Cassandra Wilson: There is absolutely a different skillset involved when a musician works with a vocalist. There's a different kind of breathing that happens when you work with someone who's singing lyrics than with someone who is playing notes. So it takes a different kind of sensibility and a different understanding of the shape of a voice. The voice is not the same as the instrument. The instrument is supposed to imitate the voice. That's why instruments begin to be used, is to be like a voice. But the voice has so many more facets than an instrument has. An instrument can be worked into having different layers of meaning, but the voice is ultimately the best at doing that.

Music Credit: “NY” composed and performed by Kosta T from the cd  Soul Sand, used courtesy of the Free Music Archive

Jo Reed:  From the National Endowment for the Arts, This is Art Works—I’m Josephine Reed.

Today—we’re revisiting my 2016 interview with Pulitzer-Prize winner, MacArthur Fellow, and photojournalist Lynsey Addario.

We know women make history; well they also document history—and sometimes they do both. In the current war in Ukraine, photojournalist Lynsey Addario recently took what many consider to be a war defining photograph. That of a church worker, a mother and her children killed by a mortar as they tried to flee the Russian bombardment outside Kyiv…their luggage strewn around them.  First seen on the front page of the New York Times, It is a picture that has resonated—that brings home the cost of this war for civilians…. This is what Lynsey Addario does--she has documented the price paid by women and children caught in the crossfire in every major theater of war in the 21^st century. Since her first trip to Afghanistan in 2000, Addario has focused particular attention on women living in male-dominated societies, gaining access to their schools, hospital rooms, and homes. Again and again—in Darfur, Iraq, Congo, Libya, Syria, and now Ukraine— Lynsey Addario has been showing us to ourselves. Known for combining journalistic rigor with the eye of an artist, Lynsey Addario’s work appears regularly in the New York Times and National Geographic and has been seen in museums throughout the world. I first spoke with her in 2016 after the paperback publication of her book, “It’s What I Do: A Photographer's Life of Love and War” a memoir rich in her startling often breathtaking photographs and an honest reflection on the life she’s chosen and the risks that she takes.

Lynsey Addario: I like doing things that are tough to get access to and to provide a new perspective, so I moved to India and I started covering Afghanistan under the Taliban. And that was in 2000 so it was before September 11th and it was also a place and a region that not many people were interested in and not many people had access to document life under the Taliban. Photography was illegal, it was very difficult to get a visa, it was hard to move around if you did get in, and so I went three times under the Taliban and then I moved to Mexico City to start working in Latin America and that’s when September 11th happened.

Jo Reed:  How did 9/11 change the trajectory of your career?

Lynsey Addario: Well, 9/11 for me defined my career. Immediately I knew I had to get back to the region, I had to get back to South Asia, get to Afghanistan, get to Pakistan, it was a region that I knew very well by then and I also sort of had a body of work already from before when the Taliban was in power and I thought—continuity is also something that’s very important to me. So I was—basically got on the first plane in—out of Mexico City and then went almost directly to Pakistan and waited for the fall of the Taliban in Kandahar. So to me 9/11 and the War on Terror basically defined the next 15 years of my life.

Jo Reed:  You've traveled and you've worked a lot in Muslim countries and as we know these societies are very much segregated by gender but you worked with that and made it work for you. 

Lynsey Addario:  Yes, the Muslim world is segregated by gender and I think what’s interesting is that as a woman people always ask me, “Is it a hindrance that you’re a woman? Does it hold you back? Is it worse?” and actually no, it’s an absolute asset. And I have found incredible hospitality and access in the Middle East and in the Muslim world I think because I’m a woman and because I’m very sincere and I go to people and say, “Look. I want to show people what your lives are like” and I think that that’s something—as a woman I can go into families’ homes; I can meet both men and women; I can do the stories that my male colleagues do to some extent. I mean of course there are limitations but I can also document the women and so for me it’s been very important to capitalize on that and to use that because I think it’s very important to see both sides or all sides of any story. And so if my male colleagues can’t photograph women or can’t get access to people’s homes in a place like Afghanistan, well, then I should. 

Jo Reed:  Lynsey, what drew you to photography?

