The Ladder of Intervention is a Public Health approach to changing public behaviour through a combination of education, nudge behaviour, empowering change, and ultimately reducing autonomy.
To assist in thinking about the acceptability and justification of different policy initiatives to improve public health, The Nuffield Council on Bioethics devised what they call the ‘intervention ladder’ within their report ‘Public Health: ethical issues‘.
The ladder of intervention lays out a structured approach to public health interventions which ranges from no intervention through to reducing autonomy and controlling choice – this is an ethical dilemma which is addressed within their report.
Another view of the ethical dilemma is that Public Health interventions actually increase autonomy (Griffiths & West, 2015).
The first and least-intrusive step on the ladder is to do nothing, or at most monitor the situation. The most intrusive is to legislate in such a way as to restrict freedoms significantly, either for some groups of the population or the population as a whole, in order to achieve gains in population health.
The higher the rung on the ladder at which the policymaker intervenes, the stronger the justification has to be. A more intrusive policy initiative is likely to be publicly acceptable only if it is clear that it will produce the desired effect and that this can be weighed against the loss of liberty that will result.
The Nuffield Council on Bioethics clarifies that it is not the case that the option of ‘doing nothing’ requires no justification, as deciding to ‘do nothing’ is itself a value judgement and may have adverse consequences for some. For example, not regulating vehicle speed limits or blood-alcohol limits might result in deaths or injuries.
Ladder of Intervention
- Eliminate choice
- Restrict choice
- Use disincentives
- Use incentives
- Change the default
- Enable choice
- Provide information
- Do nothing
- Griffiths, P. E., & West, C. (2015). A balanced intervention ladder: promoting autonomy through public health action. Public Health, 1092–1098. https://doi.org/10.1016/j.puhe.2015.08.007