Table 1.

A balanced intervention Ladder*⁴⁰

+5?	Collective self-binding: For example, a decision by a community, after debate and democratic decision-making, to ban the local sale of alcohol.
+4	Enable choice: Enable individuals to change their behaviours, for example by offering participation in an NHS ‘stop smoking’ programme, building cycle lanes or providing free fruit in schools.
+3	Ensure choice is available: For instance, by requiring that menus contain items that someone seeking to maintain health would be likely to choose.
+2	Educate for autonomy: For example through a media studies curriculum which shows children how to recognise the techniques used to manipulate choice through marketing or by banning marketing primarily targeted at children.
+1	Provide information: Inform and educate the public, for example, as part of campaigns which inform people of the health benefits of specific behaviours.
0	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).
0	Do nothing or simply monitor the situation
−1	Guide choice through incentive: 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.
−2	Guide choice through disincentive: 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.
−3	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.
−4	Eliminate choice: Regulate in such a way as to entirely eliminate choice, for example, through compulsory isolation of patients with infectious diseases.

*The Balanced Ladder suggests that public health interventions can be classified across a spectrum of levels according to their influence on autonomy. These levels range from autonomy-diminishing (eliminate choice), to autonomy-enhancing (enable choice).