million people live under current slavery nowadays⁸8. International Labour Organization and Walk Free Foundation. Global estimates of modern slavery: forced labour and forced marriage. Geneva: International Labour Office (ILO); 2017..

This type of exploitation has particularities in Brazilian society and its roots come from indigenous colonization and Africans slave trade that left strong psychosocial marks and sociocultural heritage such as racism.

Modern slavery represents a grave human right violation. In Brazil case, it is an outcome of the exclusionary development process post-legal slavery emancipation in 1888, which left black and poor people marginalized and landless⁹9. Martins JS. A reprodução do capital na frente pioneira e o renascimento da escravidão no Brasil. Rev Sociol. 1994; 6(1-2):1-25.. Nowadays, modern slavery is scattered in the entire Brazilian territory and in the last fifteen years, 45,028 workers were freed from slave-like conditions around the country¹⁰10. Digital do Trabalho Escravo no Brasil. Smartlab de Trabalho Decente MPT – OIT [Internet]. 2020 [citado 6 Abr 2019]. Disponível em: http://observatorioescravo.mpt.mp.br
http://observatorioescravo.mpt.mp.br... . In general, the socioeconomic profile of affected population tell that slaves are young men, single, mix-rare, illiterate, who work in agricultural system, construction, livestock or textile supply chain, in the countryside or big cities¹⁰10. Digital do Trabalho Escravo no Brasil. Smartlab de Trabalho Decente MPT – OIT [Internet]. 2020 [citado 6 Abr 2019]. Disponível em: http://observatorioescravo.mpt.mp.br
http://observatorioescravo.mpt.mp.br... .

Despite modern slavery extension and its potential damages to populations´ health, public health institutions and services has neglected this issue. To date, there is no policy or specific strategies to provide health care to rescued slaves in Brazil⁵5. Leão LHC. Trabalho escravo contemporâneo como um problema de saúde pública. Cienc Saude Colet. 2016; 21(12):3927-36.. Furthermore, the information on health impacts of slavery is scanty and there is little point of entry to health sector to participate in workers liberation, emancipation and cure in the current Brazilian antislavery policy.

This situation highlights the scientific and social relevance of antislavery social movements engaged in workers` liberation from slave-like conditions. Since 1960 and 1970 decades, several social movements reported this grave problem, building tools to welcome and embrace workers, to address escaped slaves needs, to produce information about the cases and to publish statistics about incidents, to proceed inspections and preventive actions¹¹11. Ribeiro TAN. Vigilância da escravidão contemporânea: saberes e práticas de movimentos sociais em Mato Grosso [dissertação]. Cuiabá: Universidade Federal de Mato Grosso; 2019..

The emergence of the contemporary antislavery social struggle have started due to the recognition of the critical situations lived by poor workers in Brazilian countryside – in the State of Pará (PA) and Mato Grosso (MT) in 1970 decade – and due to the indignation caused by the disrespect inflicted on workers¹²12. Casaldáliga P. Uma igreja da Amazônia em conflito com o latifúndio e a marginalização social. São Felix do Araguaia: Carta Pastoral; 1971.,¹³13. Honneth A. The struggle for recognition: the moral grammar of social conflicts. Great Britain: Library of Congress; 1995.. The confront with this drastic situations of death risk, violence, humiliations and labour exploitation that went beyond the workers limits and capacities, engendered indignation in religious men who worked in land pastoral movements that received workers who escaped from farms. Thus, they awoke for this social struggle¹³13. Honneth A. The struggle for recognition: the moral grammar of social conflicts. Great Britain: Library of Congress; 1995.,¹⁴14. Figueira RR. Por que trabalho escravo? Estud Av. 2000; 14(38):31-50..

