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To compare receipt of acute cardiac care in people with versus without severe mental illness (SMI) and investigate the impact of the COVID-19 pandemic on any differences in care. We hypothesised that, compared with those without SMI, patients with an SMI are less likely to receive guideline recommended acute cardiac care and that disparities worsened as a result of the pandemic.
Methods
We conducted a cohort study using data from the CVD-COVID-UK resource, which links electronic health data from multiple sources. Our cohort included 95,125 adults with a non-ST-elevation MI (NSTEMI) recorded in the Myocardial Infarction National Audit Programme (MINAP) dataset between 1 November 2019 and 31 March 2022. We defined SMI as schizophrenia, schizoaffective disorders or bipolar disorder (BD), ascertained through recorded diagnosis in primary care or hospital admission records. We examined receipt of cardiac care standards for NSTEMI, including: admission to a cardiac ward; angiogram eligibility; receipt of angiogram (in those eligible); angiogram within 72 hours; secondary prevention medication prescribing at discharge, and arrangement of post-discharge cardiac rehabilitation. We used logistic regression to obtain odds ratios (ORs) for the association between SMI and receipt of each care indicator, adjusting for age, sex and time period. We tested for an interaction between SMI and time period in order to determine if any disparities had changed since the start of the COVID-19 pandemic.
Results
Within our cohort, 620 patients (0.6%) had schizophrenia and 575 (0.6%) had BD. Compared with people without SMI and after adjusting for age, sex and period, patients with an SMI were less likely to receive each of the cardiac care standards. For example, compared with those without SMI, those with SMI were less likely to: be admitted to a cardiac ward (schizophrenia: OR 0.72, 95% CI 0.61–0.85; BD: 0.74, 95% CI 0.63–0.88); be eligible for an angiogram (schizophrenia: 0.37, 95% CI 0.29–0.47; BD: 0.52, 95% CI 0.40–0.68); receive an angiogram (schizophrenia: 0.22, 95% CI 0.18–0.28; BD: 0.51, 95% CI 0.39–0.66); and receive an angiogram within 72 hours (schizophrenia: 0.71, 95% CI 0.56–0.90); BD: 0.80, 95% CI 0.64–1.00). We generally found no evidence that disparities had changed since the start of the COVID-19 pandemic.
Conclusion
We identified marked SMI disparities in receipt of acute cardiac care among people treated in hospital for a NSTEMI. Further research should seek to identify reasons for, and inform interventions to, address these disparities.
This article was prompted by a Ministerial veto (2021) of the Australian Research Council’s decision to fund a research project by the authors to explore the student-led climate movement in Australia. It was also prompted by criticism of the veto which accused the Minister of bringing “politics” into what was represented as a scholarly matter. It addresses two questions: How should we understand this idea of “politics” in the context of Australian climate politics since the 1990s? Secondly it considers dominant ways of thinking about “the political” devised by ancient Greek writers and politicians which still inform the European liberal tradition. We question how fit for purpose this approach is in the Anthropocene? Our key argument is that the western tradition of thinking about “the political” is deeply anthropocentric. Historical traditions have encouraged inegalitarian and anti-democratic accounts of who can be political by excluding different kinds of people from political life. The Anthropocene requires a new, critically reflexive account of “the political” that is inclusive of people currently marginalized and excluded as well as nonhumans and nonliving components of ecosystems on which we all depend. This extends the idea of democracy beyond the human and points to a politics of climate justice.
Of 731 restricted antimicrobial prescriptions subject to antimicrobial stewardship program (ASP) prospective audit and feedback (PAF) over a 3-year period, 598 PAF recommendations (82%) were fully accepted. Physician auditors had an increased odds of PAF recommendation acceptance, reinforcing the complementary role of the ASP physician in the multidisciplinary ASP team.
The global political environment in the twenty-first century is proving dynamic and challenging for Australian policymakers and political institutions. Australian Politics in the Twenty-first Century contextualises the Australian political landscape through an institutional lens. It examines the legislative and judicial bodies, minor parties, lobby groups, the media and the citizenry, providing historical and contemporary facts, explaining political issues and examining new challenges. The second edition has been updated to reflect the application of political theories in today's civic environment. New spotlight boxes highlight issues including marriage equality, COVID-19 and federalism, the inclusion of First Nations peoples in the political system, and gender equality in public policy. Short-answer, reflection, research and discussion questions encourage students to test and extend their knowledge of each topic and to clearly link theory to practice. Written in an accessible and engaging style, Australian Politics in the Twenty-First Century is an invaluable introduction to the Australian political system.
