Levels of intervention

October 2012

There are a wide range of approaches you can take to intervention, from providing information through to offering incentives, restricting choice and, at the top end of the scale, introducing regulation.

The government’s approach to improving health and wellbeing – relevant to both national and potential local actions – is based on:

  • strengthening self-esteem, confidence and personal responsibility
  • positively promoting ‘healthier’ behaviours and lifestyles
  • adapting the environment to make healthy choices easier.

The ladder of interventions

The Public Health White Paper refers to a ‘ladder of interventions’ which can be used to promote positive lifestyle changes. Many would argue that ‘do nothing’ is not an option for injury prevention – whether morally, socially or economically – due to the high cost of accidents. However there are opportunities to take action for safer lives and communities at the other levels of the ladder of interventions.

Ladder of interventions

The above image showing the ladder of interventions is taken from the Public Health White Paper, Healthy Lives, Healthy People: Our strategy for public health in England. It is based on the ‘intervention ladder’ described in the Nuffield Council on Bioethics' 2007 report Public Health: Ethical issues report.

Information, education and guidance

There are many ways in which parents, families and children themselves can be supported and encouraged to lead safer lives through information, education and guidance. However, it is important for the information to be:

  • Picture of Safety coveraccessible: for example, to parents with lower literacy levels: research and practitioner demand shows that CAPT’s Picture of Safety series is an effective way of providing ‘safety without the small print’
  • credible: are the recommended actions practical, easily understood and achievable?
  • trusted: is the advice is from familiar practitioners and/or from trusted agencies and organisations?
  • empowering: do the recommendations help to build confidence and responsibility?

Guiding choice through incentives

In addition to the role of education in promoting safer lives and lifestyles, the provision of properly fitted safety equipment helps to guide choice through incentives. Equipment such as smoke alarms, stair gates, cupboard locks and window restrictors, reinforced by appropriate information and training, enables all family members to understand and take responsibility for everyday safety in the home.

Restricting choice

Outside the home and family, environmental change may be necessary to create safer surroundings and neighbourhoods, in effect through restricting choice. Structural and engineering changes, such as those involving roads and the built environment, will involve a greater level of investment and collaboration. This will often involve specialists in subjects such as planning and regeneration, who would not normally be part of injury prevention partnerships. See, for example, the NICE public health guidance on preventing unintentional road injuries among under-15s: road design and modification.

Regulation

Regulation has saved many lives, for example through product safety, the introduction of seat belts on the road and the requirements for fire-safe furnishings in the home. A review of the Furniture and Furnishings Regulations (please note this link opens a PDF) is currently being undertaken with a view to updating them to improve consumer safety, support more effective enforcement and reduce costs.

Updated June 2013