The land pastoral commission (CPT) and other social movements has played a privileged role to contact and reach workers submitted to slave-like conditions. In the social history of contemporary slave labour concept in Brazil, they were responsible to the emergence of this category and, to date, they have produced information and estimative about slave labour around Brazilian territory¹³13. Honneth A. The struggle for recognition: the moral grammar of social conflicts. Great Britain: Library of Congress; 1995.,¹⁵15. Silva MP. O trabalho escravo contemporâneo e a atuação da CPT no campo (1970-1995) [tese]. São Paulo: Pontifícia Universidade Católica de São Paulo; 2016.. Currently, there is a huge network scattered around the nation that produce public denounces, embrace escaping slaves, generate information and develop preventive actions to face land conflicts, labour and environmental exploitation¹¹11. Ribeiro TAN. Vigilância da escravidão contemporânea: saberes e práticas de movimentos sociais em Mato Grosso [dissertação]. Cuiabá: Universidade Federal de Mato Grosso; 2019.,¹⁵15. Silva MP. O trabalho escravo contemporâneo e a atuação da CPT no campo (1970-1995) [tese]. São Paulo: Pontifícia Universidade Católica de São Paulo; 2016.,¹⁶16. Bales K. Ending slavery: how we free today´s slaves. London: University of California Press; 2007..

This article aims to comprehend the impacts of modern slavery in workers’ health and its implications to the health systems according to the point of view of antislavery movements engaged in slave-like workers liberation in Brazil.

Methodology

In order to grasp the knowledge and practices of social movements engaged in slavery eradication, we conducted an exploratory qualitative research focusing on the meaning given by their active participants¹⁷17. Deslandes SF, Assis SG. Abordagens quantitativa e qualitativa em saúde: o diálogo das diferenças. In: Minayo MCS, Deslandes SF, organizadores. Caminhos do pensamento: epistemologia e método. Rio de Janeiro: Fiocruz; 2002. p. 195-223.,¹⁸18. Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 12a ed. São Paulo: Hucitec; 2010..

Our study took place in the state of Mato Grosso because it is one of the Brazilian states of highest occurrence rates of modern slavery. From 2003 to 2018, around 4,994 workers were rescued from slave-like conditions there, corresponding to 9.76% of the country total rescued. The state of Mato Grosso is the eighth in terms of freed workers who declared to be residents in this state in the rescue moment¹⁰10. Digital do Trabalho Escravo no Brasil. Smartlab de Trabalho Decente MPT – OIT [Internet]. 2020 [citado 6 Abr 2019]. Disponível em: http://observatorioescravo.mpt.mp.br
http://observatorioescravo.mpt.mp.br... .

In Mato Grosso, the Special Mobile Inspection Group have done 229 operations in 105 municipalities (74,4% of municipalities of this state) and have rescued around 19 workers in each inspection, demonstrating how modern slavery is spread in that territory. Those rescues have occurred in economic activities linked to agribusiness that is responsible for the most of the Mato Grosso and Brazilian GDP – Gross Domestic Product, especially owing to agriculture and timber commodity chain.

We conduced our research in Cuiabá – capital of Mato Grosso – at active antislavery social movements´ head office: Pastoral Land Commission (CPT), Burnier Faith and Justice Centre, Migrant Pastoral Centre and Agricultural Workers Federation.

The fieldwork was carried out between July and December of 2018 and in-depth semi structured interviews were performed individually with eight agents experienced in prevention, denounces, assistance actions against modern slavery and one interview with a researcher who worked during twenty years in the beginning of CPT movement.

The interviews were composed by open questions regarding organization, activities, collecting information processes, achievements and difficulties, characterization of modern slavery and its effects on health and connections to Brazilian health system.

The interviews were recorded and fully transcribed. We used the discourse analysis approach to grasp the speech of the interviewed people not only as communication/ information transmission tool, but also as a way of social action. The speech represents a scenario of ideological conflicts and confrontation under which the meanings emerge in its total complexity¹⁹19. Brandão HHN. Introdução à análise do discurso. Campinas: Unicamp; 2004.. We chose to use the French school approach of discourse analysis (AD), understanding the discourses as a range of meanings manifested by verbal and non-verbal expressions, by speech, gestures and attitudes. The discourse is produced since interactions among subjects circumscribed by ideology, history and unconsciousness in certain historical, social, cultural and economic context. Such interaction produces drift effects, new senses, overcoming in this way the notion that comprehends language as something neutral just oriented to describe and reflect the world²⁰20. Orlandi EP. Análise de discurso: princípios e procedimentos. 8a ed. Campinas: Pontes; 2009..

