A Back and Forth between Tourism and Health

Sebastien Fleuret is a health geographer and director of research at the CNRS (ESO Angers). He is editor-in-chief of the Revue francophone sur la santé et les territoires and has published several works on the geographical dimensions of health.

Introduction Ix

Chapter 1 Tourism and Health, a Long-Standing and Renewed Relationship 1

1.1 From Hippocrates to Thermalism 3

1.1.1 The Roman Period 3

1.1.2 Elsewhere in the World 5

1.1.3 To the Middle Ages, Then in the Renaissance 7

1.1.4 Modern History of Spa Towns 9

1.2 From Sea Bathing to Coastal Tourism and Thalassotherapy 14

1.2.1 Thermal Medicine 16

1.2.2 Thalassotherapy 19

1.3 Fresh Air, Nature, Health and Tourism 21

1.4 From Heliotropism to a Reflection on Social Inequalities in Tourism 24

Chapter 2 Travel Health, Risks and Diseases 27

2.1 Diseases and Risk Areas 28

2.1.1 Infectious and Parasitic Diseases 29

2.1.2 Prevention is Better Than Cure 54

2.2 Circulation of Tourists, Circulation of Diseases 56

2.2.1 International Travel and the Spread Of Epidemics 57

2.2.2 Non-Infectious Risks and Diseases: Travel-Related Variations 60

2.2.3 Travel Mortality and Its Causes 70

2.2.4 Health upon Return Home (Example of Post-Travel Depression) 70

2.3 Bodies, Tourism Activities and Health 71

2.3.1 The Relationship with the Sun and How New Body Norms Emerge 71

2.3.2 Worship of Bodily Beauty 77

2.4 Accidents, Insurance and Repatriation and Access to Travel Healthcare 91

2.4.1 Comparing Healthcare Systems around the World 91

2.4.2 Health Insurance, Assistance and Repatriation 98

Chapter 3 Medical Tourism, Health Mobilities and Global Processes 103

3.1 Medical Tourism, Definition(S) and Trends 103

3.1.1 Definition(S) 104

3.1.2 Trends and Issues 108

3.2 The Patient Tourist Experience 117

3.3 Tourism and Disability 119

3.3.1 Adapted Travels 119

3.3.2 Respite Tourism for Caregivers 125

3.4 Retirement Tourism: From Tourism to Winterization 127

3.5 The Backpacker Phenomenon and Health 130

3.5.1 Risk Assessment and Risk Taking 131

3.5.2 Seeking Care and Searching for Alternative Practices 133

3.6 Circulations, Vernacular Knowledge and Health Versus Tourism and Globalization 134

3.6.1 Substance Circulations and Pharmaceutical Tourism 135

3.6.2 From Traditional Health Knowledge Tourism to Shamanic Tourism 141

Chapter 4 Impact of Tourism Development on the Health of Destinations 147

4.1 Impacts on Health Systems 147

4.1.1 Does Tourism Unbalance Local Health Systems? 148

4.1.2 Does Tourism Initiate Public Health Policies? 153

4.1.3 Labels and Certification Standards 158

4.1.4 Special Case: The Impact of Medical Tourism 161

4.2 Health and Environmental Impacts 164

4.2.1 Pollution or Degradation of Ecosystems 165

4.2.2 Example: The Impact of Cruise Tourism 170

4.2.3 Social Environment 171

4.3 Social Health Impacts 173

4.3.1 Occupational Health 173

4.3.2 Changing Lifestyles: Thoughts on Food 177

4.3.3 Tourist Carrying Capacity and Health Issues 179

Chapter 5 Health, Ignored In Tourism Development? A Neglected Asset? 183

5.1 Health and Wellness as a Tourist Segment 183

5.1.1 Health Benefits of Travel and Tourism 185

5.1.2 Health, Well-Being and Tourist Attractiveness 186

5.2 Synthesis of Potentials 189

5.2.1 Flagship Products 189

5.2.2 An Evolving Clientele 190

5.2.3 Four Facets of the Same Object 191

5.3 What Role for Each Category of Actor? 193

5.3.1 Territorial Actors: Assessing the Health Impacts of Tourism Development 194

5.3.2 Health Actors: Taking Into Account the Fact of Tourism 195

5.3.3 Tourism Stakeholders: Linking Tourism and Health 196

5.4 Transforming Tourism: Goal 3 of the Berlin Declaration 198

Conclusion 201

References 205

Index 221