A: Problem question Peter Paddock has a wine growing business in the South of England,1 which in the wake of global warming is becoming ever more successful. Peter's Chardonnay grapes in particular are in high demand because they won a number of awards. In 2017, Peter plans to expand his operations, step up production and to conquer new markets in other EU Member States. On planning his new business strategy, Peter becomes wary of a number of potential hurdles and wonders whether he can challenge them relying on EU law while it still applies in the UK. a) New French legislation (fictional) bans the sale of Chardonnay wines without a clear indication of country of origin. Further, OPSF (fictional), an ingredient ensuring sufficient sweetness for wine in years of little sunshine, is forbidden in France for use in wine. OPSF is allowed as an addition to fruit juices, although the legislation on wine ingredients is justified by health concerns connected to OPSF. Further, the rules of the Michelin Guide provide that any restaurant serving Chardonnay wines from outside France will not receive more than two Michelin stars. The Michelin Guide is produced by a private organisation, but the award is sponsored by state funds. Peter Paddock foresees severe marketing barriers for his business in France, and wishes to know whether these rules can be challenged under EU law. b) Peter Paddock has an employment problem: reliable wine harvest helpers from Sussex are not prepared to work for wages close to the minimum wage. With the help of employment agencies in Poland, Romania and Spain, Peter Paddock engages a number of workers from these countries, including two sales assistants from Spain, Maria Goncales Alvaro and Ana Garcia Nieto. Peter's employers' association provides useful information leaflets in the native languages of prospective employees advising the workers how to apply for tax credits and child benefits. Maria and Ana, who are accompanied by their children, are initially granted child benefits. A few months after the Brexit vote, the child benefits are discontinued. The reason given is that the children fail an 'ordinary residency test' on the grounds that they spend 3 months a year with their grandparents in Spain. The mothers want this to continue in order for the children to remain fluent in Spanish and also learn to read and write the language. Peter Paddock wishes to know whether he or his workers can challenge these new restrictions by relying on EU law. c) Peter Paddock also experiences difficulties in exporting his wines to Latvia. In an effort to combat increasing alcoholism, the Latvian Parliament has adopted legislation on the socially conscious trade in alcoholic beverages. This legislation requires that any wholesale trade in alcoholic beverages must be conducted by a trading company which has established a branch in Latvia. Peter Paddock has established a branch of his trading organisation in Lithuania, from where he intends to serve the Baltic region and Poland. He considers that the emerging trade in the region renders established branches in each of the countries inefficient, and also prefers Lithuania because he has a reliable business partner there. 1 Peter Paddock wishes to know whether he can challenge these Latvian rules, relying on EU law. SECTION B: Essay questions 1) 'Horizontal effect of the freedom to provide services is not defensible, because it compromises business freedom of entrepreneurs as well as private organisations such as trade unions'. Critically discuss this statement (which is not a quote from anywhere), referring to at least one judgment of the Court of Justice and discussion in academic writing. Running head: HEALTHCARE RESPONSIBILTY Healthcare as a Citizens Responsibility Student Name Course Name of Supervisor Institutional Affiliation Date of Submission HEALTHCARE RESPONSIBILITY 1 Introduction Health is a basic human need, and it affects every aspect of human existence, including mental, financial, emotional and physical wellbeing. An observation of current health trends shows that the incidence of diseases is increasing and worldwide, the cost of healthcare is on the rise. These observations beg the question, who is responsible for the health of citizens in any given state or nation? According to the CDC (2016), in the United States alone, approximately 117 million people suffer from chronic lifestyle diseases which are all preventable. One of the most notable lifestyle health problems is obesity where more than one-third of the adult population have obesity and associated health problems (CDC, 2016). Therefore, it is the responsibility of citizens to maintain their health by eating healthy, exercising regularly, and making a point to see a physician for early diagnosis and health advice regularly. Case study This paper will use a case study of a man known as Walter aged 53 years who lives in Cumberland in the United States (PF,2009). He was diagnosed with multiple chronic conditions. He was in fact diagnosed with diabetes. Walter as forced to routinely seek medical attention from the health facilitates to try and help alleviate his illness. He had to endure long queues at the health facilities; sometimes the medical practitioners could not even see him and if they did, they spoke in terminologies he could not understand. Walter found this system so difficult to navigate through as a matter of fact, he at times perceived prejudice as he waited to be attended to at the