Lynsey Addario:  When I was about 12 or 13 years old I was visiting my father-- my parents had separated and I was at his house and I saw a Nikon camera, and I asked about it and he gave it to me and I started playing with the camera and became obsessed with photography, but for me it was always something that was a hobby; I didn’t know any photojournalists, I didn’t know any professional photographers except for a few people, and I just never really considered it something that I would do for a living.

Jo Reed: How did you figure out photography could be a career?

Lynsey Addario: I was studying international relations and graduated from the University of Wisconsin and when I graduated all I wanted to do was photograph, and I still at that point wasn’t familiar with photojournalism so I didn’t realize that you can sort of marry international relations with photography and use the research and use my sort of wherewithal of what’s going on in politics and the economy and combine that with photography until I moved to Argentina and that’s when I started becoming aware of pictures in the newspaper and I really started getting into photographing for the news and photographing the news and photographing international stories.

Jo Reed:  Let me ask you, how did you learn to compose a picture?

Lynsey Addario:  There used to be a bookstore in Soho called A Photographer’s Place and in the ‘90s when I moved back to New York after Argentina I used to just sit in that bookstore and look at photography books every day basically. A lot of them were war photographers but I wasn’t even interested in war at that time; I just found the images really dramatic. There were a lot of different photographers who influenced me and inspired me at that time and I would look at their composition, and I think it’s interesting with photography because even if I’m not conscious of the fact when I’m taking a picture I might be mimicking someone or I might be recalling an image I’ve seen somewhere in the reserves of my mind and my memory, I think it happens. So for many, many years I was looking at these books and images and then I started freelancing for the Associated Press in New York and I had an incredible mentor, Bebeto Matthews, and he really helped me-- helped guide me with composition and taught me to sort of get closer and get more intimate with the subject and really get in there. And I also had great editors at the AP at the time; I was really, really lucky to get a lot of one-on-one feedback and it taught me sort of everything.

Jo Reed:  You did an early series on transgendered prostitutes in the meatpacking district of New York City and I wonder how that assignment helped you become the photographer you became.

Lynsey Addario:  So in 1999 I was freelancing for the Associated Press. I had been freelancing for them for about three years, and I still hadn’t really done a long-term story and-- an in-depth photo essay and Bebeto came to me, my mentor, and he said, “We’ve got the story on a series of murders in the transgender prostitution community in New York and we would like to sort of get inside that community and do a profile and we basically thought you would be great to try and do this.” And so I of course was so excited by the idea of getting into this community that was very hard to penetrate and to access and also to do a story that was more sensitive and something that I felt what would interest me about photo essays is doing stories that I feel like the general public isn’t already bombarded with images and ideas from. So I like doing new things, I like doing things that are tough to get access to and to provide a new perspective, so for me this was my first opportunity. And I went down to the meatpacking district, and this is in 1999 so it was pretty gritty at that point, and I basically hung out there for weeks before they started inviting me into their homes in the projects and the Bronx and then eventually just learned how to be patient and how to really make people feel comfortable and how to not only get the obvious images but to get the quieter images and that was a very-- an incredibly instrumental and important project for me.

Jo Reed:  You make it clear that photography is about relationships, that your photography is about relationships. 

Lynsey Addario:  Correct. I mean for me I’d say 80 percent of photography is about relationships, is about access, is about being there, getting there, doing your homework. There’s so much that comes before actually taking a picture and so to me that’s the most important part because not only is it about access but it’s about understanding who the people are that I’m photographing and letting them know that I am not judgmental, I am strictly there to tell their stories, and that’s something that I think any journalist has to sort of impart when they meet someone.

Jo Reed:  And for your work abroad, you really credit your interpreters and your drivers in teaching you and  opening doors for you.

Lynsey Addario: Correct. Nothing about my career would be possible without my drivers and translators because they have provided me with translation, access, instinct, they’ve kept me alive, they’ve been everything, and I think that they are the people that-- they’re the sort of invisible people in the culture of journalism because they rarely get credit. They’re often the ones killed in war zones; they’re the local people who sometimes pay a price for helping facilitate interviews once we leave. They’re incredibly brave and dedicated people that I’ve worked with over the years, and I mean I can’t say enough about how grateful I am and how wonderful and how lucky I’ve been to work with such intelligent people.  

Jo Reed:  You’re a reasonable person, and your work puts you in situations that are often dangerous, violent—you have to be scared at times. What do you do with that fear?

