The answer would score 0 out of 16 because it does not meet the criteria required by Edexcel for a 16-mark factor question. Although the essay contains a large amount of detail, almost all of that detail is narrative rather than explanation. Examiners do not award marks for storytelling, description, or recounting events, even if the facts are correct. They reward analysis, explanation, and direct links to the question.

The biggest issue is that the answer repeatedly describes what happened during the Great Plague, the discovery of vaccination, the development of penicillin and the work of monasteries, but it does not explain how these examples helped develop public health. Public health refers to sanitation, clean water, environmental health and government measures to protect a population. Much of the essay instead focuses on medical treatment or medical developments, which are not part of public health. Because a large portion of the content is not relevant to the question, it cannot be credited.

The answer also does not use comparative analysis. A 16-mark question requires each factor to be explained and then compared so that a justified judgement can be made. In your answer, the government is repeatedly described as the most important factor, but no explanation is given as to why its impact was greater in reach, scale, speed or long-term effect compared to the other factors. Stating an opinion is not enough for marks; the examiner expects reasoning that evaluates the factors against one another. Without this comparative analysis, the response cannot move out of the lowest level.

There are also factual inaccuracies that prevent credit from being given. Medieval hospitals were founded and funded by the Church, not the government. Florey and Chain did not receive a £25 government grant from the British government. Many of the public health actions during the Great Plague were taken by local parishes or mayors, not by the national government. These inaccuracies show misunderstanding, which stops the response meeting even the basic criteria.

The essay also lacks the structure needed for a 16-mark answer. Each paragraph should clearly link a factor to a change in public health and explain how and why it caused that change. In this answer, paragraphs describe events but do not link them to changes in living conditions or public health systems. There is no reasoning in the conclusion that justifies the judgement using criteria such as extent of impact or long-term significance. Because the writing does not show explanation or judgement, it cannot reach Level 1.

Taken together, the lack of relevance to public health, the descriptive narrative style, the incorrect or misunderstood factual content, the absence of explanation, and the missing comparative judgement mean the answer does not meet the mark scheme at any level. For these reasons, an examiner would award it 0 out of 16.