2024 CCEA AS-Level Health and Social Care 0003 Practice Paper with Answers

The socio-economic factors specified are gender, social class, housing, and culture and ethnicity; any two of these are acceptable.
Final answer: gender; social class (or any other two from the list).

[2] 1 mark for each of two valid socio-economic factors named from: gender, social class, housing, culture and ethnicity. All other valid responses will be given credit.

Statutory organisations responsible for health and well-being in Northern Ireland include the Department of Health (DoH), the Public Health Agency (PHA) and Health and Social Care Trusts; any two are acceptable.
Final answer: Department of Health; Public Health Agency (or any other two from the list).

[2] 1 mark for each of two valid statutory organisations named from: Department of Health (DoH), Public Health Agency, Health and Social Care Trusts. All other valid responses will be given credit.

(i) Housing [3]: poor-quality or overcrowded housing can harm physical health, for example damp or mould increasing the risk of respiratory illness such as asthma [1]; it can also affect social well-being, since a lack of space can limit opportunities for family time, study or entertaining visitors, straining relationships [1]; and it can affect psychological well-being, as living in poor or overcrowded conditions can cause stress, anxiety or low self-esteem [1].
(ii) Culture and ethnicity [3]: cultural or religious dietary practices can positively or negatively affect physical health depending on what they involve [1]; a strong sense of cultural identity and community can provide valuable social support, benefiting social and psychological well-being [1]; however, experiencing racism or discrimination linked to ethnicity can cause psychological harm, such as stress or low self-esteem, and social exclusion [1].
(iii) Occupational hazards [3]: exposure to hazards at work, such as chemicals, noise or manual handling, can directly harm physical health, for example causing hearing loss, back injury or a respiratory illness [1]; it can also affect psychological well-being through work-related stress or anxiety about safety [1]; and it can affect social well-being if an injury or illness caused by the hazard prevents the person from working and socialising as before [1].
Final answer: housing, culture/ethnicity and occupational hazards can each affect physical, social and psychological well-being in the ways described above, e.g. poor housing → respiratory illness and stress; discrimination linked to ethnicity → psychological/social harm; occupational hazards → injury, work-related stress.

Marked [3] per heading (9 marks total). Examples of suitable points to be included in description: (i) Housing — damp/overcrowding causing physical illness [1]; reduced space affecting family relationships/social well-being [1]; stress/anxiety/low self-esteem from poor conditions [1]. (ii) Culture and ethnicity — dietary practices affecting physical health [1]; community/cultural identity supporting social/psychological well-being [1]; discrimination causing psychological/social harm [1]. (iii) Occupational hazards — physical injury/illness from workplace exposure [1]; work-related stress/anxiety [1]; social impact of resulting injury/illness [1]. All other valid responses will be given credit.

(a) The scenario shows James is affected by an occupational hazard [1] — his sun exposure at work has caused skin damage [1] — and by geographical location [1], since he lives in a rural area far from services.
(b) Taking geographical location: living in a rural area far from a hospital can negatively affect James's physical health, since it would take longer for him to reach emergency medical treatment if needed [2]; it can also negatively affect his social and psychological well-being, since being far from social activities and health services can lead to isolation and loneliness, which can in turn cause low mood or stress [2].
Final answer: (a) occupational hazard (sun exposure) and geographical location (rural, distant from services); (b) geographical location affects James physically (delayed access to emergency care) and socially/psychologically (isolation and loneliness from being far from services and social activities).

(a) [3] 1 mark: occupational hazard identified; 1 mark: correctly linked to sun exposure/skin damage from the scenario; 1 mark: geographical location identified (rural/distance from hospital and services). Accept environmental factor named with correct scenario evidence.
(b) [4] Up to 2 marks for a clear description of one well-being dimension affected (e.g. physical: delayed access to emergency care) with scenario detail; up to 2 further marks for a second well-being dimension affected (e.g. social/psychological: isolation, loneliness) with scenario detail. All other valid responses, correctly applied to the scenario, will be given credit.

1. The PHA runs health promotion campaigns [1], for example encouraging healthy eating or reducing smoking, which raises public awareness and encourages people to make positive lifestyle choices [1].
2. The PHA has a health protection role [1], monitoring public health and responding to disease outbreaks, which helps to prevent and control the spread of infectious disease within the population [1].
Final answer: the PHA contributes to health and well-being by (1) running health promotion campaigns, and (2) protecting public health by monitoring and responding to disease outbreaks.

