HSC Exam Practice

Sample response. Prevention is action taken to reduce disease risk before harm occurs. Primary prevention acts before disease exists by removing or reducing the exposure itself, for example tobacco excise increases or sun protection. Secondary prevention acts after the disease process has begun but before symptoms appear, for example a bowel-cancer screening program that detects and removes polyps.

Marking notes. 1 mark for defining prevention as reducing risk before harm occurs. 1 mark for correctly distinguishing the two levels by the disease status of the target group, with a valid example of each. Naming the levels without an example, or with examples that do not match the level, earns no second mark.

Sample response. A one-off poster supplies only general information, so at best it changes knowledge, and knowledge change does not reduce disease risk on its own. A stronger strategy targets the biological risk factor, ultraviolet exposure, through education combined with practical actions such as shade, free sunscreen, protective clothing and a hat policy, which remove the cost and convenience barriers that stop students acting on what they know. It also specifies a target audience and a measurable outcome, so effectiveness can be evaluated rather than assumed.

Marking notes. 1 mark for identifying that a poster changes knowledge without changing exposure. 1 mark for identifying the combined strategy as targeting the risk factor and removing a practical barrier. 1 mark for the evaluability point, that specifying audience and measure allows effectiveness to be judged.

Sample response. A process measure counts what the campaign delivered, such as sunscreen bottles distributed, lessons taught or students reached; it confirms the campaign happened but says nothing about whether it worked. An impact measure records the change in the behaviour or exposure that was targeted, such as observed hat wearing, sunscreen use, reported sunburn or measured UV exposure. An outcome measure records the change in disease itself, such as melanoma incidence or mortality.

Marking notes. 1 mark per measure correctly defined with a valid sun-safety example. Do not award the impact mark for an example that is really a process count.

Sample response. Melanoma develops over decades, because ultraviolet damage to DNA in skin cells accumulates before disease appears. Three months is far shorter than that lag, so melanoma incidence cannot have responded to the campaign, and any change observed over that period would be background variation rather than an effect. An honest evaluation therefore states the expected lag, reports an impact measure such as observed protective behaviour or sunburn against baseline as the strongest available short-term evidence, and names melanoma incidence as the long-term goal that cannot yet be assessed.

Marking notes. 1 mark for identifying the decades-long lag with a biological reason. 1 mark for stating that any short-term change in incidence would not be attributable to the campaign. 1 mark for naming the correct alternative, an impact measure reported against a baseline.

Sample response. Any two of the four, each with a reason. Who produced it, and do they benefit from the conclusion? An organisation with a commercial or reputational interest in the finding has an incentive to present it favourably. When was it published? Disease rates, programs and behaviour change over time, so an old figure may no longer describe the population. Does it report real data with sample sizes, or only claims? A percentage with no sample size, baseline or comparison group cannot be interpreted, and a media figure should be traced back to the study to check whether behaviour was observed or self-reported. Does it agree with other independent sources? A finding corroborated by independent bodies such as the AIHW, ABS, Cancer Council or peer-reviewed journals is far more secure than a single uncorroborated claim.

Marking notes. 1 mark per question correctly identified (maximum 2), plus 1 mark for explaining why at least one of them changes the conclusion that can be drawn.

Sample response. Disease: melanoma. Risk factor: harmful ultraviolet exposure, especially intermittent intense exposure and sunburn. Target audience: secondary students during lunchtime and outdoor sport, whose barrier is a lack of shade plus the cost and inconvenience of carrying sunscreen and a hat. Action 1, education: teach students to use the UV index rather than temperature to decide when protection is needed, since UV can be high on cool or cloudy days. Action 2, upstream: install shade over the courts and place free sunscreen dispensers at the gate and sports shed, with a hat rule applying to everyone so the protective choice requires no extra effort or money. Measure of effectiveness: the observed proportion of students wearing hats and applying sunscreen at lunch, compared with a pre-campaign baseline, together with reported sunburn episodes across the term, with melanoma incidence named as the long-term outcome that cannot be measured within a school year.

Marking notes. 1 mark for correctly naming disease and risk factor. 1 mark for a specific target audience and the barrier it faces. 1 mark for two linked actions of which at least one is genuinely upstream, that is, it changes the conditions rather than asking individuals to try harder. 1 mark for a measure that is an impact measure reported against a baseline. Accept any non-infectious disease, for example Type 2 diabetes with physical inactivity, or cardiovascular disease with tobacco exposure, provided the risk factor is modifiable and correctly linked.

Sample response. Knowledge of the activity guidelines is a process measure: it confirms the campaign reached people but does not show exposure changing. Measured weekly active minutes is an impact measure, recording the targeted behaviour itself. No outcome measure such as Type 2 diabetes or cardiovascular incidence is reported, which is honest, because those diseases develop over decades and could not respond within twelve months.

Area-wide, the campaign performed well on both: knowledge roughly doubled, from about 45% to about 90%, and the active-minutes index rose substantially, from about 25 to about 55. In the most disadvantaged suburb, knowledge rose just as steeply, from about 40% to about 85%, but the active-minutes index barely moved, from about 20 to about 25.

