Jonathan Haeber
for National Geographic News
November 20, 2003

View an Impact: From the Front Lines of Global Health Photo Gallery: Click Here

Impact: From the Front Lines of Global Health, an in-depth look at global health issues from AIDS to obesity, is the latest book (details) issued by photojournalist Karen Kasmauski. National Geographic News spoke with the National Geographic Contributing Photographer-in-Residence about the insights she's gained documenting human health crises around the world.

A range of health problems—AIDS, obesity, SARS—are addressed in Impact. Which one do you feel requires the most attention?

Two drops of oral polio vaccine will protect a Bangladeshi boy from a scourge that once crippled millions of children. Global efforts have almost eradicated polio and Guinea worm disease, an African affliction that can impact whole communities. Photograph copyright Karen Kasmauski, National Geographic Society

The reason why I wanted to do a book like Impact was not to emphasize any disease but to emphasize change in geography and the repercussions of those changes, whether it's disappearing borders, increase in population, or destruction of our natural environment. Unhealthy conditions, which give rise to disease, are usually the end products of these disruptions.

How does globalization affect these health issues?

I think globalization is a two-edged sword. In one way, it's great to be connected to everybody, but the reality is that there is unfairness in how wealth is distributed. We're not really paying the true price of what it costs to produce items and that's sort of the unfairness of globalization.

How did you get interested in health issues?

There are things that you observe in the course of your job. My first story on health, I was wondering why everywhere I went to cover an epidemic there was disruption going on, whether it was environmental or political. This was back in the early '90s, and it made me think about the whole ecology of disease. That story was sort of my jumpstart to thinking about health in a much more global way. If you're aware of it—if you're an observer—you do notice these things along the way. And that got me thinking about how interesting it would be to look at how changes in geography can affect our health. Of course, working for National Geographic, geography is a major part of our mission.

How does it affect you when you're photographing people with health afflictions, or people who are starving?

I'm as guilty as the next person of enjoying a comfortable lifestyle. But one of the hardest things I face is coming back in from a developing country. I was shocked when I realized how overwhelmingly soft we live, how consumer oriented we are, how spoiled and how wasteful we are as a population. That is very hard to deal with. When [you hear that] to eliminate AIDS in Africa it would take so many billions of dollars, it sounds like a lot of money, but when you think about the fact that this war in Iraq will cost $400 billion, then you realize it's not really a lot of money, and that is a major issue that we could solve if we put our minds to it.

Do you see the biggest present-day problem as AIDS?

No, I don't. The biggest problem in health is not one particular disease; it's the lack of empowerment of women, the mistreatment of children, and poverty. AIDS is a big disease—it's affecting a lot of people—but the reason why it's spreading so rapidly is women have no control over their own lives and they are afraid, or they're being told to follow arcane practices. I don't want to say women should be running the world, but they should have the right to be healthy and have healthy children. There are a lot of cultures that don't allow that, in some ways certain elements of our own culture. Those are the things that are the biggest threat to health in our world, as well as not having clean water and nutrition. It's really not any one disease that is the biggest threat, it is the conditions that are causing diseases to take hold.

Are you optimistic about change in the future?

If we can get over the politics—politics in a very broad sense—then I think there is hope. There are a lot of people on the ground who are dedicating their lives to helping people in whatever arena it may be, for the good of the planet, realizing that we are a planet. We are an island in the solar system. We have to eventually live together or destroy each other.

How do your photographs communicate this?

I used to think that photographs could change the world, but in the twenty-odd years I've been in photography, I haven't seen a whole lot of change. In some ways, photography doesn't do a whole lot other than sing to the choir. There are people who are moved by one image or one story, but I think it really takes a big effort by everybody to decide that they want to make change. Unfortunately, we're in a toxic environment, and I don't just mean environmentally; I mean socially also. Unfortunately, faith is not being used to bring people together; it's being used to separate people from each other.

Do you have a favorite photo in the book?

I've always liked the picture of Fanny, who is the middle-class mother in Macon, Georgia. She got AIDS from her husband and they both have since died. She and her husband had just had a big fight; she's lying on the bed and he has his head in his hands. I debated whether to take that picture, because it was a very private moment, but then I realized that one of the big issues of AIDS is that it disrupts families.

Another picture I like is also related to AIDS—and I don't mean to focus specifically on that—is of a man in a flophouse in San Francisco showing us a picture of his daughter. He died [of AIDS] about two weeks after that picture.

How can Americans who haven't been to the places that you've been get some perspective?

I don't think people realize that there's something beyond their immediate community. If you see that there's a larger world out there, you're not going to have a lot of available space to fill with your own neuroses. You also realize that some problems, like not having the proper cheese or not getting the car you wanted, are not really that important.

I'm hoping that, through my photography, I can expose people to these cultures and the different ways people live. If we had looked more at Middle Eastern culture, and looked at Islam more, we might have had a better understanding so when these unfortunate horrible events have occurred maybe they wouldn't have occurred in the first place, maybe we would've made different moves, maybe our society would've acted differently. I don't know. You need to get information out there that talks about different lives, different cultures, different ways of viewing the world. Not everyone views the world the way we do, and I think it's important to understand that.