If you search for ‘federation’ on the internet, you will find accounts of systems of government in which sovereignty is divided between a central, national government and a series of regional, partially self-governing states. You may well find a webpage of the Parliamentary Education Office recording that, ‘in a process known as Federation’ Australia ‘became a nation on 1 January 1901 when six British colonies – New South Wales, Victoria, Queensland, South Australia, Western Australia and Tasmania – united to form the Commonwealth of Australia’ (PEO 2020). These search results suggest some key takeaway points for students of Australian politics. First, a federation is a particular form of political system where two tiers or levels of government (national and regional) share power and neither has authority over the other. Second, when capitalised ‘Federation’ describes the process which resulted in the creation of Australia at the dawn of the last century. The final point to note is that Australia’s federal system shapes its politics and other activities. Its federation provides a good example of how 21st century Australian politics remains in the grip of institutions established in the distant past.
While conventional accounts of the political landscape highlight Australia’s well-established formal institutions such as the electoral system, parliament, federalism, the public service and judiciary, a holistic approach to the study of Australian politics must also include the political contributions of a wider range of citizens and the various ways in which governments attempt to structure their input.
The chapter begins with a description of the organisational landscape of citizens’ groups in Australian politics and summarises the main advantages and drawbacks arising from the active participation and engagement of citizens’ groups.
The relative merits and drawbacks ofgovernment-initiated opportunities for citizens to contribute to political debate and public policy are then discussed with reference to theoretical modelling of community engagement.
The final section of the chapter examines the new challenges arising from the growing citizen participation and demand for community engagement in Australian politics. The discussion of these issues demonstrates how the participation and engagement of citizens’ groups is evolving in 21st century Australia.
The Australian party system comprises many more parties than just the ALP and the Liberal-National Party coalition. As dominant as the big two parties are, they do not exercise a complete duopoly over the House of Representatives or the Senate. Indeed, with its multi-member proportional electoral system, the Senate has always offered greater potential for a much more diverse set of political parties to win representation, although this was not really realised until the 1980s. Generally, a party is considered ‘minor’ not only because of a small vote share, but also because of a lack of representational success in the lower house contest, or where success is confined to the proportionally representative Senate. While this labelling is contested (Kefford, 2017), it is a useful counterpoint to the ‘major’ party tag of Labor and the Coalition. This chapter discusses a number of the minor parties, their role and function in contemporary Australian politics and the growing number of independents.
You might expect a textbook on Australian politics to begin with a discussion of contemporary Australian politics taking place in a strangely shaped building in Canberra, or with a somewhat esoteric discussion of colonial parliaments. What we will explore in this first chapter are two connected ideas: what is politics and why do we study it. There will, of course, be an overview of the political institutions, as well as discussion of some important terms, and a peek at what challenges might lie ahead for Australian political structures.
So how should we think about with an examination of contemporary politics in Australia? We should begin with acknowledging that the politics we study now is the product, one way or another, of a series activities, actions and interactions that stretch far back in time. The real politics and history of Australia starts somewhere between 50,000 and 65,000 years prior to white settlement – although how far back is not clear. If we acknowledge the past, we can understand how it has shaped our contemporary society.
This chapter examines the role of the administrative arm of government known as the bureaucracy, public service or civil service. The first section of the chapter charts the origins and development of bureaucracy as a model of organisation, which contrasts with the popular, and largely negative, understanding of the term. Turning to the Australian context, the chapter then provides an overview of the Australian federal bureaucracy, the Australian Public Service (APS). In explaining the bureaucracy’s role, the chapter outlines a key activity: policymaking. It examines definitions and stages of public policy, noting that in practice these stages represent an idealised understanding of the policy work of the bureaucracy. In reality, the world of policymaking is often chaotic, ad hoc and subject to opportunities and political leadership.