[4] Marked as 2 × [2]. For each way: 1 mark for a valid role of the PHA identified; 1 mark for a clear explanation of how it contributes to health and well-being. Examples of suitable points to be included: health promotion/awareness campaigns; disease surveillance and outbreak response; commissioning/supporting health improvement programmes; working with HSC Trusts on public health priorities. All other valid responses will be given credit.

A poor diet, high in fat, sugar or salt, can increase the risk of physical conditions such as obesity, type 2 diabetes and cardiovascular disease, while also potentially affecting psychological well-being through poor body image or low self-esteem. Lack of exercise similarly increases the risk of weight gain, cardiovascular disease and conditions such as osteoarthritis, and can also negatively affect mental health, since regular exercise is known to reduce stress and improve mood.
Smoking significantly increases the risk of serious physical conditions such as chronic lung disease and various cancers, and can also affect social and psychological well-being, since the addictive nature of nicotine can cause stress about cost or health, and smoking-related illness can limit a person's ability to work or take part in social and leisure activities.
Alcohol misuse can cause physical harm, such as liver disease, and can impair judgement, increasing the risk of accidents; it can also damage relationships with family and friends (social well-being) and can cause or worsen anxiety and depression, or lead to dependency (psychological well-being).
Overall, behavioural factors differ from factors such as genetic inheritance because they are, in principle, within an individual's control, meaning health promotion and lifestyle change can have a significant positive impact. However, addiction and ingrained habits can make change genuinely difficult, meaning individuals often need support, such as from health promotion services or their GP, to make and sustain positive changes.
Final answer: behavioural factors such as poor diet, inactivity, smoking and alcohol misuse increase the risk of serious physical conditions (e.g. cardiovascular disease, cancer, liver disease) and can also harm psychological and social well-being; because these factors are within an individual's control, health promotion support can have a significant positive impact, though addiction can make change difficult.

Levels of response (9 marks). Basic (1–3 marks): identifies one or two behavioural factors with limited, undeveloped comment on impact; little or no reference to physical/social/psychological well-being; weak written communication. Adequate (4–6 marks): describes the impact of more than one behavioural factor with some development and some reference to different aspects of well-being (physical/social/psychological); satisfactory written communication. Competent (7–9 marks): evaluates the impact of several behavioural factors in a well-developed way, covering physical, social and psychological well-being with accurate detail and a balanced concluding evaluation (e.g. factors being within individual control, role of health promotion/addiction); confident use of specialist vocabulary and clear written communication. Examples of suitable points to be included in evaluation: poor diet/inactivity → obesity, type 2 diabetes, cardiovascular disease, osteoarthritis, low self-esteem; smoking → lung disease, cancer, addiction-related stress, reduced ability to socialise; alcohol misuse → liver disease, accidents, damaged relationships, anxiety/depression, dependency; evaluative point that behavioural factors are within individual control and can be improved through health promotion, though addiction/habit can be a barrier. All other valid responses will be given credit.

(i) Health can be defined as a state of complete physical, social and psychological well-being [1], and not merely the absence of disease or infirmity [1] — meaning a person can only be considered fully healthy if they are well in all three of these dimensions, not just free from illness.
(ii) Mental illness can be defined as a diagnosable condition, such as depression or an anxiety disorder, that significantly affects a person's thinking, feeling, mood or behaviour [1], and disrupts their ability to function in everyday life, for example in relationships or at work [1]. This is different from general mental health, which refers to a person's overall state of psychological well-being.
Final answer: health = complete physical, social and psychological well-being, not merely the absence of disease; mental illness = a diagnosable condition that significantly disrupts thinking, feeling, mood, behaviour or everyday functioning.

(i) [2] 1 mark: reference to complete physical, social and psychological well-being; 1 mark: reference to health being more than just the absence of disease/infirmity.
(ii) [2] 1 mark: reference to a diagnosable condition affecting thinking/feeling/mood/behaviour; 1 mark: reference to disruption of everyday functioning, or a valid named example (e.g. depression, anxiety disorder). All other valid responses will be given credit.

