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Introduction
Melanie Kay Smith and László Puczkó
Health and travel? Travelling for health? Healthy travel? The arena of health-related tourism appears to be very dynamic. Medical tourism is forecast to enjoy exponential growth. Wellness tourism is forecast to grow at an exponential rate. We can read annual trend reports and forecasts which enlist destinations and services that are expected to represent a high rate of growth or popularity every year. Industry publications and press releases are shared almost daily indicating how exceptional this industry is. Professional books and journal articles show the interest of the academic community, too.
Still, we know relatively little about this rather complex form of travel. The definition and taxonomy of health tourism are topics which are often discussed both in academic and in industry circles. It is worth noting that the UN World Tourism Organization and the European Travel Commission will soon publish their first study on this topic, titled Exploring Health Tourism. The editors of the handbook were co-authors of that study and learned from numerous sources how diverse and rich this industry actually is. The study suggests definitions and descriptions which the editors of this volume used as a guide for their work. Most of the chapter authors also shared similar views regarding the structure and scope of health tourism (with a few exceptions, but such debates are to be expected and encouraged, especially with authors of this calibre).
This handbook represents an important addition to existing literature in the field of health, wellness, medical, spa, wellbeing and tourism as it brings together some of the most significant authors, researchers and practitioners in the field to share their latest thoughts and most recent cutting-edge work. It is recognised that there is now a growing body of literature in this fast-growing field and that books are emerging on sub-sectors of health tourism such as wellness tourism (e.g. Voigt and Pforr, 2013), medical tourism (e.g. Connell, 2011; Lunt, Horsfall and Hanefeld, 2015), as well as more comprehensive publications encompassing all of the sectors (e.g. Smith and Puczkó, 2013). There are also numerous industry reports providing research-based studies on spas and wellness and their relationships to tourism (Global Spa Summit, 2011).
The chapters in this handbook indicate some rather important and critical aspects of the relationship between health and tourism. The authors go beyond the traditional understanding of health tourism. Many apply a wider understanding of health, which is wellbeing. Chapters explore the more holistic relationship between wellbeing, health and travel and discuss the differences and similarities between health tourism and healthy travel.
There have been few comprehensive publications which bring together such a broad spectrum of theories and research about the relationships between tourism, wellbeing and health. There have already been several studies on tourism, wellbeing, health, happiness and quality of life (e.g. Corvo, 2010; Puczkó and Smith, 2010; Nawijn, 2011; Dolnicar, Yanamandram and Cliff, 2012; Filep, 2012; Uysal, Perdue and Sirgy, 2012). It has been suggested that individual trips can create greater pre-trip than post-trip happiness (Corvo, 2010; Narwijn, 2011), that vacationers’ happiness does not increase long-term wellbeing (Nawijn, 2011) and that research should perhaps focus on tourism and ‘authentic happiness’ rather than SWB or subjective wellbeing (Filep, 2014). It is also interesting to note that Brajša-Žganec, Lipovčan and Poljanec-Borić’s (2014) research showed that residents of destinations with a higher evaluated quality of tourist offer were happier and more satisfied with their lives in general. Some of the authors in this handbook take these debates further and elaborate on them.
Numerous academic and research-based studies have attempted to define and measure wellbeing and differentiate it from quality of life, life satisfaction, happiness and other indicators of a good life. Theofilou (2013) suggests that most recent studies have failed to make a clear distinction between quality of life and wellbeing. However, when indicators are developed for wellbeing research, health is one dimension that is always included (e.g. Gross National Happiness Index, 2010; Eurofound, 2013; Gallup, 2013; Halleröd and Seldén, 2013; OECD, 2013; Human Development Index, 2014; King, Reno and Novo, 2014; Villamagna and Giesecke, 2014).
Many recent studies emphasise the importance of environmental quality for human wellbeing (e.g. Knight and Rosa, 2011; New Economics Foundation, 2012). Previous studies also suggested that nature-based experiences can improve health and wellbeing (e.g. Kaplan and Kaplan, 1989; Ulrich et al., 1991; Kaplan, 1995; Louv, 2005, 2012; Bell and Ward Thompson, 2014; Tyrväinen et al., 2014). Research has suggested that people may be at risk of losing contact with nature and developing what Louv (2005, 2012) describes as ‘nature deficit disorder’. This involves an outdoor-to-indoor migration and intensive use of electronic media (Barton, 2012). Many authors in this handbook place considerable emphasis on the importance of natural landscapes as health- and wellbeing-enhancing environments in which to take holidays.
The major focus of the Handbook is not only on health tourism, but more the ways in which tourism can improve health and what forms of activities, experiences or environments can enhance wellbeing. There is therefore little debate about definitions of health tourism, which have been the starting point for many books in this field. It has been relatively well established that wellness tourism and medical tourism are sub-sectors of health tourism and that spa resorts, wellness hotels, retreats and hospitals are some of the contexts in which such forms of tourism take place (Smith and Puczkó, 2013). In some countries, the term ‘wellness’ has not always been appropriate to describe the main forms of health-related tourism that takes place there. For example, the Finnish have no word for ‘wellness’ and have been using the term ‘wellbeing tourism’ for more than ten years now, with the health-enhancing qualities of nature and landscape being a major focus (Konu, Tuhoino and Björk, 2013). Van den Eynde and Fisher (2013) examined the Australian context where wellbeing tourism is also widely used. Indeed, forms of tourism which take place in natural landscapes do not fit easily into the conventional categories of health tourism (i.e. wellness and medical tourism). However, they are becoming increasingly important for human wellbeing in the light of debates about sustainability, nature deprivation and urban stress and speed.
