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NSWBiologySyllabus dot point

Inquiry Question 3: Why are epidemiological studies used?

Investigate the treatment, management and possible future directions for the cure of non-infectious diseases using an example that has been treated by both pharmaceutical and medical interventions, including education programs and screening

A focused answer to the HSC Biology Module 8 dot point on disease prevention. Covers education campaigns, screening programmes (mole-watch, bowel screening, BreastScreen, cervical screening) and public-health interventions such as plain packaging and immunisation.

Generated by Claude Opus 4.89 min answer

Reviewed by: AI editorial process; not yet individually human-reviewed

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  1. What this dot point is asking
  2. The answer
  3. Examples in context
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What this dot point is asking

NESA wants you to describe how non-infectious disease can be prevented or its burden reduced through education, screening and public-health programmes, using named Australian examples.

The answer

Prevention of non-infectious disease operates at three levels:

  1. Primary prevention. Stops disease occurring (vaccination, smoking cessation, sun protection).
  2. Secondary prevention. Detects disease early (screening).
  3. Tertiary prevention. Reduces complications of established disease (rehabilitation, ongoing management).

Education programmes

Education increases health literacy and changes behaviour. Effective programmes have clear messaging, repeated exposure, structural support (regulation, infrastructure) and target specific behaviours.

SunSmart
Launched 1981 by Cancer Council Victoria with the Slip-Slop-Slap slogan; expanded to Slip-Slop-Slap-Seek-Slide. Targets skin cancer through sun protection. Backed by no-hat-no-play policies in schools, shade structures, and free sunscreen.
QUIT
Tobacco cessation campaign with graphic warnings, plain packaging (2012), the Quitline, nicotine replacement subsidies on the PBS, and indoor smoking bans. Adult smoking rates fell from 35 percent in 1980 to under 11 percent in 2022.
LiveLighter
Targets obesity, diabetes and cardiovascular disease through advertising on the harms of excess sugar and processed food. More mixed evidence on outcomes; obesity rates have continued to rise, suggesting education alone is insufficient.
Drink Wise / Don't Drink and Drive
Targets alcohol-related disease and trauma through warning labels, advertising restrictions and graphic campaigns.

Screening programmes

Screening tests asymptomatic people to detect disease early, when treatment is more effective and survival is higher.

Criteria for effective screening (Wilson and Jungner).

  • The disease is important and detectable in a preclinical phase.
  • The test is sensitive, specific, affordable and acceptable.
  • Effective treatment exists for early-stage disease.
  • Screening is cost-effective.
BreastScreen Australia
Free biennial mammography for women aged 50 to 74. Detects ductal carcinoma in situ and small invasive cancers before they are palpable. Reduces breast cancer mortality by approximately 20 to 25 percent in regularly screened women.
National Cervical Screening Programme
Since 2017, replaced two-yearly Pap smears with five-yearly HPV testing from age 25. Combined with the HPV vaccine (introduced 2007), cervical cancer incidence has halved and Australia is on track to be the first country to effectively eliminate cervical cancer.
National Bowel Cancer Screening Programme
Free immunochemical faecal occult blood test (iFOBT) every two years for adults aged 50 to 74, mailed directly to homes. Detects adenomatous polyps and early bowel cancer. Has reduced bowel cancer mortality by approximately 15 to 20 percent in screened groups.
Newborn screening (heel prick test)
Within 48 hours of birth, blood is tested for over 25 conditions including phenylketonuria, congenital hypothyroidism and cystic fibrosis. Early detection allows dietary or hormonal intervention that prevents severe disability.
Mole-watch and skin checks
Not a formal national programme, but Cancer Council and GP-led skin checks identify melanoma early. Self-examination using the ABCDE rule (Asymmetry, Border, Colour, Diameter, Evolution) is taught widely.

Genetic counselling and screening

Couples with a family history of inherited disease can access genetic counselling and carrier screening before pregnancy (cystic fibrosis, fragile X, spinal muscular atrophy). Prenatal screening (combined first-trimester screening, NIPT) detects trisomies. These programmes reduce the incidence of severe genetic disease.

Structural and regulatory interventions

Education is more effective when backed by structural change.

  • Tobacco. Plain packaging (2012), 20 dollar pack price, indoor and outdoor smoking bans, graphic warnings.
  • Alcohol. Minimum unit pricing, advertising restrictions, drink-driving limits.
  • Diet. Health Star Rating system, kilojoule labelling on menus, sugar tax debates.
  • Sun safety. UV Index broadcasting, shade structures, school sun-protection policies.
  • Genetic. Newborn screening mandate, subsidised carrier screening through Medicare.

Worked example: cervical cancer prevention in Australia

A coordinated three-pronged programme has produced one of the world's lowest cervical cancer rates.

  1. Primary prevention. HPV vaccination of all 12 to 13 year olds since 2007 (girls) and 2013 (boys), free through schools.
  2. Secondary prevention. Five-yearly HPV-DNA screening from age 25.
  3. Tertiary prevention. Colposcopy and treatment of high-grade lesions.

Outcome. Cervical cancer incidence in Australia has fallen from approximately 14 per 100 000 in 1991 to under 7 per 100 000 in 2022. Australia is projected to effectively eliminate cervical cancer (incidence under 4 per 100 000) by 2035.