Lynsey Addario: I guess during the fall of the Taliban in 2001 when we were getting ready to go into Kandahar was really the first time I was sort of terrified. And I was very conscious of the fact that this fear is an integral part of doing this job and I don’t believe that people should pretend like they’re not scared but I do believe it’s important to recognize the fear and to try and understand where it’s coming from and what the actual dangers are and to just be focused. So it’s—I take that fear and I put it in a very specific spot and I am in touch with it often as I’m working but the thing is I have to keep working; I have to keep photographing. 

Jo Reed: How important is intuition?

Lynsey Addario: The most important thing about this job is listening to one's instinct and also to sort of check back in with colleagues and people who know a situation and who also can read a situation and so in Libya, for example, we had been working on the front line for several weeks every single day in the throes of incredibly difficult combat. We were watching people die all around us for two straight weeks and then I sort of started feeling, well, my number’s going to come up; I mean we have to get out of here; we’re really testing our fate a lot. I felt like something was going to happen, I just had this feeling, and so I actually gave a hard drive of all of my images up until that point to Bryan Denton, a colleague at The New York Times, and said, “Look. If something happens to me, can you please make sure my pictures survive and FedEx this hard drive to my agency?” and in fact two days later we got kidnapped.

Jo Reed:  Well, let’s talk about that kidnapping. You were with three of your colleagues. Tell me what happened?

Lynsey Addario:  Well, it was March 15th, 2011, and I was working with Tyler Hicks from The New York Times and we were in a car with our driver, Mohammed, and Anthony Shadid and Steve Farrell, also from The New York Times, drove in from Benghazi to meet up with us in Ajdabiya and Ajdabiya at that point was sort of a front line. It was an area that the rebels were holding and Kadhafi’s troops were moving in pretty quickly from the west, and so from that morning we had a sense that the city was going to fall into the hands of Kadhafi’s troops but we continued working. We were in two vehicles, which is a precaution that many journalists take in case one vehicle breaks down or something happens you have a backup car. We were in two vehicles and at some point as the fighting got heavier and heavier and as the combat was moving in, one of the drivers, Anthony and Steve’s driver, just quit; I mean he literally stopped the car in the middle of the battle and said, “My brother’s been shot. I’m leaving” and he dumped their stuff on the sidewalk and left. And so we all ended up in one car. There were four of us and Mohammed, the driver, and at that point it was clear that the city was about to fall. And so we got word that Kadhafi had snipers in the city. We started hearing bullets, snipers, which means obviously there are troops in the city, our driver started getting phone calls saying Kadhafi’s men were in the town, and when we finally made a decision to flee east we ran directly into one of Kadhafi’s checkpoints. We sort of saw them on the horizon and at that moment you have to make a decision. It’s chaos because everyone in the car knew that that was the worst possible thing short of getting hit—short of getting shot or hit by a mortar—the worst thing that could happen is getting taken by Kadhafi’s troops because Kadhafi had repeatedly announced, “If you see journalists or spies then you should kill them.” And so we were all fighting about keep driving, don’t stop, stop the car, everyone was sort of yelling something different, and when we reached the checkpoint it was complete mayhem. Mohammed stopped the car, jumped out, said, “We’re journalists” and we never saw him again because the rebels started opening fire on our checkpoint and so we were literally caught in a wall of bullets and eventually we got behind this sort of cement building because of course we had to get behind cover; I mean the most dangerous thing were the bullets. And so we got behind this building and there were a handful of soldiers and they told us to lie face down in the dirt and they put guns to our heads, they asked for our passports and they started searching us and tied me up, tied my hands behind my back and my feet together. They decided not to shoot us for whatever reason; later Anthony Shadid translated that the commander said you can’t kill them, they’re American, and then we were sort of carried away and put in vehicles on the front line so literally for hours as bullets and mortar rounds and tank rounds landed all around us we were tied up in these vehicles in the middle of the fighting. Over the course of the first three days we were tied up, blindfolded, beaten. The men were really smashed in the back of the heads with the butts of the guns. For me, as the only woman I was groped repeatedly, they touched my breasts and my butt and were very aggressive, also punched me in the face and repeated death threats, repeatedly “We will kill you tonight”; “Tonight you will die.” I’ve been held hostage twice now actually, once in Iraq and once in Libya, and the scariest thing about any experience or that particular experience is that you don’t know what’s going to happen next. So I think the mind is very powerful and it has the ability to survive and to go into the survival mode and to just stay alive but the scary thing is you have no idea how long it will last and how bad it will get.