New public management reforms and modern policymaking are then placed in a broader context of a shift from government to governance that has taken place in recent decades. The chapter concludes by discussing the challenges the public service faces in the 21st century.
When we come to think about what a democracy is, and how a nation might go about constructing a democratic government, an election is often the first thing we think is important in that process. While elections do not in themselves guarantee democracy, they are certainly seen as a key element, without which any regime will have a hard time calling itself a democracy. We need to be aware that there are a number of important provisos that allow us to call an election democratic or ‘free and fair’:1. elections are held on a regular basis2. a range of candidates and parties can participate3. as many people as possible can vote freely for the candidate or party of their choice4. a wide range of policies are debated in the public arena5. there is a potential for a change in government at any given election.Elections in Australia generall refer to the elections for the Commonwealth Parliament in Canberra, the state and territory parliaments, and at a local level for the councils and shires. This chapter will explore the nature of those elections, and some of the challenges facing the systems we use.
When we think about parliaments and the legislature, we often find ourselves casting our minds back to the first ‘parliaments’, such as the fora of Ancient Greece or the Althing of Norse Iceland. Broadly speaking they were similar – a group of people coming together to make laws. Parliaments and legislatures have developed considerably since those times to be complex bodies, but the key idea of a group coming together to make laws remains. At the same time we might also think that this collection of people is also somehow representative of democracy – but we need to be clear that just having a legislature does not itself mean you are democratic. A variety of other conditions need to be met before we would usually say that a country is 'democratic', though in the case of Australia this is generally a given. While other chapters will discuss the way parliaments are elected – the electoral system – and who gets to choose who the candidates are – the parties or individuals – this chapter will discuss the role, purpose and operation of the Australian Parliament, as it is the legislature that citizens, members of parliament (MPs) and parties all aim to attend and control.
In Australia, executive power is concentrated in the roles of the prime minister and the Cabinet – the body of senior ministers who provide leadership for the government and departments of state. Executive power is the capacity to ‘execute’ or implement political decisions and legislation. Although the Australian Constitution formally vests executive power in the Queen, which is then ‘exercisable by the Governor-General as the Queen’s representative’ (Australian Constitution, Chapter 2, article 61), this executive power is chiefly symbolic. Real executive power resides in the elected government of the day, led by the prime minister and the Cabinet.
In this chapter, we begin with defining executive power and distinguishing between the political and administrative wings of executive government. We continue with a consideration of the functions that the executive government serves. The chapter then delves deeper into the heart of Australia’s executive government, examining the key features of the roles of the prime minister and the Cabinet, and the relationship between them. We end by considering the tensions between executive power and accountability.
In a democracy the people are said to lead. And yet within Australia’s liberal democracy, the people elect individuals to represent them. This sets up a unique role for political leadership. Debates about leadership churn are especially relevant in Australia given the number of political leaders that were replaced in the decade following the 2007 federal election.
Understanding the friction between leadership and liberal democracy provides us with a deeper grasp of our institutional setup. In considering political leadership in Australia, this chapter begins by considering the tension that exists between leaders in liberal democracies and the democratic institutions they work within. It then outlines some of the theories about leaders and leadership. It goes on to investigate and discuss Australian political leadership by considering the different types of political leadership in Australia. Following this, debates about recent leadership failure and supposed ‘poor leaders’ in Australia will take place. This chapter also deals with questions related to structure and agency as well as the political leadership gender gap in Australia.
According to liberal democratic theory, a free press is necessary for a well-functioning democracy. In its ‘ideal’ form, the news media play an essential role in informing the public sphere.
This chapter provides an overview of the challenges and opportunities for media institutions and political journalism in the digital age. It provides a better understanding of the Australian media’s contribution to the public sphere and its role to critically inform Australians about politics and policy. We do this, firstly, by examining the media sphere, including its production, content, and audience within various ‘models’ of media. We then look at a range of theories of media that accounts for its affect, use, and reception. We consider whether having fewer media proprietors affects diversity of voices or the quality of journalistic practice. Finally, we turn to the ‘new media’ political landscape by exploring not only how networks and social media platforms have affected the public sphere but also how media technologies have led to increased form of surveillance of the public.