Health, Tourism and Hospitality

Spas, Wellness and Medical Travel

Melanie Smith, Laszlo Puczko

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781136187346
• Edition: 2
• Topic: Business
• Subtopic: Hospitality, Travel & Tourism Industry
• Index: Business

Health, Tourism and Hospitality: Spas, Wellness and Medical Travel, 2nd Edition takes an in-depth and comprehensive look at the growing health, wellness and medical tourism sectors in a global context. The book analyses the history and development of the industries, the way in which they are managed and organised, the expanding range of new and innovative products and trends, and the marketing of destinations, products and services. The only book to offer a complete overview and introduction to health, tourism and hospitality this 2nd Edition has been updated to include:

• Expanded coverage to the hospitality sector with a particular focus on spa management.
• New content on medical tourism throughout the book, to reflect the worldwide growth in medical travel with more and more countries entering this competitive market.
• Updated content to reflect recent issues and trends including: ageing population, governments encouraging preventative health, consumer use of contemporary and alternative therapies, self-help market, impacts of economic recession, spa management and customer loyalty.
• New case studies taken from a range of different countries and contexts, and focusing on established or new destinations, products and services such as: conventional medicine, complementary and alternative therapies, lifestyle-based wellness, beauty and cosmetics, healthy nutrition, longevity and anti (or active)-ageing, amongst others.

Written in a user friendly style, this is essential reading for students studying health, tourism and hospitality.

PART History and development of health, wellness and medical tourism

CHAPTER Definitions and concepts

Much of wellness tourism is based on getting in touch with what is (inside or outside us) without reasoning it through or even having the words to express what is going on. This makes wellness tourism a manifestation of phenomenological ‘letting be’, which Heidegger… actually claims is our most natural way of encountering and dealing with the world. We have lost our natural way and seek it in wellness tourism.

(Steiner and Reisinger, 2006: 9)

This chapter defines some of the main concepts and terms that are used throughout this book. It is important to note that there are major debates about the precise meanings of certain words or concepts, but the increasing research in the field has led to more focused definitions, especially those relating to tourism. What is offered here are definitions based on a combination of academic theory and industry research, which are certainly not definitive or entirely comprehensive, but they provide a firm foundation for our discussions in this book and research in this field.

Defining key terms: health, wellness, well-being, happiness and quality of life

Health is the umbrella term for many of the other terms used in this book, especially the broad definition of the World Health Organization (WHO) from 1984:

The extent to which an individual or a group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources as well as physical capabilities.

(WHO, 1984)

In addition to freedom from the risk of disease and untimely death, the WHO also refers to people’s abilities to perform family, work and community roles; their ability to deal with physical, biological, psychological and social stress; the extent to which they experience feelings of well-being; and their state of equilibrium with their environment.

Quality of life is an even broader and more complex concept than health and combines both objective and subjective elements. Rahman et al. (2005) include the domains of health, work and productivity, material well-being, feeling part of one’s local community, personal safety, quality of environment, emotional well-being, and relationship with family and friends. Puczkó and Smith (2012) apply Rahman’s quality of life domains to tourism and they also add spiritual well-being and social and cultural well-being to this list. They argue that tourism can contribute to most of the domains, but in particular health, work and productivity, emotional and spiritual well-being and relationship with family and friends. Tourists may also feel part of a temporary community when they are travelling, and may pay more attention to the environment, especially if they are ecotourists or travelling in beautiful or fragile locations.

Happiness is a somewhat elusive term, although considerable research is now devoted to producing global indices of happiness for numerous countries. As stated by Gilbert (2007: 238), ‘There is no simple formula for finding happiness’. Martin Seligman (2003), one of the founders of positive psychology, defines happiness as both positive feelings such as ecstasy and comfort and positive activities that have no feeling component at all such as absorption and engagement. In his happy life formula, Seligman defines a happy life as a life filled with positive feelings and activities. Haidt (2006) suggests that happiness comes from within and without; however, the Dalai Lama (1999), who believes that the very purpose of life is to seek happiness, suggests that happiness is determined more by the state of one’s mind than by one’s external conditions, circumstances or events – at least once one’s basic survival needs are met. Haidt (2006: 242) analyses different approaches to happiness: ‘The East stresses acceptance and collectivism; the West encourages striving and individualism… both perspectives are valuable. Happiness requires changing yourself and changing your world. It requires pursuing your own goals and fitting in with others.’ It is interesting to note that Buddhists are often considered to be some of the happiest people in the world, partly because of their practice of meditation and mindfulness (Connor, 2003). The Vietnamese Buddhist monk Thich Nhat Hanh emphasises the importance of mindfulness in being happy. However, even the Dalai Lama (1999) recognises the importance of achieving material stability or comfort first in these four factors of fulfilment:

1 wealth;

2 worldly satisfaction;

3 spirituality;

4 enlightenment.