AD is helpful to better comprehend about how people think and act within the world, because the “enunciator of the discourse is not a subject of experience and of the individualized existence within the world, but, instead, it is subject of discourse whose personal history is included in the social history ideologically marked”²¹21. Gondim SMG, Fischer T. O discurso, a análise de discurso e a metodologia do discurso do sujeito coletivo na gestão intercultural. Cad Gestao Social. 2009; 2(1):9-26. (p. 21).

The discourse analysis task presuppose to comprehend the rules that circumscribe enunciates and the conditions for its emergence²²22. Foucault M. Arqueologia do saber (1969). Neves LFB, tradutor. 7a ed. Rio de Janeiro: Forense Universitária; 2008.. The productions of the discourse do not occur freely. It is controlled, organized, selected and distributed under certain rules and ordering procedures²³23. Foucault M. A ordem do discurso (1971). Sampaio LFA, tradutor. 5a ed. São Paulo: Edições Loyola; 1999.. The analyses that we carried out here looked for broaden understanding toward discourses production and its meaning effects regarding what was said and what was hidden.

During the data organization, deep reading of the interviews and oral reports analyses, the following categories emerged: modern slavery as the destruction of the body and mind potentials of human beings and the health sector responsibilities.

The research followed ethical principle according to 466/2012 Resolution and it was approved by Health Research Ethical Committee (3.293.655).

Results and discussion

Two major elements have emerged from the discourses: the modern slavery impact in workers’ health and the issue of the responsibilities of the of the SUS.

The modern slavery impact in workers’ health

The social movements´ activists depict the physical and mental health impacts in rural workers from the countryside of Mato Grosso as drastic situations characterized by diseases and exhaustion linked to the extrapolation of body limits caused by exhaustive labour, degrading conditions, threats and corporal punishments.

The interviewees expressed that since 1970, when they started to welcome workers, they have received reports of “work related disease, symptoms and fever”, “diarrhoea”, “malaria”, “work accidents”, “breathing problems”, “lung problems”, “alcohol and other drugs uses”, “alcoholism”, “worker killed”, “murders pretended of work accidents”, “signs of wear”, “blind worker”, “debilitated”, “fragile”, “destroyed”. This situation is reported as continuous events over workers in a process that lead to get them sick and dead.

These workers under modern slavery have no possibilities the come and go freely, because the slave perpetrators put them in debt bondage, overcharging them to pay for shelter, transport, food and denying the access health care, worsening the clinical condition related to dangerous diseases like malaria and others. Slavery also means that there is no availability of medical and hospital care in the case of accidents and disease.

Another pivotal element is the social isolation in terms of relationships, social networks and family ties, which leave the workers in a vulnerable position, as well as the suffering and other affections that reach the workers families.

It is important to highlight that classical studies on legal slavery and slave-trade process point out that one strategy largely used to subjugate workers and enslave them was to break their family ties²⁴24. Elkins SM. Slavery: a problem in American institutional and intellectual life. Chicago: University of Chicago Press; 1959.,²⁵25. Mustakeen SM. Slavery at sea: terror, sex and sickness in the middle passage. Chicago: University of Illinois Press; 2016..

Our data has showed, as well, how degrading is the modern slavery condition. Workers are exposed to restrictions of the liberty in coming and going and they experience debt bondage, malnutrition, unhealthy shelter and often perform their labour in exhausting worktime.

The discourse also has characterized the absence of adequate transport and appropriated dressing to the task be performed. The narratives have mentioned workers being transported even in cages on trucks keeping in places used to store agricultural inputs and dangerous pesticides without sanitary structures, etc.

It is important to demonstrate that several studies on slave’s illness in the time of Colonial America has showed accurately that the slaves’ morbidity and mortality were related to strenuous worktime, poor diet, precarious garment, bad conditions of housing and punishments²⁶26. Sheridan R. Doctors and slaves: a medical and demografic history of slavery in the British West Indies 1680-1834. Cambridge: Cambridge University Press; 1985.

27. Fett S. Working cures: healing, health and power on southern slave plantations. Chapel Hill: University of North Carolina Press; 2002.-²⁸28. McCandless P. Slavery, disease and suffering in the Southern Lowcountry. Cambridge: Cambridge University Press; 2011..

The narratives we have analysed here present, in the same way, many forms of psychological and physic violence which beget fear, psychiatry pain, physic and emotional trauma.