A stress-related illness is a physical or psychological illness that is caused, or made worse, by prolonged exposure to stress [1]. In Freya's case, months of working long hours in a demanding job appear to have caused this build-up of stress [1]; this could result in physical symptoms such as headaches, high blood pressure or disturbed sleep, or psychological symptoms such as anxiety, low mood or poor concentration [1].
Final answer: a stress-related illness is a physical or psychological illness caused/worsened by prolonged stress — in Freya's case, likely caused by her demanding job and long working hours, resulting in symptoms such as high blood pressure or anxiety.

[3] 1 mark: correct definition of stress-related illness (physical or psychological illness caused/worsened by prolonged stress); 1 mark: correctly linked to Freya's situation (long hours/demanding job as the cause); 1 mark: a valid named symptom or effect (e.g. high blood pressure, headaches, anxiety, poor sleep, low mood). All other valid responses will be given credit.

(a) Ryan may experience significant anxiety or fear about developing symptoms in the future, since Huntington's disease is a progressive condition that can affect movement, cognition and mental health as it develops [1]; he may experience low mood or distress even while currently symptom-free, simply from knowing his diagnosis [1]; and he may feel a loss of control or uncertainty about his future, for example around his career or life plans [1].
(b) Ryan's family are also likely to be significantly affected: they may experience ongoing worry and emotional strain about Ryan's future health and the possibility of needing to care for him as the condition progresses [1]; because Huntington's disease is genetically inherited, other family members may now face the difficult decision of whether to be tested themselves, which can cause additional anxiety within the family [1]; and family relationships may be placed under strain by the emotional impact of the diagnosis, though some families may also grow closer through mutual support [1].
Final answer: (a) Ryan may experience anxiety/fear about future symptoms, low mood and a sense of losing control; (b) his family may experience worry about his future/caring responsibilities and difficult decisions about their own genetic testing, which can strain (or, with support, strengthen) family relationships.

(a) [3] 1 mark each for up to three valid psychological effects, e.g. anxiety/fear about future symptoms; low mood/distress; loss of control/uncertainty about the future; must be correctly linked to the progressive, currently incurable nature of Huntington's disease for full credit.
(b) [3] 1 mark each for up to three valid effects on the family, e.g. worry/emotional strain about Ryan's future or caring responsibilities; relatives facing decisions about their own genetic testing; strain on (or strengthening of) family relationships. All other valid responses will be given credit.

1. Marie Curie [1] provides nursing and hospice care, as well as emotional support, for people with a terminal illness and their families, helping to manage their health and well-being at the end of life [1].
2. Age NI [1] provides services and support for older people, such as advice, befriending schemes and practical help, helping to reduce isolation and support independence and well-being in later life [1].
3. Mencap [1] supports people with a learning disability and their families, for example through advocacy, information and practical support, helping them access appropriate services and improving their quality of life [1].
Final answer: voluntary organisations support health and well-being, e.g. Marie Curie (end-of-life nursing/support), Age NI (support and befriending for older people), and Mencap (advocacy/support for people with a learning disability).

[6] Marked as 3 × [2]. For each voluntary organisation: 1 mark for a correctly named organisation; 1 mark for a clear explanation of how it supports health and well-being. Examples of suitable organisations: Marie Curie, Age NI, Northern Ireland Chest Heart and Stroke, Praxis, Childline, Simon Community, Mencap. All other valid responses will be given credit.

Education: if or when symptoms develop, the cognitive decline associated with Huntington's disease could make it difficult for an affected individual to complete or continue in education; even before symptoms appear, anxiety about the diagnosis could affect concentration and performance in study.
Employment: as motor, cognitive and psychiatric symptoms progress, the individual may become less able to carry out their job safely or effectively, which could mean needing workplace adjustments, reduced hours, or eventually being unable to continue working at all.
Income: loss of employment or reduced working hours would likely reduce the individual's and possibly the family's household income; there may also be increased costs associated with care and support as the condition progresses, adding further financial pressure.
Leisure activities: involuntary movements (chorea) associated with the later stages of the condition can make it difficult to continue with certain hobbies or sports; psychological effects such as anxiety or depression may also cause the individual to withdraw from social and leisure activities they previously enjoyed.
Relationships: family relationships may come under strain due to the emotional impact of the diagnosis and, later, caregiving responsibilities; however, some families grow closer through providing mutual support. There is also a risk of stigma or reduced social contact affecting friendships as the condition becomes more visible.
Overall, the impact of Huntington's disease is likely to increase significantly over time as symptoms progress from none (as in Ryan's current situation) to affecting movement, thinking and behaviour, so the family's ability to plan ahead, access support (for example from voluntary organisations or HSC services) and adapt will strongly influence how far these negative impacts can be managed.
Final answer: Huntington's disease can, as it progresses, negatively affect education and employment (through cognitive/motor decline), reduce income (job loss, care costs), limit leisure activities (motor symptoms, social withdrawal) and place strain on family relationships (caregiving, emotional impact) — though support and planning can help the family manage these impacts.