This is the knowledge-to-behaviour gap appearing in one group only. The message was delivered successfully everywhere, so the failure is not one of awareness. Behaviour is shaped by cost, convenience, safety and the physical environment far more than by information, and the campaign's upstream component, the new outdoor exercise facilities, was built only in wealthier suburbs. Residents of the disadvantaged suburb therefore learned what they should do without gaining any change in the conditions that would let them do it.

The council's conclusion is therefore not supported as written. Gains in activity were not delivered "across the community": the area-wide average conceals a group in which the impact measure is essentially unchanged, and because that group typically carries the higher baseline disease burden, the campaign risks widening the health gap it was meant to close.

The design change most likely to fix this is to place the upstream infrastructure where the need is greatest: build the exercise facilities, safe walking routes and lighting in the disadvantaged suburb, ideally co-designed with residents, and continue to report active minutes disaggregated by suburb rather than as a single average.

Marking notes. 1 mark for correctly classifying knowledge as a process measure and active minutes as an impact measure. 1 mark for noting the absence of an outcome measure and why that is appropriate. 1 mark for describing the area-wide results with values. 1 mark for describing the disadvantaged-suburb divergence with values. 1 mark for explaining the divergence by reference to barriers and the placement of the upstream actions. 1 mark for an explicit evaluation rejecting or qualifying the council's conclusion, including the point that an average conceals the gap. 1 mark for a specific, data-driven design change; generic answers such as "advertise more" earn nothing.

Sample response outline (melanoma; other non-infectious diseases equally acceptable).

Risk factor and evidence base. Melanoma; the modifiable risk factor is harmful ultraviolet exposure, particularly intermittent intense exposure and childhood sunburn. Australia has the highest melanoma rates in the world. Secondary sources: Cancer Council Australia, the Australian Institute of Health and Welfare and the Australian Bureau of Statistics, judged on who produced them, how recent they are, whether they report real data with sample sizes, and whether they agree with one another.

Evaluating current methods. Australian sun protection is layered, and the layers have different evidence behind them. Education through SunSmart supplied knowledge from 1981. Structural measures did the heavier work: no-hat-no-play rules, shade construction at schools, workplace sunscreen provision for outdoor trades and UV-index reporting in weather forecasts. The strongest available evaluation is the cohort split: melanoma incidence in Australians under 40 has fallen while rates in older Australians, whose formative exposure preceded the campaign, continued rising for decades. That divergence matches the predicted exposure-to-disease lag and is difficult to explain by a general cause such as changed diagnostic practice, which makes it strong rather than weak evidence. Tobacco control offers the parallel lesson: price had the strongest evidence base and the largest effect on young people, and lung-cancer rates followed smoking rates down only after twenty to thirty years.

Strategy developed. Target secondary students during lunch and outdoor sport. Education: teach decision-making from the UV index rather than temperature, since UV is high on cool, cloudy days. Upstream actions, each justified against a barrier: shade over the courts, which removes the environmental barrier of nowhere to be out of the sun; free sunscreen dispensers at the gate and sports shed, which remove cost and the need to carry it; and a universal hat rule, which shifts the social norm so protection is not a visible individual choice.

Measurement and timescale. Process measures confirm delivery, for example lessons run and sunscreen distributed. Impact measures are the meaningful short-term evidence: observed hat wearing and sunscreen use at lunch, reported sunburn episodes, and where possible measured personal UV exposure during outdoor sport, all against a pre-campaign baseline or a comparison school, and re-measured after the campaign ends to test whether change was sustained. Use observed rather than self-reported behaviour, because self-report is routinely overstated. The outcome measure, melanoma incidence and mortality, must be named as the long-term goal and explicitly deferred, since the disease takes decades to appear.

Equity. Equity must be designed in, not added on. Remove cost by supplying hats and sunscreen rather than recommending purchase; remove the access barrier by siting protection where students already are; co-design messaging with the communities it targets rather than translating at them. Equity is also a measurement question: report behaviour change separately for the highest-risk and lowest-income students, because a strategy with 70% uptake overall and 25% among those students has not succeeded, and an unequal campaign can widen the very gap it set out to close.

Judgement. Current Australian prevention of melanoma is effective and unusually well evidenced, but its effectiveness comes chiefly from the structural layers rather than from education alone. A strategy that pairs education with upstream change, measures observed behaviour against a baseline and reports results disaggregated is therefore the defensible design.

Marking notes. 1 mark for the disease and modifiable risk factor correctly identified. 1 mark for appropriate secondary sources named with a quality criterion applied. 2 marks for evaluating current prevention methods using evidence, including at least one specific evaluative result rather than assertion. 2 marks for the strategy: 1 for an education component with a specific audience, 1 for at least one upstream action justified against the barrier it removes. 1 mark for measurement matched to timescale, with the process, impact and outcome distinction used correctly. 1 mark for equity treated as both a design and a measurement requirement.

Band guidance. Band 6 justifies each action against a named barrier, uses a real evaluative result, and treats equity as integral. Band 5 develops a complete strategy with measures but evaluates current methods by assertion. Band 4 lists prevention actions and awareness measures without distinguishing measurement depths or addressing equity.