The Pain of Representing Pain
An interview with social scientist, Arsenii Alenichev
Arsenii Alenichev, lead author of “Assembling a global health image: Ethical and pragmatic tensions through the lenses of photographers”, spoke with Jon Shaffer about how photographers face pressures to stage, shape, and alter ‘global health’ images.
Photo by Ning Shi.
JS: Why interview photographers? Global health photographers specifically?
AA: Well, I think it goes in unison with kind of the recent wave of studies in global health that try to learn about interventions from the point of view of frontline workers, e.g. of nurses or lab technicians, and others, to see how the problems that we're dealing with are perceived by people who are doing actual labor. In terms of photography, and representation, it is photographers that produce images that would be disseminated on behalf of global health organizations. And those images are always political agents. Right? So they would always be kind of stimulating or challenging stereotypes about people, especially people from the global South. So that's why photographers because I was really curious to learn about how the stereotypical global health images are enacted in real world contexts and what are kind of challenges, or maybe like dynamics that might be overlooked
JS: Who all did you interview? What kinds of photographers and what were their backgrounds?
AA: From all over, really. Because initially I started messaging the global health networks that I'm part of that wasn't really successful. And then I just started literally googling Global Health Photographer. And it showed me professional websites of photographers. And, you know, I saw that some of them work for WHO, you know, Unicef, I don't know, various charities. So the category of global health photographers is something I projected onto photographers. Some resisted it, but most of them accepted it.
The history of global health photography is largely abusive photojournalism. And in response to that, there has been the emergence of various marketing and communication teams that kind of try to moderate the images that are produced.
In the end, I interviewed like 29 photographers from all over the world. It’s interesting that most of my informants were not white. That is something that I didn't expect because historically, you know, global health photography has been dominated by kind of, Western, mostly white photographers on parachute assignments. But, you know, I also kind of was explicit in my recruitment email that I wanted to talk about the challenges and problems experienced by photographers. Maybe that's why a lot of critical people were attracted to it. There was probably a bias or a peculiarity of the sampling.
There was definitely a problem, you know, with global health photography: the tension between photojournalism and marketing. The history of global health photography is largely abusive photojournalism. And in response to that, there has been the emergence of various marketing and communication teams that kind of try to moderate the images that are produced. So photographers are often expected to produce a certain kind of image.
JS: So what did these photographers tell you? What was the story? What was their experience and what did they share?
AA: Yeah, I mean, a lot of people, they were happy that they're doing this kind of job. But a lot of people, they openly said that they are in constant, tedious negotiation with the comms [communications and marketing] people.
Assignments typically contain an actual description of what images a photographer should take, like a list of images. And often the problem is that, you know, people in communications, they're often sitting in London or in New York, and they envision what the local would be let's say, in, in West Africa. And they send photographers a shot-list of what images they need. And often photographers don't have enough time or resources to do the assignments ‘properly’. They don't often have the freedom to do things differently, to challenge those briefs. So it kind of leads to a situation where photographers are pretty much structurally forced to stage things, assemble scenes to meet the requirements, especially for young photographers just entering the emerging field and they really want to please the institutions so they can get more contracts and build their name. And they really try to stick to, you know, the briefs. And these briefs can be, well, they can be either looking for the images of empowerment, like, you know, working class women smiling in fields while doing manual labor or the poverty porn type of images. You know, someone in misery.
And again, for journalists, whose goal is to somewhat describe the ‘reality’ – but then the question of what reality is comes up – or to at least minimize the representational bias as much as possible. I mean, it's often an impossible task. But still, for global health photographers, this is a major problem because it's very difficult to represent local people and communities without a kind of predefined idea of how this community should be depicted.
JS: And how did they feel about that? How did they feel about those tensions, those problems, those ambivalences?
AA: Well some photographers, they were really happy because they could, you know, claim the northern pay rates, which can be like really, really a lot. Northern pay rates can be like several hundred dollars per hour. And if you and if you live in a context where $100 is a monthly wage, you can clearly see how people would kind of become local elites, almost, economically speaking. Upper middle class, definitely.
While other people, especially younger photographers, experienced problems because they all have to compete with each other, and it’s precarious because there are not many insurances provided to photographers Compared to Western photographers. A couple of people told me that their friends died on assignments or something else terrible happened – that they got sick, that their stuff was stolen, there was no insurance – so, local photographers are now trying to kind of push back against these kinds of contracts and assignments. Photographers try to organize and push back in terms of arguing for a more equal pay scale. So you have a situation where people are either severely underpaid or people are just being overpaid. So there's like almost nothing in between, you know?
JS: A lot of work goes into shaping, staging, sort of re-enacting local scenes to produce these images. What does this mean for the visual culture of ‘global health’?