Levels of response (12 marks). Basic (1–4 marks): identifies one or two areas of impact (from education, employment, income, leisure, relationships) with limited, undeveloped comment; weak written communication. Adequate (5–8 marks): describes the impact on several of the five named areas with some development and some evaluative comment; satisfactory written communication. Competent (9–12 marks): evaluates the impact on most or all of the five named areas (education, employment, income, leisure activities, relationships) in a well-developed, balanced way, with a clear, justified overall evaluation (e.g. impact increasing as the condition progresses, importance of support/planning); confident use of specialist vocabulary and clear, well-structured written communication. Examples of suitable points to be included in evaluation: cognitive/motor decline affecting education and ability to work; reduced income from job loss and increased care costs; motor symptoms/psychological withdrawal reducing leisure activity; caregiving strain and stigma affecting relationships, balanced against family support/closeness. All other valid responses will be given credit.

1. Physical needs [1]: for example, help with mobility, or with personal care such as washing and dressing [1]; meeting this need, for example through appropriately trained care staff and adapted facilities such as handrails or hoists, helps maintain the resident's dignity, safety and physical health [1].
2. Emotional needs [1]: for example, the need to feel valued, secure, and to maintain a sense of identity and self-esteem, which can be especially important given the change to living with a disability in a care setting [1]; meeting this need, for example through person-centred care that respects the resident's choices and involves them in decisions about their own care, supports positive psychological well-being and reduces feelings of low self-worth [1].
Final answer: physical needs (e.g. mobility/personal care support, met through trained staff and adapted facilities) and emotional needs (e.g. feeling valued/maintaining identity, met through person-centred care).

[6] Marked as 2 × [3]. For each need identified: 1 mark for correctly identifying a need type (physical/intellectual/emotional/social) with a valid example; up to 2 further marks for explaining how the setting could meet this need and the benefit of doing so. All other valid responses (including intellectual or social needs) will be given credit.

Intellectual needs can be met through activities that stimulate the mind, such as puzzles, reading groups, quizzes or reminiscence sessions, helping to maintain cognitive function and provide mental stimulation; staff can also involve residents in decisions about their own care, respecting their capacity to make informed choices, which supports their sense of intellectual engagement and autonomy.
Social needs can be met through organised group activities, communal dining, and encouraging visits from family and friends, helping to prevent isolation and loneliness; this is especially important for a resident whose physical disability may limit their ability to leave the setting independently. Staff building positive, respectful relationships with residents also supports social well-being.
Overall, a good residential care setting should provide a person-centred balance of mentally stimulating activities and social opportunities tailored to the individual resident's abilities, interests and preferences, recognising that meeting both intellectual and social needs contributes to overall quality of life, not just physical care.
Final answer: intellectual needs can be met through stimulating activities and involvement in care decisions; social needs can be met through group activities, communal dining and encouraging family/friend contact — both are essential alongside physical care for the resident's overall well-being.

Levels of response (6 marks). Level 1 (1–2 marks): basic, undeveloped mention of an activity or approach for one need only. Level 2 (3–4 marks): identifies valid ways to meet both intellectual and social needs, with some development. Level 3 (5–6 marks): detailed, well-developed discussion of both intellectual needs (e.g. stimulating activities, involvement in decisions) and social needs (e.g. group activities, family contact, preventing isolation), clearly linked to the resident's well-being, with good written communication. Examples of suitable points to be included in discussion: puzzles/quizzes/reminiscence for intellectual stimulation; involving residents in care decisions; group activities/communal dining for social contact; encouraging family/friend visits; addressing isolation caused by reduced mobility. All other valid responses will be given credit.