The narratives have reported permanent damages on the workers body, like blindness caused by poisoning, death threat and murders. This situation indicates a kind of managing by terror linked to ‘armed vigilance and strong discipline’ cross-cutting Brazilian scenario since 19^th century²⁹29. Figueira RR. Pisando fora da própria sobra: trabalho escravo no Brasil contemporâneo. Rio de Janeiro: Civilização Brasileira; 2004.,³⁰30. Loner BA, Gill LA, Scheer MI. Enfermidade e morte: os escravos na cidade de Pelotas, 1870-1880. Hist Cienc Saude-Manguinhos. 2012; 19 Supl1:133-52.. According to Orlando Patterson³¹31. Paterson O. Slavery and social death: a comparative study. Cambrigde: Havard University Press; 1982., the violence has a central role in the creation and maintenance of domination relations in slavery. Thus, we observe in the social movement’s discourses the recurrent punishment of workers body.

The social movement’s expressions as ‘marked in the body’, ‘slashing with whip’, ‘burned with ember and iron’, show some unfair and dishonourable ways on which modern slavery perpetrators deal with the workers. It is a form of infusing terror to subjugate the other to extreme types of exploitation that cross the labour history and the use of the body in that purpose. During traffic crossing towards the Americas, aa few slave bodies were dismembered to infuse terror as a way of “mutilation to intimidate”²⁷27. Fett S. Working cures: healing, health and power on southern slave plantations. Chapel Hill: University of North Carolina Press; 2002..

As such, modern slavery can be characterized as an experience of violence that produce many psychic and emotional traumatic situations.

Generally, most of the victims are in a state of extreme fear and terror because the menaces, coercion, ostensive vigilance and, in many cases, armed surveillance that can create a feeling of being impotent.

Felling fear is a common factor among most part of people who were submitted to cruel forms of exploitation. Some interviews carried out with slavery victims in some research on this issue highlighted great fear manifested among workers²⁹29. Figueira RR. Pisando fora da própria sobra: trabalho escravo no Brasil contemporâneo. Rio de Janeiro: Civilização Brasileira; 2004.,³²32. Leao LHC. Trabalho escravo contemporâneo: a construção social de um problema público no norte fluminense. Psicol Soc. 2015; 27(1):120-30..

The worker tent to fell himself diminished and oppressed due to isolation, abandonment and misery, with difficulties to break the barriers and escape from this condition. According to Figueira²⁹29. Figueira RR. Pisando fora da própria sobra: trabalho escravo no Brasil contemporâneo. Rio de Janeiro: Civilização Brasileira; 2004., it is not uncommon that social movement agents come across workers who have difficulties to speak out and to denounce, because the possibility of being persecuted. Those who get away and report their situation show an incredible resistance and limits overcoming, because their mental health is strongly affected in this violence and threats process and context.

In historical perspective, Amantino³³33. Amantino M. As condições físicas e de saúde dos escravos fugitivos anunciados no Jornal do Commercio (RJ) em 1850. Hist Cienc Saude-Manguinhos. 2007; 14(4):1377-99. analyse the health conditions of runaway slaves in Brazil during 1850 year and suggests that the main scape causes ‘were mistreatment, excessive punishment, malnutrition and disrespect to the acquired rights. In other words, the main causes of workers scape from the farms in the second half of 20^th century have almost no difference comparing with done in the second half of 19^th century. “The analyse of the daily life of a slave population indicate the submission to a permanent and exacerbated physical and psychological violence – real or imagined –, that could provoke stress problems”³³33. Amantino M. As condições físicas e de saúde dos escravos fugitivos anunciados no Jornal do Commercio (RJ) em 1850. Hist Cienc Saude-Manguinhos. 2007; 14(4):1377-99. (p. 1386).