Jo Reed: Did your family have any sense of where you were or what was going on? What were they thinking?

Lynsey Addario: I think the most stressful thing for me about this job is what I put my family through and what I put my husband and my parents and my sisters—I mean I come from a big Italian American family and we’re incredibly close and we all talk on the phone all the time and we’re very tight. So I think when I was in Libya we were held for about a week and the entire time all I can think about was I feel so horrible for what I’m putting my family through because I knew that to them we were missing. And we had no idea what the outside world knew, we had no idea if Libya had admitted to having us or if they thought we were dead, and in fact we found out later that for the first three days there was no information about us. And my husband who was a journalist with Reuters for many years he intuited obviously that if our bodies hadn’t turned up we had just been captured and so he started sort of working the phones and dealing with his contacts in Turkey because he had been bureau chief in Turkey. And at that time Turkey was acting for a proxy for the American government who had already pulled out. My husband is incredibly solid and pragmatic and he’s a journalist so he understands this work and so I knew he would be okay but there’s an incredible amount of guilt, you know I just feel horrible about what I’ve put my family through both times. And of course it was easier before I was married because it was me. Now I have a son and I have my husband and I carry that with me.      

Jo Reed: The full title of your book is It's What I Do: A Photographer's Life of Love and War and you're very honest about your personal life—because you're a photojournalist who worked primarily in conflict zones that it was very difficult and challenging to have relationships. 

Lynsey Addario:  Yeah. I mean for many, many years it was almost impossible. I think it depends on the person. Obviously, any relationship takes work and it takes commitment and I kept fooling myself into thinking that I was putting a lot of work into relationships when in reality I was never home.  You know, all I really cared about was becoming a photojournalist and covering these stories that I felt were so incredibly historic and important to cover. And I just wanted to be in Iraq and Afghanistan, in Darfur, in Congo, in all these places covering stories that I really believed needed the coverage.  And so, whatever relationship I was in was always sort of second to that passion and to that belief that I had to be there.

Jo Reed: You quote the great photographer Robert Capa, as saying, “If your pictures aren't good enough, you're not close enough.” But that is an especially hard thing to do when you have a husband and a child, particularly.

Lynsey Addario: Yeah, I mean I think anyone who’s a photographer who covers dangerous situations knows that there's no secret; you have to be there.  You have to be on the front.  You have to be exactly where the action is.  If your goal is to cover war, there are certainly tons of stories on the margins of war and other humanitarian stories, stories that are less dangerous.  And so, since Libya, I’m still working in many of the places that I used to work in like Afghanistan and Iraq, and I went into Syria recently.  But I'm trying to do it by covering the humanitarian angle or trying to cover the margins rather than being in the throes of combat.

Jo Reed: You're taking pictures of people in heartbreakingly tragic circumstances, and it would seem to me that your camera is a way of on the one hand letting you get to the heart of what's going on but on the other hand kind of provides some protection as well, some emotional distance. Is that accurate?

Lynsey Addario: That's totally accurate.  I would say my camera, first of all, enables me access, because everyone understands what a photojournalist does.  There are very few parts of the world one can go now where people are not familiar with photos and cameras and journalism.  And so, I do get access to these unbelievably intimate moments that I sometimes can't even believe I'm there.  I think when it is a particularly heart-wrenching scene or if I’m photographing someone dying or it's a funeral or—I’ve seen everything.  I often keep the camera in front of my face as a way to not get too close, as a way to sort of distance myself and almost pretend I'm watching a movie rather than actually being present, because the second I put my camera down, I often get very choked up and I get very overwhelmed.

Jo Reed: When you're in a situation where news is breaking—conflicts are right in front of you, how does the artistry, the composition of a picture come into what you do at that moment? 