1. Training and supervising staff [1]: a manager can provide regular training on equality and anti-discriminatory practice, and supervise staff to check this is being followed day-to-day [1]; this helps ensure staff have up-to-date knowledge of appropriate practice and are held accountable, reducing the likelihood of discrimination occurring [1].
2. Directly challenging discriminatory practice [1]: if a manager observes, or is informed of, discriminatory behaviour, they should challenge it directly and, if it continues, use disciplinary procedures or report the member of staff to their professional body [1]; this sends a clear message that discrimination will not be tolerated in the setting and helps protect service users from harm [1].
Final answer: managers can promote anti-discriminatory practice by (1) training and supervising staff, and (2) directly challenging discriminatory practice and using disciplinary/reporting procedures where necessary.

[6] Marked as 2 × [3]. For each way: 1 mark for a valid managerial method; up to 2 further marks for explanation of how it promotes anti-discriminatory practice. Examples of suitable points: training/supervising staff; setting a good example through their own practice; policies such as complaints and whistle-blowing procedures; directly challenging discriminatory practice; using disciplinary procedures or reporting to professional bodies. All other valid responses will be given credit.

1. Disability [1]: for example, a service user who uses a wheelchair being unable to access a building or service because of a lack of ramps or accessible facilities [1]; this is an example of indirect discrimination, since the environment itself creates a barrier that prevents the person receiving equal access to care [1].
2. Mental health [1]: for example, a service user with a diagnosed mental illness being spoken to in a dismissive or patronising way by staff, or having their views about their own care ignored because of assumptions based on their condition [1]; this can be a form of direct discrimination, and can seriously affect the person's dignity, confidence and willingness to engage with services in future [1].
Final answer: examples include disability discrimination (lack of accessible facilities preventing equal access) and mental health discrimination (dismissive treatment/assumptions ignoring the person's views).

[6] Marked as 2 × [3]. For each example: 1 mark for a correctly identified characteristic (from race, beliefs, gender, disability, cognitive ability, mental health, sexuality); up to 2 further marks for a valid, well-described example of discrimination relevant to that characteristic in a health, social care or early years setting. All other valid responses (any two different characteristics) will be given credit.

The impact of discriminatory practice: psychologically, experiencing discrimination can cause significant distress, low self-esteem, anxiety or depression, and feelings of being undervalued; socially, it can lead to exclusion or isolation, damage a service user's relationship with staff, and cause them to lose trust in services; physically, discrimination can lead, directly or indirectly, to unmet needs, for example if a service user is denied equal access to appropriate care or treatment, which can allow health conditions to go untreated or worsen.
The impact of anti-discriminatory practice: psychologically, it promotes feelings of being respected, valued and included, supporting positive self-esteem and confidence; socially, it builds trust between service users and staff, encourages service users to engage with and return to services, and supports positive relationships and inclusion within the setting; physically, it helps ensure service users receive equal access to appropriate care and treatment tailored to their needs, supporting better physical health outcomes.
Overall, anti-discriminatory practice is important not only ethically but practically: negative experiences of discrimination can directly discourage service users from accessing care they need in future (for example, avoiding appointments after a poor experience), which can have serious long-term physical health consequences on top of the psychological and social harm already caused; consistently applied anti-discriminatory practice, by contrast, supports better engagement, trust and, ultimately, better physical, social and psychological outcomes for service users.
Final answer: discriminatory practice harms psychological well-being (distress, low self-esteem), social well-being (exclusion, mistrust) and, indirectly, physical health (unequal/avoided care); anti-discriminatory practice supports confidence and inclusion and better, more equal access to appropriate care — making it essential for good service-user outcomes across all three dimensions.

Levels of response (12 marks). Basic (1–4 marks): identifies one or two impacts (of discriminatory and/or anti-discriminatory practice) with limited, undeveloped comment; little coverage of physical/social/psychological well-being; weak written communication. Adequate (5–8 marks): analyses impacts of both discriminatory and anti-discriminatory practice with some development, covering more than one well-being dimension; satisfactory written communication. Competent (9–12 marks): detailed, well-balanced analysis of the impact of both discriminatory and anti-discriminatory practice, covering physical, social and psychological well-being for each, with a clear overall analytical conclusion (e.g. link between negative experiences and future avoidance of services); confident use of specialist vocabulary and well-structured written communication. Examples of suitable points to be included in analysis: discrimination → psychological distress/low self-esteem, social exclusion/mistrust, indirect physical harm from unequal access to care; anti-discriminatory practice → confidence/self-esteem, trust/engagement with services, equal access to appropriate care supporting physical health. All other valid responses will be given credit.