Studies have demonstrated modern slavery impacts on the victims. A research on experiences of women survivors from human trafficking in England have showed the presence of infectious diseases and psychological trauma³⁴34. Dando CJ, Brierley R, Saunders K, Mackenzie JM. Health inequalities and health equity challenges for victims of modern slavery. J Public Health (Oxf). 2019; 41(4):681-8.. Haase³⁵35. Haase E. Human trafficking, public health and the law: a comprehensive analysis of intersections. J Public Health (Oxf). 2014; 22(2):121-9.and Oram et al.³⁶36. Oram S, Abas M, Bick D, Boyle A, French R, Jakobowitz S, et al. Human trafficking and health: a survey of male and female survivors in England. J Public Health (Oxf). 2016; 106(6):1073-8.have demonstrated that the physical wellbeing of freed workers is affected by violence, injuries due to the transport, labour activities and degrading conditions. The signs and symptoms of accidents often reported are headache, back pain, significant weight lost, malnutrition, depression, post-traumatic disorder, anxiety disorder, suicidal ideation, abusive alcohol consumption and other drugs.

In summary, in the perspective of social movement agents the slavery impacts are extremely strong enough to affect the body and mind potentiality of the people submitted to such condition.

The social movements’ discursive line is that the slavery lead to human being destruction. Under this understanding, the slavery is a process of body and mind destruction, because all human dimensions are affected by that experience.

This notion of body destruction was highlighted by Mustakeen²⁵25. Mustakeen SM. Slavery at sea: terror, sex and sickness in the middle passage. Chicago: University of Illinois Press; 2016.who observed a process of ‘unmaking bodies’ through the physical, psychic and emotional slaves` conditions under an overwhelming power dynamic. That process of unmaking bodies results in mental disorientation, communal and familiar separation, malnutrition, absence of sanitation and hygiene, severe isolation, disestablishing diseases, sexual abuse and psychological suffering. The slavery regime is a dehumanizing operation, which deplete the limits of the human and exposing to constant dangers and risks reducing to a thing condition³⁷37. Esterci N. Escravos da desigualdade: um estudo sobre o uso repressivo da força de trabalho hoje. Rio de Janeiro: Centro Edelstein de Pesquisas Sociais; 2008..

Slavery produce a violated and fractured body, and both contemporary and colonial forms of slavery operate logics based on the necropolitics project of modernity that make human existence an instrument or a mere thing and destroy bodies and populations³⁸38. Mbembe A. Necropolitics. Public Cul. 2003; 15(1):11-40.. More than the perversity of ones over others¹⁶16. Bales K. Ending slavery: how we free today´s slaves. London: University of California Press; 2007., the slavery manifest itself as a denial of rights, absence of worker recognition showed in terms of violation of their body and life expectance¹³13. Honneth A. The struggle for recognition: the moral grammar of social conflicts. Great Britain: Library of Congress; 1995.. The social movements understandings demonstrated those large and deep dimensions of modern slavery that generate physic pain and psychological sufferings that are forms of disregard toward human being wellbeing and can play the same role of the organic infections in the body reproduction¹³13. Honneth A. The struggle for recognition: the moral grammar of social conflicts. Great Britain: Library of Congress; 1995..

The role of the of the SUS in the face of modern slavery

The social movements’ discursive production has revealed the recognition of the health services value regarding modern slavery to contribute in detecting new cases, recovering victims’ health, providing worksite surveillance and inspection in a collaborative approach with movements and other state bodies, and researching and producing knowledge.

The health sector is pivotal to identify new modern slavery cases because Brazilian health system “is a point of entry to just about everything” (Joana).

Many people under modern slavery situation go to health services, receive care, have contact with health professionals and go back to the same situation. If the health sector has the sensibility and mechanisms to adequate identifying the new cases, it would be possible to reach innovative outcomes, because health services are located in a wide range of territories around the country. The community health workers (CHW), for instance, are professionals of great potential to accomplish this task, because they get in communities and gain accurate and ground knowledge about the community reality. They have a particular knowledge because they live in the same territory where they work and are immerse in its dynamic and culture. It, for itself, denotes unique possibilities to reach important actions to deal with modern slavery.

One research carried out with 12 rescued people from modern slavery in Los Angeles³⁹39. Baldwin SB, Eisenman DP, Sayles JN, Ryan G, Chuang KS. Identification of human trafficking victims in health care settings. Health Hum Rights. 2011; 13(1):36-49., demonstrated that all of them got in public health services and their slave conditions was not identified by any health professional.