medical facilities. We therefore observe that this system of healthcare where we have to rely of government facilities for health maintenance is not proactive in providing adequate healthcare to citizens. Due to the digital revolution witnessed in the world today, Walter can now smile and maintain his own health at his homes without having to go through the difficulties in reaching HEALTHCARE RESPONSIBILITY 2 health facilities. He has been provided with an internet-enabled mobile phone, thermometer, scales, sugar levels monitor and a pulse dosimeter to help him monitor his condition on his own house and order for appropriate drugs when it is necessary. This will help prevent his condition from getting worse. This is a perfect example of a scenario where patients are making use of digital revolution to maintain their health. Indeed,the citizens have a responsibility if maintaining their own health. Overview of Healthcare Stakeholders The term "health" refers to a state of being mentally, physically, psychologically wellbeing without a disability. This means that when one is healthy, they can function properly in all aspects without any difficulty. It does not limit just to the absence of diseases or infirmity in human bodies, but it goes down to physical, psychological and social being of an individual (Knickman et al., 2015). In most countries, the government has for a long time been responsible for providing healthcare services for their citizens. In fact, this has always been that the traditions; that the government has a duty to maintain the health of her citizens (WHO, 2014). The truth of the matter is that the citizens have the primary responsibility to maintain their health other than relying on the government to do this. It is not the full responsibility of the government to maintain the health of the citizens. Predictors of Health There is an understandable correlation that the economy of a country has an impact on the state of health amongst the citizens. When the economy of a country improves, the health of the citizens proportionally improves in an equal or more measure (WEF, 2013). However, what might not be obvious is that the opposite is also true; that when a country improves the health of HEALTHCARE RESPONSIBILITY 3 her citizens, there is a resultant economic growth, just because more people will be able to engage effectively in activities that have an economic inclination (Knickman et al., 2015). It is worth noting that health presents a major challenge for all nations. In a research conducted by the Pew research centre, an estimated 85% of the respondent believe that health was a major in their in their country (Morgan, 2012). It is, therefore, clear that when effective public health systems are in place, it helps in providing proper care for those that are sick. This, in fact, gives rise to measures which promote general wellness and prevent diseases. Taking an example of tobacco; which is one of the greatest dangers we face in the world today; those who smoke make personal decisions to begin smoking, while the danger of smoking tobacco is obvious, citizens still choose to start smoking (Morgan, 2012). Established health problems arising from tobacco smoking include lung cancer, respiratory diseases such as COPD (Chronic Obstructive Pulmonary Disorder), are among the top causes of disability and fatalities in tobacco smoking (Knickman et al., 2015). This, in turn, burdens the government healthcare system in trying to fight such diseases when clearly the citizens who smoke had a responsibility not to engage in smoking. The role of the government is to make sure that these effects are known which places the responsibility of maintaining health on the hands of citizens. It is not the building of more health facilities that help maintain the health of the citizens but putting in place educational campaigns and other campaigns that create awareness amongst the citizens so that they know the importance of healthy living. On the other hand, one may put forward an argument that that responsibility to maintain the health of the citizens rests on the government. The world health organization (WHO) recommends that government get involved in promoting physical certainty and proper healthy diets amongst her citizens (WHO, 2014). This argument is supported by the proponents in that HEALTHCARE RESPONSIBILITY 4 they believe that it is cheaper to take care of a healthy and fit population. They argue that risk factors, physical inactivity being among them, have the possibility of leading to lots of health problems. Such health problems include but not limited to heart diseases together with some types of cancers. Studies on increasing cost of health, in Europe, for instance, show that the government spends 80 billion Euros in a year (Knickman et al., 2015). Therefore proponents of the argument that the responsibility of maintaining the health of the citizens rests on the government; suggest that such costs can be saved and be put to development. Why then should citizens take the sole responsibility to maintain their health? It is arguably notable that the responsibility of the government to maintain the health of the citizens. This is argued as important because such a responsibility protects those that are helpless and poor. It is further argued that when a government provides a paper health care system for her citizens, it guarantee quality this that if such a more is adopted, then cases of citizens becoming