Article Text

Download PDFPDF
Systemic intervention can be intrusive, too: a reply to Paetkau
  1. Tess Johnson
  1. Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Tess Johnson, Ethox Centre, L1 Big Data Institute, Old Road Campus, University of Oxford, Oxford, Oxfordshire, UK; tess.johnson{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

In his feature article, Tyler Paetkau1 argues that the Nuffield Council on Bioethics’ (NCOB) infamous intervention ladder2 fails to acknowledge systemic influences towards poor health outcomes and instead places the blame on individuals. The ladder of interventions to change individual health behaviours runs from less intrusive to more intrusive and pays less attention to possible regulatory mechanisms for big businesses that would often avoid such intrusion on individuals and the punitive implications of that intrusion. Paetkau cites smoking bans and food labelling as examples of various levels of public health measures intruding on individual freedoms. According to him, instead of preventing people from smoking in public spaces or trying to influence their food purchase decisions, we should instead address the social determinants of health through systemic interventions, by which he means ‘interventions that operate on the level of systems rather than individuals and do not target or require individual behaviour change’1 (p. 2).

The argument, however, might be questioned. At points in the article, Paetkau proposes that his new, broadened ‘stairway’ set of public health interventions ‘highlights the intimate connection between systemic interventions and individual outcomes’1 (p. 5). However, in some places, …

View Full Text


  • X @drtessjohnson

  • Contributors TJ is the sole author of this work.

  • Funding This work was funded by the Wellcome Trust (221719).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Linked Articles