Appendix Four: Nuffield Council on Bioethics - The Ladder of Intervention

The ladder of possible government actions is as follows:

_ Eliminate choice. Regulate in such a way as to entirely eliminate choice, for example through compulsory isolation

_ Restrict choice. Regulate in such a way as to restrict the options available to people with the aim of protecting them, for example removing unhealthy ingredients from foods, or unhealthy foods from shops or restaurants.

_ Guide choice through disincentives. Fiscal and other disincentives can be put in place to influence people not to pursue certain activities, for example through taxes on cigarettes, or by discouraging the use of cars in inner cities through charging schemes or limitations of parking spaces.

_ Guide choice through incentives. Regulations can be offered that guide choices by fiscal and other incentives, for example offering tax-breaks for the purchase of bicycles that are used as a means of travelling to work.

_ Guide choice through changing the default policy. For example, in a restaurant, instead of providing chips as a standard side dish (with healthier options available), menus could be changed to provide a more healthy option as standard (with chips as an option available).

_ Enable choice. Enable individuals to change their behaviours, for example by offering participation in a NHS `stop smoking' programme, building cycle lanes, or providing free fruit in schools.

_ Provide information. Inform and educate the public, for example as part of campaigns to encourage people to walk more or eat five portions of fruit and vegetables per day.

_ Do nothing or simply monitor the current situation.