more complacent and dependent on the state shall be on the rise (Bodeinheimer et al., 2009). An argument in support of whether the government should take full responsibility for the health of the citizens can also merit. This is more particular when it comes to long term and the most ethical diseases such as HIV/AIDS and cancer (Lakshminarayanan, 2011). These diseases have proved to be extremely costly for an average and low-income citizen. In this case, the role of government in maintaining the health of citizens emerges as, ensuring access to health facilities and required drugs. Also, the government has to should the cost of medication, hence the free provision of some drugs at public hospitals across the world. However, these interventions alone cannot assure a long-term wellbeing. Citizens must come up with a way of ensuring that they keep their health even in the course of treatments (Bdeinheimer et al., 2009). HEALTHCARE RESPONSIBILITY 5 One of the scenarios where the government is in charge of maintaining citizens' health is the promotion of preventive as opposed to curative measures. However, we observe that if the government is given the sole responsibility to maintain the health of the citizens, there is an impending impact on free -market when it comes to the drug industry. Note that the drugs industry is more interesting in making and more sales of drugs. It, therefore, follows that if the government puts in place preventive measures, citizens will need to buy fewer drugs. This will affect the pharmaceutical in industries return on investment (ROI) (WHO, 2014). That will translate to a loss of jobs in the pharmaceutical industries. However, the above argument can be rebutted. This is because the primary ethical goal of the healthcare is reaching the ultimate point where it is barely needed, and in fact maybe even not necessarily needed. Therefore the fear that the pharmaceutical industries might collapse if citizens buy few drugs is not watertight. The primary goal is not making high drug sales, but the major concern is ensuring good health for the citizens. On the contrary, while preventive healthcare is undoubtedly something good for the public health little is known as to whether it is indeed cost-effective, whether this is cost effective or not, it remains debatable (WHO, 2014). Taking an example of China, it is evident that China has been spending increasingly on healthcare. This is due to here increasing the population. As a result, China spends between 20% and 25% of her budget on maintaining the health of her citizens (WEF, 2013). It is, in fact, spending more funds on Biomedical Research, with these figures; China will certainly start spending more on healthcare than the United States. China, therefore, has taken tremendous steps in taking care. Note that not every country has the resources to do so HEALTHCARE RESPONSIBILITY 6 The situation in West Africa seems to be different. Take for example the recent outbreak of Ebola. It was so widespread that the governments of Liberia and Gambia were not able to contain the outbreak. This went beyond the control of the government. In fact, other countries in Africa had to go in and help. Kenya is a perfect example of such a country that helped Liberia deal with Ebola. This is an isolated case where the state was unable to take care of the health of her citizens (WEF, 2013). This was due to lack of resources. This is a typical example of a scenario where the government might not have the required resources to help in maintaining the health of the citizens. Furthermore, the fact is that health costs are on the increase in many countries. Some governments are unable to maintain the health of their citizens. This is a serious crisis indeed, therefore; the answer to this enormous crisis is not the government to take care of the health of the citizens. Instead, we must consider harnessing the energy of the citizens who are concerned with improving their own health (Knickman et al, 2015). Strategies to Promote Health among Citizens There has been a campaign program in the United States dubbed the "blockbuster drug of the Century." An example of such a drug is 'stations.' This drug lowers the levels of cholesterol in the body. This helps reduce heart diseases. Millions of the people are taking them (Kopera, 2016). These drugs help prevent a heart attack. This is a scenario whereby citizens have taken the initiative to prevent diseases that can attack them. This saves the government resources. This is why the responsibility to maintain the health of the citizens be left to the citizens themselves. Some programs can be initiated by citizens themselves. An example of such a program is the coordinated care program for patients run by Kaiser Permanente: which is a health insurance company in the United States (Kopera, 2016). These programs make use of technology in HEALTHCARE RESPONSIBILITY 7 helping patients with heart attack diseases. It further helps those that intend to prevent themselves from heart diseases. As a result, the death rate among those who have enrolled in the program was cut by seventy-six percent (76%) (Kopera, 2016). It, therefore, follows that the citizens should take a bold step towards ensuring that they maintain their health. This is not only important to them, but it also helps in cutting down the resources the government uses on health care service provision (Kopera, 2016). It is evident that when citizens' shares in making decisions