Impact: From the Frontlines of Global Health by Karen Kasmauski and Peter Jaret. Washington, DC: National Geographic Society; 2003. 240 pages, softcover, $30.00.

The authors provide a breathtaking photo essay of contemporary society. They did not set out to make this a book that left the reader with a warm feeling that all is right with the world. Instead, they realistically, and with magnificent photos, displayed "the global conditions under which disease and epidemics emerge." Former President Jimmy Carter wrote the introduction to this photo journey and some of his most telling comments are: "As individuals, we can[horizontal ellipsis]extend ourselves to others. As communities and nations, we can educate our citizens, legislate ethically and wisely, and support organizations that conduct research and help those who are ill. Perhaps the most important challenge is to share wealth, opportunities, and responsibilities between the rich and the poor-for a world where the chasm between rich and poor grows wider will be neither stable nor secure."

The first chapter discusses the state of health across the globe. As a preamble to the book and especially to chapter one, Donald Hopkins, the Associate Executive Director of the Carter Center, which was founded by the former President and Mrs. Carter, offers a compelling appeal for us to do more to improve the world's health. The enormous differences in the quality of health, the birth outcomes, and the overall quality of life in industrialized compared to developing nations is emphasized. As we know, so many of the diseases that were considered cured around the world are now recurring, especially in non-industrialized nations. They are a threat to all, given the current era of global migration and travel. The photos and discussion in chapter one describe to readers the issues and challenges of an aging society that is growing obese and where hunger, pollution, and technology are growing by leaps and bounds. It also shows, in the most elegant way possible, key issues related to health care, AIDS, empowerment, and viruses. Consistent with the expected quality of the National Geographic, the photos are unbelievably good. As a person who has had the opportunity to travel to many of the countries portrayed, by either examining their health care or simply by being a tourist, I can truly appreciate the excellent photo journal and the reality of the photos selected for this excellent book.

Chapter two, which talks about symptoms of change in the world, illustrates, first, the mounting problems of communicable diseases. We know that old diseases that we thought were eradicated or for which vaccines were available and adequate are recurring in new and hard-to-combat strains. Similarly, new infectious diseases are occurring. Diseases like a rare influenza found in birds in Hong Kong or severe acute respiratory syndrome, or SARS, were unknown to us in the past. The authors compare contemporary infectious diseases to the age-old concept of evolution. They say, "Like all forms of life, the agents of infectious disease, locked in a struggle for survival, are constantly evolving."^(p48) The evolution that they describe only adds to the stress and unpredictability of contemporary life. In the past, how many of us would have really thought it was strange to get on an airplane to Asia and see passengers wearing face masks. Personally, I would have assumed they had an infectious disease or had just been released from a hospital. I would not have thought that they were trying to protect themselves from airborne diseases in the airplane.

Each chapter contains a compelling essay on the theme of the chapter followed by breathtaking photos. In this chapter, the authors focus on population and the many issues that accompany population changes, especially growth, lifestyle, the family tragedy of Alzheimer's disease, borders, political and social upheaval (including the unlikely but crucial topic of the resurgency of tuberculosis), environmental disruptions, and HIV/AIDS. The discussion and photos about the last topic in chapter two are compelling, including the pictures of the 50-year-old man dying of AIDS in a boarding house in San Francisco and the mother with HIV whose child was born with the virus. Before this woman, Fanny, died, she used her tragedy to help others by going into high schools and helping others understand what was devastating her life and family as a result of her husband's chronic drug use.

Chapter three, the final chapter, is "meeting the challenge." The range of topics moves from a family in Niger who must sleep under a bed net to avoid disease-carrying insects to an 80+-year-old California man who vaults in order to keep fit. The themes of this chapter are clean water, safe food; empowering women; woman to woman; vaccines; genetics; and healthy aging. I especially appreciated the closing pages that focused on healthy aging that portrayed older people both having a great time and also engaging in exercise and recreation designed to keep them young.

The authors have produced an excellent work. Clearly, it is a book that will appeal to the socially conscious. In words and photos, Impact, talks about what is the best and most perilous in today's society. It is a photo journey of reality that is worth taking.