AA: Well, in the end people sitting in the Global North offices, they envision the Global South in particular. If unchallenged, we'll just have the continuation of the same stereotypes. Again there's been a lot of criticism of the poverty porn and misery images. But now we have the emergence of, like the opposite, like the images of empowerment. And it seems that everyone is like, magically empowered at this point, which is, again, can be equally dehumanizing. Because if you just, I don't know, tell kids to smile. Or, like, make people smile for the sake of taking a photo. Again, the images are political agents. Right?
And, I think the very goal of this article was to demystify the production of global health images because empowerment can easily be reduced to a visual practice rather than something more meaningful. Again, the discourse of empowerment is still very neoliberal. So we should even probably ditch the concept and go beyond it. But in reality, for the global health action, empowerment can be easily reduced to a visual practice, unfortunately.
JS: So you've written a lot about the challenges of generative AI [artificial intelligence] in global health. Presumably these staged images become a kind of raw training data for this generative AI. How do you think about this?
It almost leads to a situation of, for the lack of better word, the production of “hyperfakes”, as in the situation when staged or of artificial images that exaggerate the posing, the composition, the misery, the empowerment; and those images are fed into the AI to produce another degree of fake images. So you can see that the fakery is amplified.
AA: It's actually very interesting. There is no clarity for how AI actually learns, but I think with quite some confidence we can say that some models learn from whatever is on the internet, if it's not a custom training data set. It actually creates a very interesting dynamic between what is considered fake and real.
Because if we assume that, you know, staged images are ‘fake’ in some sense or that they're staged, right? And AI approaches those images as ‘real’ and creates fake images based on those ‘real’ images. It almost leads to a situation of, for the lack of better word, the production of “hyperfakes”, as in the situation when staged or of artificial images that exaggerate the posing, the composition, the misery, the empowerment; and those images are fed into the AI to produce another degree of fake images. So you can see that the fakery is amplified. There are already examples of real global health organizations using generative AI for marketing and communication.
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I want to actually step back to the question of briefs, because often photographers don't just receive the text, they often receive specific past images as a point of reference. These could be real and they also could be AI generated. So those global health images at large, they're almost like self-fulfilling, self-amplifying, in a way. AI generated images aren’t solely the output to be published in the media. They can also be the point of reference of what image needs to be taken, and to be reenacted in real life. So, yeah, I’m fascinated by these cascades of imaginations and the ways we can challenge them.
I don't think it's very easy to challenge them, but at least we can study them and demystify them so the next time when someone looks at an image of some charity, some images of empowerment, the reader might be start questioning like, oh, how was this image taken and what was in the brief? Or, if it's an AI generated image, what was the text-to-image prompt? What was the textual medium that led to the emergence of that image?
And also don't forget about the issues with consent and power imbalances, because a lot of what photographers reported, people often feel coerced to be in the images. If an organization that is providing care is not attainable otherwise , people often feel – at least according to photographers – that photography is a prerequisite for receiving care. Some people would even think that photography entails care – that if they're being photographed, they are entitled to something. Other people would be afraid that the act of signing something on paper would just mean that they're going to lose the house, because, you know, signature in itself is a very interesting social practice. It has very different local meanings. Photographers also often reported that the consent forms become increasingly complex to the point of almost being impossible to explain in a lay manner. It's just hard. Yeah.
And photographers reported that images are sometimes just, like, problematically recycled. One of the most striking quotes came from West Africa, and the person told me that he took photos of a pediatric patient, a girl who passed away. But the images, they became the commodity of an institution. They became pretty much like a photo bank type of image, like a stock image, that has now been circulated and they cannot take it down. The same person told me that some of the images that he took in West Africa, they've been used by a major global health organization to depict something in East Africa. Which basically amplifies the harmful idea that, you know, ‘Africa is a country’ – just savannah from one ocean to another across the continent.
In relation to beliefs and ways in which they are often detached from reality, one photographer told me that they were asked to produce an image of a baobab tree in South Africa. But the image that they sent them was from Madagascar. This shows me how stereotypical images of Africa are kind of envisioned by the [NGO] communications people. I think photographers should have more agency into the ways their context should be represented. That's kind of one of the takeaway messages.
JS: What needs to change or what can change about the production of global health images and their circulation?
AA: I think the radical solution to ensuring ethicality of global health images is to make sure that we don't use them at all. Why do we even need those images?
And if we look at the postcolonial history of the Global South, the emergence of global health, photography can be linked back to things like structural adjustment policies. When the fragile postcolonial national health care systems were pretty much undermined by private-public partnerships. Photography was central to those partnerships. They always need images to show because they exist in a circumstance where those organizations require donations. So to receive those donations, they require emotionally triggering effects, triggering images.
In my opinion, global health photography and global health images are an indirect product of structural adjustment policies; one of its many manifestations.
In reality, I think what needs to change is for there to be a robust frontline health care system that is resilient and adaptive for everyone. Then, you wouldn't even need to commodify those images. So global health photography would be literally just reduced to photojournalism, you know?