relating to health care and are encouraged managing their health, their health improves and as a result, they make less use of health services (Lakshminarayanan, 2011). This cut down the government's spending on the healthcare services provision. The increasing digital revolution in the world today can help citizens maintain their health. There are websites known as 'Health Fabric' which ensures that people get personalized care. This reduces the use of the anti-psychotic drug. It further reduces admission of patients to health facilities. This is how effective it is when citizens make the decision to maintain their health. These strategies ensure that the government spends fewer resources on health care service provision. This only happens because the citizens now take it upon themselves to maintain their health. The message from the preceding is that citizens may improve the effectiveness of the healthcare system that is charged with maintaining their health. Top priority should be given to the patients' experience (Kopera, 2016). This is an aspect that has been overlooked. In fact, this will reduce the costs of health services provision incurred by the government. It further reduces wastage of resources that are well -intentioned yet poorly designed programs fail to achieve the objective of ensuring that the health system is effective (Kopera, 2016). HEALTHCARE RESPONSIBILITY 8 The citizens have a responsibility to ensure that they take proper diet. Fast foods should be avoided or rather discouraged. It is evident that the citizens should take it upon themselves to do more exercises so as to keep their bodies fit. Regular medical check-ups should be encouraged (Bodeinheimer et al., 2009). As a matter of fact, this can tremendously reduce the governments' expenditure in treating terminal diseases like cancer. This is because such diseases are better managed when discovered at early stages. Moreover, a clean environment guarantees good health. This is because some diseases are brought about by the poorly managed environment (Kopera, 2016). Having argued on both sides of this issue, it should be noted that although individual citizens must take the sole responsibility for maintaining their health the government still have a role to play. They can play this role by regulating the food supplied which causes poor diet. The governments should further put measures in place so as to ensure that citizens maintain their health. Future Research Avenues and Gap in Knowledge The above context supports the thesis that it is the responsibility of citizens to maintain their health. However, the efficiency of self-mediated health interventions has not been established. Future research can explore the efficiency of each intervention process undertaken in an attempt to reduce barriers to health care and ensure a uniform global health outlook. There is a gap in knowledge when it comes to making and implementing policies that will promote citizens to reduce reliance on government health funds, and engage in preventive measures as opposed to curative measures. The use of herbal medicine and photochemical have been shown to have both nutritive and curative properties. However, except in some few countries, there lacks an established system to teach citizens on how to use available resources and ensure safety. HEALTHCARE RESPONSIBILITY In summary, the responsibility of maintaining health should be left to the citizens themselves. It is evident that when citizens' opinions in making decisions relating to health care and are encouraged managing their health, their health improves and as a result, they make less use of health services. This cut down the government's spending on the healthcare services provision. In most countries, the government has for a long time been responsible for providing healthcare services for their citizens. In fact, this has always been that the traditions; that the government does not have a sole duty to maintain the health of her citizens. 9 HEALTHCARE RESPONSIBILITY 10 References Bodenheimer, T., Chen, E. & Bennett, H. D. (2009). Confronting the growing burden of chronic disease; Can the U.S. Health care workforce do the job? Health Affairs, 28 (1): 64 - 74. Centers for Disease Control and Prevention (CDC). (2016). Chronic disease prevention and health promotion. Retrieved from https://www.cdc.gov/chronicdisease/overview/ Knickman, J., Kovner, A.R, & Jonas, S. (2015). Jonas and Kovner's Healthcare Delivery in The United States.New York: Springer Publishing Company. Kopera, F.K. (2016).Health Literacy Among Older Adults. New York: Springer Publishing Company. Lakshminarayanan, S. (2011). Role of government in public health: Current scenario in India and future scope. J Family Community Med, 18 (1): 26 - 30. Morgan, L.A. (2012). Quality assisted living: informing practice through research. New York: Springer Publishing Company. PF.(2009). Patient Experience Case Studies. Retrieved from https://www.longwoods.com/articles/images/PF-Walters_Story.pdf WEF. (2013). Sustainable Health Systems: Visions, Strategies, Critical Uncertainties And Scenarios. Retrieved from https://www.weforum.org/reports/sustainable-health-systemsvisions-strategies-critical-and-scenarios World Health Organization (WHO). (2014). Global Status Report on Healthcare. Retrieved From https://who.int/substance_abuse/publications/global_alcohol_report/en/ https://www.longhoods.com/articles/images/PF-Walters_Story.pdf HEALTHCARE RESPONSIBILITY 11