Seligman uses the words happiness and well-being interchangeably, but the New Economics Foundation (NEF, 2004) makes a distinction between happiness and well-being as follows: ‘Well-being is more than just happiness. As well as feeling satisfied and happy, well-being means developing as a person, being fulfilled, and making a contribution to the community.’ This definition takes the discussion beyond the transformation of the individual through self-development and personal fulfilment towards a sense of social responsibility. Alison van den Eynde and Adrian Fisher discuss the concept of well-being in more depth in Part III based on their research in Australia. The concept of wellness takes this idea even further and includes domains such as physical, mental and spiritual health, self-responsibility, social harmony, environmental sensitivity, intellectual development, emotional well-being, and occupational satisfaction (Müller and Kaufmann, 2001; National Wellness Institute, 2007). Wellness has stronger ties with changing lifestyle or doing something healthy than with curing a specific disease. People consuming wellness services tend to show higher health awareness than others. They are eager to do something for a healthier lifestyle, they are conscious about their nutrition and often do physical exercise. Wellness addresses human health in a holistic or comprehensive sense and assumes that each person will actively participate in protecting their health, in preventing diseases and will not leave all this to medication. Myers et al. (2000) define wellness as being ‘a way of life oriented toward optimal health and well-being in which the body, mind, and spirit are integrated by the individual to live more fully within the human and natural community’. GSS (2010: ii) describes wellness using the following dimensions:

• wellness is multi-dimensional;

• wellness is holistic;

• wellness changes over time and along a continuum;

• wellness is individual, but also influenced by the environment;

• wellness is self-responsibility.

It seems to be the case that the concept of health and wellness are increasingly being used inter-changeably, but it should still be emphasised that health tourism includes medical or cure aspects, and that wellness is more preventative than curative. In recent years the term ‘medical wellness’ has been used, especially in German-speaking environments. The Deutscher Wellness Verband (2008) suggests that the term ‘medical wellness’ can be used to integrate the concepts of health and wellness, in the sense that there is a medically supervised programme that enhances wellness for clients. This involves making specific changes to lifestyle which can help to achieve optimum wellness. However, Nahrstedt (2008) argues that this does not meet the goal of complete well-being, whereas the concept of ‘cultural wellness’ combined with ‘wellness education’ takes us to a form of ‘high level wellness’. The US-based Medical Wellness Association defines medical wellness as ‘the practice of health and medical care relating to proven wellness outcomes’. A more specific definition of medical wellness by AMWA is an approach to delivering care that considers multiple influences on a person’s health and consequently multiple modalities for treating and preventing disease as well as promoting optimal well-being (Breuleux, 2013). Several industry representatives also argue, based on their experiences, that the term ‘medical wellness’ confuses not only the customers but also creates tension between the medical and wellness professionals. Probably another term, such as structured wellness, can provide a solution to the debate.

Cultural differences in understandings of health and wellness

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There are clearly different historic, cultural and linguistic understandings of health and wellness. In some languages (e.g. Hebrew) there is no word for ‘wellness’, and it is merely translated as ‘health’. However, it seems to be increasingly common that the term ‘wellness’ is used internationally, even in those countries where the language is very different from English (e.g. Hungary) or in countries which are protectionist about language (e.g. France). Translating the term for the purposes of marketing or carrying out research can create a few problems. For example, in Finnish, there is not an easy direct translation of the word ‘wellness’ and the Finnish version corresponds more closely to ‘well-being’. Well-being seems to be used increasingly in many English-speaking countries, also in the context of tourism. For example, the term ‘well-being’ tourism is quite common in Australia, as well as in Finland. In Slovenian, the translation is more like ‘well-feeling’. In German-speaking countries, not only is the term wellness (in English) fully embraced, but it has even been taken a stage further with the concepts of ‘selfness’ and ‘mindness’ being developed. ‘Selfness’ and ‘mindness’ imply that people are taking responsibility for their own lifestyle and making relevant physical, emotional, psychological and social changes. Interestingly, as noted by the BMWA (2002), some Anglicisms like the term ‘wellness’ (and even less, ‘selfness’ and ‘mindness’) are not so well understood in the UK, neither is the term ‘health tourism’, mainly because of the lack of a kur (sometimes translated as ‘resort medical therapy’) or medical wellness tradition. In Spanish or Portuguese Latin-based expressions are common, such as saúde (health) and bem-estar (well-being). In German tourists can find terms such as wohlbefinden, wohlfülen (well-feeling) or vitality as an alternative to wellness.

Irrespective of terminology, health and wellness as a concept clearly means different things in different countries and cultures. In Central and Eastern Europe and the Baltic States, the term health is closely related to physical and medical therapeutic healing. The existence of medical waters and other natural assets (such as muds, peloid or caves) means that the main association for people in the region is with these forms of activity. Treatments tend to be curative for specific physical conditions. Visitors from these ...