Health and Wellness Tourism Today

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According to the World Health Organization (WHO) health is a state of physical mental and social well-being and not merely the complete absence of disease or infirmity. In accordance with this definition wellness can be equated with health. Health and wellness involves several well-being dimensions including physical mental social sexual emotional cultural spiritual educational occupational financial ethical and existential dimensions.


This article represents an attempt to develop an understanding of current health and wellness tourism around the world. The aims are to:

  • clarify concepts because of the usual incipiency and lack of conceptual rigor regarding health and wellness tourism
  • qualify procedures and patient safety as crucial factors
  • importance of destination branding.

Brief History: Health and Wellness

Past ancestors: Ayurvedic Medicine (India 3000 BC) Chinese Medicine (Emperor Sheng Nung 20382698 BC) Thai Traditional Medicine Japanese Onsen Russian Steam Bath Tell el Amarna Therms (Egypt 1350 BC) Greek Thalassa (Hippocrates 460355 BC) Roman Thermae/Balnea Publica (II BCIII AC) Arabian Medicine (8th-15th century Al Razi 850923) Turkish Haman Dead Sea Salts Baths Egyptian Mansuri Hospital (Cairo 1248).


Travellers came from all over the world Native American Sweat Lodge Mexican Temazcalli Australian Aboriginal Steam Baths Mineral Springs in Spa near Liége (14th) Climatotherapy (XVIII/XIX Centuries) in Madeira and Canarias Islands Scientific Medicine (19th century).Recent years: 1959  Inauguration of Golgen Door Spa in California 1987  Official beginning of the Global SPA industry  SpaFinder Magazine 1991  International SPA Association  ISPA (USA) 1996  European SPA Association.

In health and wellness tourism quality/excellence safety and ethics are deeply connected.


ESPA (Brussels) 1998  Guide of the 100 Best SPAS of the World 2003  Spa Asia Magazine 2007  Medical Tourism Association  MTA USA 2007  I Congress on Medical Tourism Worldwide Munich 2008  I International Health Tourism Congress Turkey  Association of Improving Health Tourism 2008 onward -- Congress took place in different cities in Turkey 2008  First Annual World Medical Tourism Association Congress 2008 onward.


Congress took place in different cities in USA 2010/2012  Annual European Medical Travel Conference (EMTC)  Venice Barcelona Berlin 2012  I International Conference on Health and Tourism Faro Portugal 2013  International Medical Travel Exhibition and Conference Monaco 2014  II International Congress on Health and Tourism Albufeira Portugal.

Emergent Paradigms on Health and Medicine

Preventive Medicine promotes healthy lifestyles and diets stress management intellectual stimulation and fitness with a focus on wellness assessments versus illness.

Predictive Medicine individual health promotion based on diagnostics of genetic and environmental determinants.

Holistic Medicine whole-being meaning physical well-being mental awareness and wisdom spiritual harmony and equilibrium.

Integrative Medicine brings together orthodox Western medicine/Allopathic and other Eastern holistic medicines  Chinese Ayurvedic and Indigenous knowledge and environmental consciousness. Integrative medicine emphasizes wellness wholeness and a preventive approach to health. Western medicine is based on an illness model concerned with treating disease rather than enhancing wellness.

Anti-Aging medicine that combines all those preceding paradigms.

Definition: Health and Wellness Tourism

Health and wellness tourism includes travelling both nationally and internationally to places and facilities such as hospitals clinics thermae thalasso wellness SPAs and fitness centers and wellness resorts.

In 2012 it was estimated that a million medical tourists travelled around the world for outbound/ inbound medical tourism.


The purpose of health and wellness tourism is medical care and health beauty relaxation recovery and rehabilitation treatments. There are more than a hundred-million health and wellness tourists around the world each year. Health and wellness tourism includes medical tourism elderly age tourism disability tourism thermal tourism and thalasso-therapy tourism.

Wellness Tourism

Wellness tourism includes consumers who travel to maintain their well-being and life satisfaction through the experiences of healthy treatments. Wellness has to do with quality of life. In a holistic approach to health (Chinese ayurvedic and integrative medicines) wellness treatments and therapies restore the vital balance among bodies mind and spirit toward equilibrium and health harmony. This harmony re-balances and restores the energy flow bringing about overall well-being.