Lynsey Addario: Well, sometimes it's almost impossible to think about how to compose a shot in the middle of complete chaos.  Obviously, it's ingrained in my mind at this point. I don't think about it that much.  Honestly, I've been taking pictures for so many years, and I've taken thousands and thousands and thousands of pictures <laughs> and when I approach a situation, I’m immediately looking for certain elements.  I'm looking for the subject, the story, the light, the composition, and I’m looking for the frame in which it all comes together at once.  And so, even if I'm covering a battle, I’m looking for those very specific things.  And sometimes, if I don't have the time to compose, well, I do the best I can, but sometimes I physically can't get close enough.  There are all sorts of elements that go into taking a good picture.  But when I do have time—when it is an assignment or a topic that there is the luxury of time and getting to know the subject and getting to be able to wait for the right light and compose a picture—well, it's a totally different story, because there is no excuse.

Jo Reed: You also work for National Geographic, what led you there?

Lynsey Addario:, I covered breaking news for 15 years, and anytime something happened, I was on a plane and there, and I think, at some point, my work was sort of stunted.  It wasn't getting any better; I just felt like I was at the same level.  And I started working for National Geographic in 2008, and suddenly, I was given two months to work on a story, and I had editors who would work one-on-one with me. Sarah Leen from National Geographic, who is now the director of photography, worked with me on my first two or three stories and really just brought me to the next level in terms of looking for the overview, looking for this and taking time.  And so, I think that was incredibly important for the development of my work and storytelling, really. 

Jo Reed: Do you have a preference? Do you prefer being able to spend more time on a photo, or do you prefer the challenge of having to shoot a picture very quickly in a precarious situation?

Lynsey Addario: Well, I think it's somewhere in the middle, actually, I think it's somewhere in the middle. I still do assignments for National Geographic, but I still work for The New York Times.  I still shoot  news stories.  And yes, I do still love those stories, because I believe they're so important to cover, and I believe the world needs to see what's happening in those moments and what emotion is involved and how people are suffering because of terrorism and how everyone is really suffering because of it.  It's not just westerners; it's everyone.  And so, I think I still love covering those stories, and I still love working for National Geographic. I love the balance, I like being able to do both.

Jo Reed: You received a MacArthur "genius" award.

Lynsey Addario: I did.  <laughs>

Jo Reed: Congratulations

Lynsey Addario: Thank you.

Jo Reed: I'd love to hear the story of how you found out.

Lynsey Addario: Yeah, I was totally shocked.  I was in Istanbul where I was living, and I had just had a really bad car accident in Pakistan in April 2009.  And my driver, Raza, was killed, and I was in and out of the hospital.  I had surgery and basically out on my back for about seven weeks.  And as a freelancer, if you don't work, you don't make money; there's no backup, and for me, I had always relied on the fact that I worked non-stop.  And suddenly, I was about to get married.  I got married after the car accident, about eight weeks later, and in about August, I basically had run out of money.  I had no money, and I just gone back to work, and I was really stressed and quite traumatized after the car accident.  Raza—our driver who was killed-- was incredible, and he was a friend too, not only me, but so many journalists, and so, going back to work was pretty tough.  And so, I got a phone call in probably October. And I was sitting in my apartment, and I got a call from a Chicago number, and I thought it was a credit card. And so, I picked up the phone, but sort of like, “Hello?”  And he said, “This is Robert Gallucci, and I'm the President of the MacArthur Foundation.”  And he said, “Do you know what that is?”  And I said yes.  And he said, “I'd like to tell you that you've been named a Fellow.”  And I was silent, and I thought for sure he had the wrong person.  And he said, “Are you there?”  And I said "Yes."  And he said, “Do you know what that means?”  And I said, “Do you have the right person?”  <laughs> And he said, “You were born November 13th, 1973, in Norwalk, Connecticut, right?”  And I said, “Yeah, that's me,” and he said,”You will receive 25,000 dollars every tax quarter for the next five years,” and I basically almost threw up <laughs>.  I couldn't believe that it -- I thought it was a joke.  And so, we had this whole conversation, and I was kind of in shock.  I was just listening to him.  So, this is 2009, and the situation in Afghanistan had gotten really bad, and he said, “So, before we hang up, what do you think about the situation in Afghanistan?”  And I was so nervous and in such shock that I was like, “Oh, you know, it's a quandary.”  <laughs>  And I thought, “Oh, my god, he's gonna take it away from me.  He's gonna say I'm not a genius <laughs>.” And then he said, “You know you can't tell anyone for two weeks,” and I said, “Well, can I tell my husband?”  And he said, “Well, can he keep a secret?”  And I said yes.  And I kept thinking, “Oh, my god, if I tell someone, then they're gonna take it away.”  I was so paranoid that it was all a dream. I hung up the phone, and I Googled the number, and it was the MacArthur Foundation, and I sat in my living room and cried for 10 minutes.  I just wept and said I can't believe this is really happening.  And then I said, “Okay, pull yourself together" <laughs> and so, I didn't wanna get on the phone, because of course, I had worked for years in dictatorship's where everyone's phone is tapped.  So, I was like, “I don't want to make a phone call, because what if they're listening?  What if they know?”  <laughs>  And so, I walked to the subway to meet my husband when he got off work, and I was standing outside of the subway.  I was basically waiting there for an hour, just waiting for him to come out. It was incredible.  It's definitely one of the most incredible things that's ever happened to me.

