• Ethics

The intervention stairway emerges from recognising the complexity inherent in public health issues. While the original intervention ladder is a valuable tool, it risks ignoring this complexity, narrowing our focus to individual-level interventions at the expense of systemic considerations. Some have interpreted this critique as claiming the ladder entirely precludes consideration of systemic factors.1 This is not the case. Instead, the claim is that the ladder obscures these factors, making them more challenging to recognise and incorporate into policy.

This critique has generated several responses. Smith and Gauthier argue that the ladder will not obscure systemic considerations as it is primarily a tool for policy evaluation, not policy creation.1 Moreover, they suggest that even if used for policy creation, the ladder will likely generate systemic interventions as these are often less intrusive. By contrast, Dawson has objected to the stairways’ focus on intrusiveness, supposedly at the expense of other values, saying, ‘the only justification for a tool such as the intervention ladder is if liberty is, implausibly, given some privileged status over other values’.2

These critiques warrant careful consideration but ultimately misunderstand the purpose of both the original ladder and the proposed stairway. Neither tool is meant to privilege liberty or be used in isolation. Rather, they are tools for weighing considerations of intrusiveness and proportionality designed to be applied within …