Some initiatives and recommendations are being created in some countries, like England⁴⁰40. Such E, Jaipaul R, Salway S. Modern slavery in the UK: how should the health sector be responding? J Public Health (Oxf). 2020; 42(1):216-20.,⁴¹41. Such E, Walton E, Bonvoisin T, Stoklosa H. Modern slavery: a global public health concern. BMJ. 2019; 364:i838. and New Zeeland⁴²42. King P, Blaiklock A, Stringer C, Amaranathan J, McLean M. Slavery in New Zealand: what is the role of the health sector? NZMJ. 2017; 130(1463):63-9., has been carried out to provide advances and avoid health sector omission concerning modern slavery.

From the point of view of health care, the social movements discourse predicate that Brazilian health system has not yet dealt with illness processes caused by modern slavery to offer proper treatment, assistance and rehabilitation to the slavery victims.

The needs to physical and mental health recovery to the victims imply greater engagement of the health sector to set up knowledge and practice regarding modern slavery impacts and therapeutic strategies.

The social movements’ discourses demarcate the need for public health system to improve knowledge about the impacts of modern slavery on health and the ways to support post-rescue life, in order to better qualify the action of entities engaged in struggle against modern slavery.

Although modern slavery is one of the greater examples of global health inequality and inequity, health professionals, generally, once in front of the victims, have difficulties to recognize and offer specific care to this particular condition⁴⁰40. Such E, Jaipaul R, Salway S. Modern slavery in the UK: how should the health sector be responding? J Public Health (Oxf). 2020; 42(1):216-20.

41. Such E, Walton E, Bonvoisin T, Stoklosa H. Modern slavery: a global public health concern. BMJ. 2019; 364:i838.-⁴²42. King P, Blaiklock A, Stringer C, Amaranathan J, McLean M. Slavery in New Zealand: what is the role of the health sector? NZMJ. 2017; 130(1463):63-9..

These barriers in health care need to be faced and overcome, because “people who survive extreme forms of exploitation are often in need of urgent, as well as ongoing healthcare, especially mental health support”⁴³43. Stanley N, Oram S, Jakobowitz S, Westwood J, Borschmann R, Zimmerman C, et al. The health needs and healthcare experiences of young people trafficked into the UK. Child Abuse Negl. 2016; 59:100-10. (p. 110).

Although little studies have verified the implications of modern slavery on health and the participation of public health in care to the victims, efforts have been done to create clinical protocols to support care⁴⁰40. Such E, Jaipaul R, Salway S. Modern slavery in the UK: how should the health sector be responding? J Public Health (Oxf). 2020; 42(1):216-20.

41. Such E, Walton E, Bonvoisin T, Stoklosa H. Modern slavery: a global public health concern. BMJ. 2019; 364:i838.-⁴²42. King P, Blaiklock A, Stringer C, Amaranathan J, McLean M. Slavery in New Zealand: what is the role of the health sector? NZMJ. 2017; 130(1463):63-9..

From the health surveillance point of view, there is little articulation among the Brazilian health system, especially by the Workers Health Reference Centre, and discontinuity in collaborative interinstitutional actions to inspect worksites. “[...] we had the Workers Health Reference Centre in the State Commission for the Eradication of Slave Labour, which is the worker’s health, this is a field, they helped a lot” (Gabriela).

This disarticulation is a critical point, because the main concern of the social movements is to adopt strategies to transform the scenario of workers submitted to modern slavery. It requires the development of robust networks and alliances, because slavery involves structural factors of the Brazilian socio-political formation. In order to dismantle slavery process, the slavery routes and culture rooted in society must be broken down. In addition to repressing practices, it is important to overcome communities’ vulnerabilities.

For this purpose, social movements have organized networks to integrate the Ministry of Labour and Employment, the Public Labour Prosecutors, the Human Rights Secretariat, to carry out collaborative inspections in work environments, and to participate in councils / commissions such as the State Commission for the Eradication of Slave Labour (COETRAE), the State Human Rights Council of MT, among others.

Social movements recognize important experiences of specific networks to provide training, overcome vulnerabilities and break slavery cycles, such as Integrated Action Movement (MAI) and Integrated Action Network to Combat Slavery (RAICE). They seek to reduce communities and workers economic vulnerabilities and generate income to strengthen the economy and sustainability, preventing them from being suppliers for the slavery cycle, establishing connections between entities, government, including the municipal health department. Even so, the health sector is not yet connected to these networks of denunciation, reception, surveillance, care, education and elaboration of strategies and policy in the councils in a robust and consolidated way. In addition to the preventive and recovery actions, the health sector can contribute to community empowerment and health education in schools, in awareness campaigns, as they already do in relation to smoking and cancer³⁵35. Haase E. Human trafficking, public health and the law: a comprehensive analysis of intersections. J Public Health (Oxf). 2014; 22(2):121-9..