Jo Reed: It's such a wonderful award on so many levels, obviously there's the acknowledgement but also financial freedom for five whole years, what a blessing. 

Lynsey Addario: It's unbelievable. I had spent so many years just trying to make it and never having a dollar and never having any money and and it's also the validation.  It's also being recognized on a professional level. It's just an incredible, incredible honor and  it couldn't have come at a better time, because I'd really gone through so much with the car accident and healing and the trauma.  And then, it was huge.

Jo Reed: What went into your decision to write your book, “It’s What I Do?”

Lynsey Addario: A lot went into the decision to write the book.  So, after we were released in Libya, we all sort of had-- we all dealt with that in a different way.  There were four of us, and we each sort of went and spent time with our respective families.  And for me, I decided, okay, maybe I should just take a little time and process this, and maybe it's time to finally do a photo book, because I'd never done a collection of my photography.

Jo Reed: I would think that writing a memoir would require you exercising a different set of muscles than when you're photographing.

Lynsey Addario: Yeah, but there is a fair amount of reporting and writing that goes into photography, at least for me.  I do a lot of interviews, and I do a lot of-- I used to keep journals for many years, and I write blogs, and sometimes I write emails-- very long, descriptive emails to friends if I’ve survived something or gone through something traumatic.  So, for me, I was always writing, but I had never really stopped to look back, so the greatest thing about writing the book was that it enabled me a chance to just basically stop and look back at over 15 years of shooting that I just had not stopped and looked back once.  And then, I got pregnant, and so then I was sort of shooting frantically until I was seven months pregnant, because I was so terrified that I would never work again.  And then, at seven months, I really buckled down and starting writing that's when I really wrote the core of the book.

Jo Reed: You're a mom now.

Lynsey Addario: Correct.

Jo Reed: And you mentioned you're kind of recalibrating the risks that you're willing to take because you're a mother.

Lynsey Addario: Yes.

Jo Reed: But does being a mother change your understanding or the depth of feeling in what you're photographing?

Lynsey Addario: Yes.  It has made it a lot harder to do this work, with every child I photograph or see dying, I just think, “What if that were Lucas?” and it kills me. I have a very hard time looking at images that I've taken and looking at images that my colleagues take when it involves children.  And I think every parent's biggest nightmare is that something would happen to their child.  And so, so much of what I'm doing involves children—children who are fleeing for their lives, who are refugees, who are dying, who have meningitis, malaria.  There’s just a countless number of stories and ways that I've watched children suffer, and it's very, very difficult to see now as a mother.

Jo Reed: Because of what you cover, Lynsey, because of what you photograph and who you photograph, do you ever find yourself just despairing of the human condition?

Lynsey Addario: Yeah.  I try really hard to maintain some degree of optimism, and I think, by nature, I'm a happy person, and I come from a family of incredibly optimistic and positive people, but it is hard.  The amount of innocent people who are dying right now...  I understand that people die when they're fighting for something and combats get killed, but to kill so many innocent women and children and men who have done nothing-- to me, it's heartbreaking.

Jo Reed: You end your book by saying you live in peace, but you witness war. That bifurcation I could imagine can be difficult at times. 

