1 Health Tourism Lecture 2 Contemporary definitions (health tourism, medical and wellness tourism) 2 Wordsworth had urged us to travel through landscapes to feel emotions that would benefit our souls. (De Botton, 2002: 159) HEALTH Opinions about what constitutes wellness diverge greatly, and the term is often confused with definitions of health. The widely accepted definition of health is that of the World Health Organization (WHO, 1948), which states that health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. WHO has broadened its definition: 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) Health tourism includes medical or cure aspects, and that wellness is more preventative than curative. 1
3 Illness Illness or disease is one of the key motivations for those people who travel to medical spas, and they often have a prescription from their doctor confirming that they need a specific treatment for an illness. Since the financial situation of national health insurances is not getting any better, patients face long waiting lists, therefore many consider having the necessary treatment in a third country for less. 4 Wellbeing The NEF (2004) make a distinction between happiness and wellbeing: Wellbeing is more than just happiness. As well as feeling satisfied and happy, wellbeing means developing as a person, being fulfilled, and making a contribution to the community Two leading American wellbeing researchers, Diener and Seligman (2004) say a (partial) formula for high wellbeing is to: live in a democratic and stable society that meets material needs; have supportive friends and family; have rewarding and engaging work and an adequate income; be reasonably healthy and able to treat mental health problems; have important goals related to one s values; have a philosophy or religion that provides guidance, purpose and meaning to one s life. 2
5 Quality of Life There are clearly objective and subjective indicators which can be used to measure QoL. Tourism-specific Quality of Life Index (TQoL) The Ministry of Local Government and Regional Development in Hungary was assigned a project to develop the Tourism-specific Quality of Life Index (TQoL) (as part of the implementation of the National Tourism Development Strategy, accepted in 2006). 6 From the many definitions and models the approach of Rahmann (Kovács et al., 2006) was selected as a basis. According to Rahmann s approach, it is anticipated that all the eight domains, directly or indirectly have some kind of relationship to and with tourism. Quality of Life Domains. Source : Kovács et al., 2006. 3
Happiness Happiness is a complex and almost undefinable term. Bond (2003) points out that many of the so-called happiest nations paradoxically often have the highest suicide rates, it is thought mainly due to the individualistic culture and lack of social and community support. 7 Shah and Marks (2004) suggest in their research that the happiest people tend to be altruistic, generous, tolerant, and sociable. Spirituality Some authors have argued that spirituality is at the core of wellness (e.g. Devereux & Carnegie, 2006; Pernecky & Johnston, 2006 ; Steiner & Reisinger, 2006). Elkins et al. (1988) described spirituality as a multi-dimensional construct with the following nine major dimensions: 1. Transcendent dimension: Belief in more than that which is seen, that may or may not be belief in God; and belief that personal power is drawn through harmonious contact with this dimension. 2. Meaning and purpose in life: Deep confidence that one s life has purpose, emerging from a quest for meaning. 3. Mission in life: Sense of responsibility to life; knowing that in losing one s life one finds it. 4. Sacredness of life: Belief that all life is holy. 5. Material values: Realization that ultimate satisfaction is from spiritual, not material things. 6. Altruism: Belief in social justice, and awareness that no man is an island. 7. Idealism: Commitment to the actualization of positive potential in all aspects of one s life. 8. Awareness of the tragic: Deep awareness of human pain, suffering, and death, and that life has value. 9. Fruits of spirituality: Benefits of spirituality realized in relationships with self, others, nature, and what one perceives as the Ultimate. 8 4
Spirituality/ cont d 9 Magyar (2008) compiled the most popular spiritual destinations around the world by collecting information from major spiritual traveloriented websites. Jerusalem (Israel) Mecca (Saudi Arabia) The Vatican and Rome (Italy) Tibet, Nepal and Mount Everest Goa and Benares (India) Machu Picchu (Peru) Egypt Mount Fuji (Japan) Navaho Region (USA) Rio de Janeiro (Brasil) Alaska (USA) New Age 10 Many of the more esoteric aspects of wellness are sometimes described as New Age, with the term often being used in a derogatory way. However, New Age beliefs are interesting as they are closely connected to non-religious spirituality and their proponents tend to be much more open minded to new experiences than those who deride it. Typical New Age activities include the following: Channelling (conjuring up spirits of the dead) Crystals (i.e. their healing energy) Meditating (blanking the mind and releasing oneself from conscious thinking) New Age music (melodic, inspirational music used for healing, massage therapy, and relaxation) Holistic health (healing techniques from traditional medical models which aim to balance body, mind, and spirit. Examples are acupuncture, crystal healing, homoeopathy, iridology, massage, various meditation methods, polarity therapy, psychic healing, therapeutic touch, refl exology, etc.) Human potential movement (individual and group mental and physical techniques used to advance spirituality. Examples include Gestalt Therapy, Primal Scream Therapy, Transactional Analysis, Transcendental Meditation, and Yoga). 5
Holism Optimum wellness comes from a balance between wellbeing in the body, the mind, and the spirit (i.e. a holistic approach to life). The American Holistic Health Association (AHHA) (2007) suggests that there are two standard definitions that are used for holistic : 1. Holistic as a whole made up of interdependent parts. You are most likely to hear these parts referred to as the mind/body connection; mind/body/spirit, or physical/mental/emotional/ spiritual aspects. When this meaning is applied to illness, it is called holistic medicine and includes a number of factors, such as dealing with the root cause of an illness; increasing patient involvement; and considering both conventional (allopathic) and complementary (alternative) therapies. 2. Holistic as a synonym for alternative therapies. By this definition, going holistic means turning away from any conventional medical options and using alternative treatment exclusively. This meaning mainly relates to illness situations, and sometimes is used for controversial therapies. 11 Wellness 12 Wellness is clearly a complex concept, incorporating elements of lifestyle, physical, mental, and spiritual wellbeing, and one s relationship to oneself, others and the environment. Adams (2003) refers to four main principles of wellness: 1. Wellness is multi-dimensional. 2. Wellness research and practice should be oriented towards identifying causes of wellness rather than cause of illness. 3. Wellness is about balance. 4. Wellness is relative, subjective or perceptual. The National Wellness Institute s (2007) six-dimensional model focuses on the physical, spiritual, intellectual, emotional, social, and occupational aspects of life. 1. Social: The social dimension encourages contributing to one s environment and community. 2. Occupational: The occupational dimension recognizes personal satisfaction and enrichment in one s life through work. 3. Spiritual: The spiritual dimension recognizes our search for meaning and purpose in human existence. 4. Physical : The physical dimension recognizes the need for regular physical activity. 5. Intellectual: The intellectual dimension recognizes one s creative, stimulating mental activities. 6. Emotional: The emotional dimension recognizes awareness and acceptance of one s feelings. 6
13 Wheel of Wellness (Source: Smith and Puczkó) 7