The social movement point of view, thereby, coincide with what many authors have been predicating: modern slavery is an important Public Health Problem and must be present in public health services agenda, in the policy plans and in health professionals training⁵5. Leão LHC. Trabalho escravo contemporâneo como um problema de saúde pública. Cienc Saude Colet. 2016; 21(12):3927-36.,³⁴34. Dando CJ, Brierley R, Saunders K, Mackenzie JM. Health inequalities and health equity challenges for victims of modern slavery. J Public Health (Oxf). 2019; 41(4):681-8.,³⁵35. Haase E. Human trafficking, public health and the law: a comprehensive analysis of intersections. J Public Health (Oxf). 2014; 22(2):121-9.,⁴⁰40. Such E, Jaipaul R, Salway S. Modern slavery in the UK: how should the health sector be responding? J Public Health (Oxf). 2020; 42(1):216-20.

41. Such E, Walton E, Bonvoisin T, Stoklosa H. Modern slavery: a global public health concern. BMJ. 2019; 364:i838.-⁴²42. King P, Blaiklock A, Stringer C, Amaranathan J, McLean M. Slavery in New Zealand: what is the role of the health sector? NZMJ. 2017; 130(1463):63-9..

Final remarks

The paper presented antislavery social movements understandings concerning to repercussions of modern slavery in workers mental and physical health and its implications towards the Brazilian health system.

Knowing the point of view of those who are in constant touch with people submitted to slavery conditions and receive these workers to help them and make denounces, provide an original and relevant understanding. Furthermore, the experience of giving attention and help the worker in slavery context afford an opportunity to characterize the phenomenon with a precious primary source – the voice of the enslaved worker. In this relationship of mutual trust, the worker is able to spell out and narrate their histories full of abuse and violence. For this reason, social movements’ agents account the modern slavery as the destruction of the body and mind potentials of human being.

The social movements’ discourses have revealed many impacts on mental and physical health of people submitted to slavery. Slavery is a situation that hurts human being entirely and it is connected with different forms of illness and death processes.

The social movements’ own action against slavery – through direct contact to the workers – is, in itself, an essential health practice to warrant a life with minimum ethical parameters, attention and care, capable of preserve workers integrity and lead them to healthier work-life experiences towards real emancipation and liberty from slave relations.

The social movements’ perspective guide to the conclusion that modern slavery represents the denial of the Right to Health, because all the basic elements to strengthen of the populations’ health are precarious in slavery situations: feeding, lodgings, work, transport, leisure and access to medical and health services. More dialogues, close information flows, and collaborations between social movements and health sector, thus, could be timely for mutual learning, advances and strengthening to effective right to health.

Certainly, there are many barriers and challenges to be faced. For instance, amplifying the recognition of modern slavery as a public health services concern and the recognition the health professionals have responsibilities in this issue; improving structures and working conditions in the health sector regarding their high demands; encouraging researches to better know the impacts of modern slavery on health; creating strategies to broad the engagement of health sector in this regard, and establishing more articulations between social movements and health professionals. These elements contribute to overcome gaps in Brazilian antislavery experiences.

Brazil has different offices and bodies that organize and carry out systematic actions to combat modern slavery. There are the National and State Commission for the Eradication of Slave Labour that implement and monitor national and state plans to eradicate slave labour and there are also the Judiciary Brazilian Bodies, the police actions and labour inspectors from Ministry of Economy, the Integrated Action Movement (MAI), the International Labour Organization Office and other Non-Governmental Organizations like “Reporter Brasil”. They produce information and public denounces, monitoring the cases, publishing reports and statistics on slavery occurrences and they have created social and juridical projects to support the victims. They also elaborate strategies to open trials to companies that has submitted people to slavery, among others actions. Regarding these actions, the knowledge and practices of social movements in articulation to health sector could contribute to amplify and strengthen them and reinforce the Brazilian antislavery programs and plans.

References

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