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

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.

Common traps

Confusing prevention with treatment. Prevention stops or delays disease; treatment manages disease once it has occurred.

Saying screening "prevents" cancer. Screening detects early; it does not prevent the cancer from occurring (except indirectly when premalignant lesions are removed, as in cervical screening).

Ignoring uptake and equity. A programme is only effective if people use it. Indigenous Australians, remote communities and lower-income groups have lower screening participation, contributing to higher mortality.

Forgetting that education alone often fails. Behaviour change requires repeated messaging plus structural support (taxation, regulation, infrastructure).

In one sentence

Australia reduces non-infectious disease burden through education campaigns (SunSmart, QUIT), population screening programmes (BreastScreen, cervical, bowel) and structural regulation (plain packaging, school sun-protection policies), with measurable falls in mortality and incidence for tobacco-related and screening-targeted cancers.