Examples in context

Example 1. National Bowel Cancer Screening Program in Australia. Since 2006, the Australian Government has mailed free faecal immunochemical test (FIT) kits to every Australian aged 50 to 74 every two years. Participants collect a small stool sample and post it to a pathology lab, where the test detects haemoglobin from microscopic bleeding from polyps or early bowel cancer. Positive samples trigger referral for colonoscopy, where polyps are removed before they become malignant. Bowel Cancer Australia reports that participants in the program have a 40 percent lower mortality from bowel cancer than non-participants. With about 50 percent uptake, the program prevents an estimated 90 000 deaths over 40 years, making it among the most cost-effective Australian preventive health interventions.

Example 2. Plain packaging laws and Australian smoking rates. From December 2012, Australia became the first country to mandate plain-packaging of cigarettes: drab dark-brown packs with large graphic health warnings replaced branded packaging. Combined with steep excise increases (a pack of 25 cigarettes now exceeds 50 AUD), the policy has driven smoking prevalence from 16.1 percent of adults in 2011-12 to 8.3 percent in 2022, according to ABS National Health Survey data. Lung cancer incidence has begun to fall about 20 years behind the smoking peak, reflecting the long lag time between exposure cessation and cancer reduction. The policy is now imitated in over 20 countries, demonstrating how structural regulation can outperform individual behavioural counselling for population-scale change.

Try this

Q1. Distinguish between primary, secondary and tertiary prevention, giving an Australian example of each. [3 marks]

  • Cue. Primary: prevent disease (SunSmart, smoking cessation). Secondary: early detection (BreastScreen, FIT). Tertiary: minimise damage post-disease (cardiac rehabilitation).

Q2. A NSW BreastScreen cohort of 100 000 women undergoes biennial mammography. If incidence is 150 per 100 000 per year and the program detects 75 percent of cancers earlier than they would otherwise present, calculate the number of cancers detected early per year and explain how this reduces mortality. [3 marks]

  • Cue. Cancers per year = 150; early-detected = 113. Earlier detection allows treatment of smaller tumours, improving 5-year survival from roughly 80 percent to 95 percent.

Q3. Evaluate the effectiveness of education campaigns in reducing non-infectious disease burden. (a) Identify one Australian education campaign. (b) Describe one outcome measure that demonstrates its effectiveness. (c) Justify whether education alone is sufficient or whether structural regulation is also required. [1+2+3 marks]

  • Cue. (a) SunSmart, QUIT, LiveLighter. (b) Falling melanoma rates, falling smoking prevalence, BMI trends. (c) Education sets the cultural conditions but structural measures (taxes, packaging laws, sun-protection in schools) drive larger and more equitable change.

Exam-style practice questions

Practice questions written in the style of NESA exam questions on this dot point, with worked answer explainers. The year tag is the paper they imitate, not the source.

2022 HSC6 marks[A graph shows the incidence of cervical cancer in Australia from 1985–2015; over this period a national screening program (from 1991) and an HPV vaccination program were introduced.] Evaluate the success of these campaigns in reducing the incidence of cervical cancer in Australian women. Include reference to the data in your answer.
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An evaluate question — top marks give a well-informed judgement based on detailed analysis of the stimulus.

Screening program
the drop in incidence to about half after the 1991 screening program suggests it was effective. But caution: you cannot conclude causation from the numbers alone — other factors may have changed, and incidence was already falling before 1991, so the decline may have continued anyway.
HPV vaccination program
because HPV causes most cervical cancers, vaccinating (ideally the whole population, including boys) should reduce viral load and add to prevention. However, the data show no clear reduction in incidence since vaccination began — likely because screening was already very effective, and because vaccinated school-aged students will only show reduced cancer years later in older age groups.
Judgement
public health programs appear effective for prevention, but they must run for many years and be studied separately before each campaign's true effect can be properly assessed.
2025 HSC3 marks[A graph shows the UV level across a single day. The Cancer Council suggests sun protection whenever the UV level is 3 or above; a sunscreen product's information suggests using sunscreen between 10 am and 4 pm.] Using the graph, evaluate the information provided on the sunscreen product with regard to the Cancer Council suggestion.
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Top marks need an accurate evaluation of the product statement showing a sound understanding of the graph data.

Judgement: the product statement (10 am–4 pm) is incorrect / inadequate because a person would not be fully protected from UV.

Use the data: the graph shows UV is 3 or above between approximately 8 am and 6 pm. So following the Cancer Council's threshold, protection is needed for roughly 2 hours before and 2 hours after the product's recommended window — during which the product's advice would leave a person unprotected. Markers reward explicitly relating both the Cancer Council suggestion and the product info to the graphed UV values to give an evidence-based judgement.

2024 HSC3 marksExplain how an educational program or campaign can be used to decrease the incidence of a disease caused by environmental exposure. (Name the disease.)
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Three marks need to explain how the program decreases incidence (cause and effect), not just list its features.

Sample (disease: skin cancer): An educational program in schools could teach students that UV exposure causes skin cancer and that, to protect themselves, they should wear hats and sunscreen when outside. This increases understanding of the risk, which increases compliance with protective behaviour, thereby preventing the cause of skin cancer (UV rays damaging DNA in cells) and so decreasing its incidence.

Marker note: the key to the top band is linking the program's features to a decrease in incidence via changed behaviour — students who only describe a campaign without that causal link score lower.

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