Lynsey Addario: I guess it's difficult, but I think I'm constantly remembering and reminding myself of how lucky I am that I live in a peaceful place right now; I live in London.  I have a place in New York, and I come back here, and I see all the people I love and my friends.  And there is a continuity to my life, no matter how crazy it is and no matter how much I travel, and that is something that so many people around the world just don't have anymore. Because they're fleeing, I mean 60 million people right now are displaced from their homes because of war and persecution. That is an astonishing figure and I think anyone who lives in peace has to recognize how lucky they are. 

Jo Reed: That is photojournalist Lynsey Addario—her book is called It's What I Do: A Photographer's Life of Love and War.

You’ve been listening to Artworks produced at the National Endowment for the Arts. Follow us on Apple podcasts or Google play—and leave us a rating—it helps people to find us. For the National Endowment for the Arts. I'm Josephine Reed. Stay safe and thanks for listening. 

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Lynsey Addario: My name is Lynsey Addario and I am a photojournalist and I am based in London and I travel around the world. All I really cared about was becoming a photojournalist and covering these stories and I just wanted to be in Iraq and Afghanistan, in Darfur, in Congo, in all these places covering stories that I felt were so incredibly historic and important to cover.

Jo Reed: I’m Josephine Reed. Welcome to “Quick Study,” the monthly podcast from the National Endowment for the Arts. This is where we’ll share stats and stories to help us better understand the value of art in everyday life. Sunil Iyengar is our pilot. He’s the Director of Research & Analysis here at the Arts Endowment. Hey, Sunil.

Sunil Iyengar: Hi, Jo.

Jo Reed: So what do you have for me today?

Sunil Iyengar: Well, Jo, you had asked me some while back to say a few words about the phenomenon of social prescribing, because you may remember I mentioned it casually in a previous installment of “Quick Study,” and it piqued your interest. So I thought maybe we could explore this practice and its relevance to participating in the arts.

Jo Reed: Oh, I’m so glad you’re doing this. Let’s start with a description of what social prescribing actually is.

Sunil Iyengar: Sure. So social prescribing is when a general practitioner or primary care provider refers a patient to nonmedical services that they might find in their own community. So these are nonclinical options such as gardening, cooking, nature walks, sports, taking part in social events, and of course, arts and cultural activities. The practice is most robust, I would say, in the UK, where just this week celebrated National Social Prescribing Day.

Jo Reed: Oh, my God.

Sunil Iyengar: Yeah. Social prescribing has really caught on since the NHS’s long-term plan for healthcare was established in 2019. The model allows for personalized care within community settings, and it’s tailored to people’s interests. According to the NHS, this means it can address what are called the social determinates of health and can help to root out health inequalities.

Jo Reed: Okay. Back up for a second.

Sunil Iyengar: Sure.

Jo Reed: Because what are some of the social determinates of health?  What does that mean?

Sunil Iyengar: Oh, yeah. So we’re really talking about any number of factors, such as the social and community context of patients, you know, their access to housing, transportation, the quality of their neighborhoods and local amenities, but also whether they grapple with racial discrimination, issues of crime or safety, as well as the status of their education, income and mobility. This could also mean such things as whether they have a nutritious and physically fit lifestyle, a whole host of considerations that arguably have not been the focus of medical training, as you understand it.

Jo Reed: So then how does social prescribing actually work?

Sunil Iyengar: Well, as far as I can figure out, there seem to be three distinct features of social prescribing. One is the healthcare professional must be trained in or have access to social prescribing as an option to complement pharmaceutical or medical care. Second, and this is crucial, there should be what the UK calls a social prescribing link worker available to the health professional. Link workers are advisors and connectors. They help patients navigate the array of community services that might be right for them. Third, there often need to be strong partnerships between the healthcare provider and local community organizations that can offer the services requested. So in the UK, for example, Arts Council England has contributed to something called the Thriving Communities Fund, which aims to boost social prescribing options locally for communities, quote “most impacted by the COVID-19 pandemic,” namely black, Asian and ethnically diverse communities, they say.

Jo Reed: So does this mean the movement has gathered steam over the last couple of years like through COVID?

Sunil Iyengar: I’m not sure that it’s necessarily gained ground during the pandemic, but I would point to a few developments in recent years that may have elevated the arts role within social prescribing. One was a report from 2019, what’s called a scoping review, commissioned by the World Health Organization. It reviewed evidence on the arts’ capacity to important health and well-being. The report was authored by Daisy Fancourt, and she’s an epidemiologist, researcher, and her team from the University of College London. Based on a sweep of evidence, they were fairly bullish about the arts’ role, not only in managing and treating chronic and acute conditions, Jo, but also in disease prevention and health promotion.

