Snakes and ladders: state interventions and the place of liberty in public health policy

Abstract

In this paper I outline and explore some problems in the way that the Nuffield Council of Bioethics’ report Public Health: Ethical Issues presents its ‘Intervention Ladder’. They see the metaphor of a ladder both as capturing key normative priorities and as making a real and important contribution to ethical policymaking in public health. In this paper I argue that the intervention ladder is not a useful model for thinking about policy decisions, that it is likely to produce poor decisions, and that it is incompatible with the report’s stated approach to relevant public health policy values.