Den tavse elite

Den tavse elite
I Sermitsiaq i marts efterlystes større aktivitet i samfundsdebatten fra "Den tavse elite" – den store gruppe højtuddannede som sidder på – ofte magtfulde – poster i samfundet. Hvor er vi som læger i samfundsdebatten? Skal vi overhovedet deltage i samfundsdebatten? Sidder vi for ofte og venter på udspil – fra politikere, administration, patientforeninger, pressen – for derefter over kaffen at vende tommelen nedad. Er vi i for høj grad tilskuere – som jo bekendt er dem der har det største overblik over en fodboldkamp, og ved hvordan den skal spilles. Er vi med på banen, når debatten om sundhedsvæsenets fremtid er på dagsordenen?		Kan vi andet end pege på nye muligheder for udgifter? - Og ikke bekymre os over hvem der skal dække disse? Det er vel ikke vore bord, eller hvad? Henning Sloth Pedersen

Many reports paint a depressing picture of the health of the Australian Aborigine. Whilst infant mortality has improved, it is still three to four times higher in the indigenous population than the total population of Australia, and even after infancy, indigenous children are 10 times more likely to die from infections than non-indigenous children are. Mortality at other ages seems to have changed little during the 1980s and 1990s. The major causes of this excess mortality are circulator conditions, injury and poisoning, respiratory diseases, cancer, and diabetes. Sudden infant deaths are decreasing amongst the non-indigenous population but are now the most common cause of death for indigenous infants.

Psychosocial morbidity is very high for indigenous Australians, manifesting in crime, family violence, and suicide and self-harm. These people are also more likely to be unemployed, to live in rented premises, and to leave school early. Tragically, the change from paternalistic attitudes to the indigenous population, which resulted in compulsory education, towards more self-determination has resulted in fewer children completing school or higher education.

If Aboriginal health is to improve, Australia has to acknowledge its history and the indigenous people within that history; we need a national reconciliation and self-determination for indigenous people with an emphasis on cultural revival and maintenance. Control of services, so that Aboriginal people take responsibility for their own health, is fundamental to improved health outcomes.

Fiona Stanley, Ted Wilkes, Lancet 1998, 351: 1569-78.

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