Jo Reed: Well, we’re not exactly strangers to this conversation.

Sunil Iyengar: No, we’re not. It’s something you and I have often discussed. So this report that I mentioned hit a nerve in the U.S., where there’s growing interest in arts and health programs and interventions. First of all, there’s a dynamic and flourishing set of fields represented by creative arts therapies, that is visual art, music, dance, or creative movement in theater, used in clinical and nonclinical settings. There are also what are called sort of arts infused programs in healthcare settings, programs that may not be offered by someone licensed or certified to offer therapy, per se, but they can be very useful, especially when integrated with other care options. Some of these programs are represented by the National Organization for Arts in Health, or NOAH.

Jo Reed: Well, the NEA has been involved with healing arts for years.

Sunil Iyengar: Yeah, we are, and we have been. At the NEA, we fund several arts in health programs, and those using creative arts therapies. I guess our flagship program here must be Creative Forces, in partnership with the U.S. Departments of Defense and Veterans Affairs and others, where we support creative arts therapies for military and veteran populations exposed to trauma, as well as their families and caregivers. What’s exciting about Creative Forces in this context is that we’ve teamed up with a regional arts organization, Mid-America Arts Alliance, to offer grants supporting community arts organizations that want to work with military-connected participants to improve their health, well-being and overall quality of life.

Jo Reed: Well, that does kind of sound like social prescribing to me. How popular is the practice here in the U.S.?

Sunil Iyengar: It hasn’t yet caught on quite, though optimists would say there’s maybe greater potential than ever before, maybe since the pandemic. The White House has been talking about the need to address the social determinates of health, such as the wider community context for patients, most recently around issues concerning mental health policy. Mass Cultural Council was one of the first organizations in the country to try to advance social prescribing of the arts. They conducted a statewide pilot of a social prescribing program involving about a dozen arts and cultural organizations working with healthcare providers.

Jo Reed: Have there been any results from the pilot or is it too soon?

Sunil Iyengar: You know, to be fair, there still needs to be a lot of research done to establish the efficacy and cost-effectiveness of such options, though one would wager that there are bound to be fewer, if any, side effects, comparative current practices. <laughs> One initiative that folks out there might want to keep an eye on is called Improving Community Health and Resilience through the Arts. This initiative was announced a few months ago by the National League of Cities, working with One Nation/One Project, and other organizations.  The goal is to bring together artists or arts organizations, community health centers and municipal leaders across 18 different cities to try to use collaborative art making to important health outcomes. The research director for this initiative is Jill Sonke, from University of Florida’s Center for Arts in Medicine, which also runs the EpiArts Lab, a NEA designated research lab that’s mining large longitudinal data sets to better understand the relationship between the arts and health.

Jo Reed: All roads lead to research, don’t they, Sunil?

Sunil Iyengar: Yes. For me, anyway here.

Jo Reed: <laughs>

Sunil Iyengar: The podcasts, certainly, and there’s a study on the horizon that I think listeners might like to know about, since you gave me that opening. We recently made an award to researchers at the University of North Carolina at Greensboro. We will be doing a systematic literature review and interviews with experts such as medical practitioners, health insurers, and artists to learn about current healthcare models that may lend themselves to social prescribing in the arts, particularly for older adults. So who know?  Maybe, to invert the famous title by Sinclair Lewis, it could happen here.

Jo Reed: <laughs> Yes. I--

Sunil Iyengar: You like how I got that in there? <laughs>

Jo Reed: I’m very pleased, actually. <laughs> I really think this is such an exciting field to watch, with wonderful, wonderful possibilities. Thank you for talking about it.

Sunil Iyengar: It’s a pleasure.

Jo Reed: And I’ll talk to you next month. Thanks, Sunil. That was Sunil Iyengar. He’s the Director of Research & Analysis here at the Arts Endowment. You’ve been listening to “Quick Study.”  The music is “We Are One,” from Scott Holmes Music. It’s licensed through Creative Commons. Until next month, I’m Josephine Reed. Thanks for listening.