Smith and Puczkó (2012) suggest that different forms of tourism are likely to have different impacts on wellbeing. For example, business trips may enhance work and productivity. Going to conferences improves a sense of social wellbeing in addition to providing new professional contacts. Sun, sea and sand tourism is one of the most traditional and best-loved forms of tourism. Although there is a temptation for many tourists in this sector to engage in hedonistic activities like drinking and partying which can be detrimental to their health, there are also ample opportunities to rest offered by sun-bathing, increasing fitness through swimming and beach sports, the vitamin D benefits of the sun and social opportunities to meet others. Most tourists exaggerate their behaviour on holiday and eat, drink, party and socialise far more than at home. This can even be detrimental to health if done in excess, even though it creates a feeling of temporary wellbeing. There are debates within both psychological and tourism circles about ‘hedonic’ versus ‘eudaimonic’ paradigms of health and wellbeing (Hartwell, Hemingway, Fyall, Filimonau and Wall, 2012; McCabe and Johnson, 2012). The hedonic approach focuses on happiness and defines wellbeing in terms of pleasure attainment and the eudaimonic approach focuses on meaning and self-realisation. Voigt, Brown and Howat (2011) suggest that, in the context of wellness tourism, more hedonic wellbeing experiences might take place in a beauty spa whereas more eudaimonic experiences can be gained from spiritual retreats.
Certain forms of tourism are designed especially to improve health. In some cases, tourism is funded by governments or employers as a way of preserving or enhancing workers’ health. The work of McCabe and Johnson (2012) analyses the ways in which social tourism impacts on the subjective wellbeing of participants. For example, this was the traditional function of seaside holidays for workers from industrial cities. Some trips have a primary focus on health, for example, going to medical spas or having surgery as part of medical tourism abroad. In Central and Eastern Europe and many former Soviet states, the governments fund health tourism, which mainly consists of spending several days or weeks in a medical spa or sanatorium with healing thermal waters and other therapies. Some companies may offer their employees incentive trips to spas or some form of ‘occupational wellbeing’. This can include massage, personal training, nutrition, meditation and psychotherapy as well as medical assessments.
The industry still remains fragmented. There are the medical people and there are the wellness (or spa) people. The communication between the two ‘sides’ is developing rather slowly but it is improving. This handbook intends to build a bridge and support the communication and understanding among all those who work and research any aspect of health tourism.
Health tourism may seem to be a new form of tourism. The contrary is true. Health tourism is one of the oldest forms of tourism. Still, certain forms of health tourism have been changing and evolving, e.g. visiting retreats. Certain forms of health tourism (e.g. thermal tourism) are recently being (re)discovered in many areas of the world. This is the real reason why such health tourism forms seem to be new. They are new to a given market but can be rather traditional in other countries.
The general ‘healtharisation’ of the tourism and hospitality industries can lead to a wider spectrum of health and wellbeing improving services in the industry. This, however, will not make tourists staying in ‘healthy’ hotels health tourists, but rather health-conscious guests. The industry has not yet agreed on what a medical or wellness hotel can and should be or what a medical spa is.
We will see more diversification as well as likely standardisation running parallel. Researchers can provide a great contribution to support a better understanding of how tourism can contribute to visitors’ as well as locals’ wellbeing and how to incorporate wellbeing, health, wellness traditions, local assets and medical procedures into tourism products.
This handbook focuses on those forms of tourism and destinations which are especially designed to improve health (e.g. medical tourism, thermal baths, spas, holistic holidays and retreats) and those which can provide wellbeing-enhancing experiences under the right conditions and with the right management (e.g. natural landscapes). It seems to be the case that there is a growing interest in identifying which kinds of environments, landscapes, activities and experiences can contribute to enhancing human health and wellbeing.
We are grateful to all of our authors for sharing their latest insights and research with us in this handbook. It has been a pleasure and an excellent learning experience working with you all!
References
Barton, K. S. (2012) ‘Colorado’s millennial generation: Youth perceptions and experiences of nature’, Journal of Geography, 111, 6.
Bell, S. and Ward Thompson, C. (2014) ‘Human engagement with forest environments: Implications for physical and mental health wellbeing’, in Fenning, T. (ed.) Challenges and Opportunities for the World’s Forests in the 21st Century, Dordrecht, The Netherlands: Springer, pp. 71–92.
Brajša-Žganec, A., Lipovčan, L. K. and Poljanec-Borić, S. (2014) ‘What is good for tourists should be good for residents too: The relationship between the quality of the touristic offer and subjective wellbeing of residents’, Tourism Analysis, 19, 719–730.
Connell, J. (2011) Medical Tourism, Wallingford, UK: CABI.
Corvo, P. P. (2010) ‘The pursuit of happiness and the globalised tourist’, Social Indicators Research, 102, 95–97.
Dolnicar, S., Yanamandram, V. and Cliff, K. (2012) ‘The contribution of vacations to quality of life’, Annals of Tourism Research, 39(1), 59–83.
Eurofound (2013) Third European Quality of Life Survey – Quality of Life in Europe: Subjective Wellbeing, Luxembourg: Publications Office of the European Union.
Filep, S. (2012) ‘The positive psychology and tourism’, in Uysal, M., Perdue, R. and Sirgy, M. J. (eds) Handbook of Tourism and Quality-of-Life Research: Enhancing the Lives of Tourists and Residents of Host Communities, Dordrecht, The Netherlands: Springer, pp. 31–50.
—— (2014) ‘Moving beyond subject...