Health Tourism

Health tourism refers to patients who travel nationally or internationally for healing therapies in hospitals and clinics. Health tourism includes medical tourism aesthetical/plastic tourism thermal tourism and thalassotherapy tourism.

Medical Tourism

Medical tourism involves travel to hospitals and clinics for medical treatments in different areas including cardiology gynaecology neurology ophthalmology oncology orthopaedic transplants preventive medicine artificial insemination anti-aging medicine and plastic reconstructive medicine.


Medical tourism is also known as medical travel health tourism health travel healthcare tourism healthcare abroad medical overseas and overseas medical.Medical tourism has two components: inbound and outbound. In 2012 it was estimated that a million medical tourists travelled around the world for outbound/inbound medical tourism.


Medical tourism is a $100 billion global industry. The most important destinations include Argentina Austria Belgium Bolivia Brazil Chile Colombia Costa Rica Cuba Cyprus Czech Republic Dubai El Salvador France Germany Greece Guatemala Hungary India Israel Jordan Malaysia Mexico Philippines Poland Singapore South Africa South Korea Spain Sir Lanka Thailand Tunisia Turkey United Arab Emirates Venezuela and Vietnam.

Aesthetical Tourism

Aesthetical tourism includes aesthetic surgery and treatments. In aesthetic/plastic tourism the most important countries are the United States and Brazil. Other destinations are Argentina Austria Belgium Bolivia Costa Rica Cuba France Germany Greece Hungary Italy Poland South Africa Spain Tunisia Turkey United Arab Emirates and Venezuela.

Quality/Excellence and Safety

Within the scope of healthcare the quality of procedures and patient/client safety is strongly connected. Quality is the level of excellence ensured by a continuous managerial system.Safety is the condition/state of being secure from hurt/ injury and aims to prevent accidents and contagious diseases. It includes protective devices to prevent hazardous accidents and nosokomeion diseases.

Quality/Excellence and Main Safety Components

Safe Environment air quality water quality reduced noise and visual pollution free of radiation pollution (magnetic electric nuclear) natural or recreated pleasant landscape - healthy trees bushes and flowers.


Architectonic Requirements Modern and pleasant-looking healthcare facilities that enable the fast physical mental and spiritual well-being of patients and that makes their relatives and visitors rest and relax.


The main architectonic requirements are operating rooms located in sterilized areas lounges designed as living rooms and libraries assuring safety patient well-being and reduced time in integrated examination rooms on the same floor special architectural design that allows optimization of patient flow within the hospital and aims to prevent infections floors walls and ceiling materials must be easy to clean and disinfect walls painted with soft colors such as blue green and pink natural lighting and ventilation and healthy plants.

Medical tourism hospitals must have a specialized staff which can speak different languages fluently namely the official voice of the patient's country.


A new generation of healthcare facilities is emerging that is very different from familiar institutional models. Based on patient-centered care and healing the whole person these health centers are spiritual sanctuaries with gardens fountains natural light art and music. Research is learning how human emotions are linked to disease and that healing is promoted by surroundings that reduce stress and engage the senses in therapeutic ways. Jain Malkin

Hotel Structure and Services

The hospital (hospital like a hotel) requires healthcare humanization beautiful lounges several restaurants and cafeterias shops exhibition galleries musical concerts conference halls containing simultaneous translation systems and catering and laundry facilities specializing in the healthcare sector.A hospital is primarily a hotel in which health services are provided. Acibadem Turkey

Technological Accuracy/Modern Technology

The latest international technology is put into service including accurate diagnosis equipment a fully equipped digital radiology department accurate radiotherapy treatments cyber-knife robotic surgery systems advanced cardiology ophthalmology and orthopaedics diagnosis treatment equipment and organ transplants.

Professional Healthcare Qualifications: Surgeons Doctors and Others

Professional staff includes a high-qualified board of internationally certified surgeons and doctors specialized in different medical fields highly qualified anaesthesiologists qualified nurses and others health professionals.

Multi-Language Staff Communicating Skills

Medical tourism hospitals must have a specialized staff which can speak different languages fluently namely the official voice of the patient's country. Good communication is very important to the safety and well-being of patients and their relatives.

Scientific Affiliation

Hospitals and clinics develop protocols with universities/ colleges and research centers. Turkey Acibadem is affiliated with Harvard Medical International and Anadolu Health Center with John Hopkins Hospital.

Healthcare Humanization

It is very important that patient-centered healthcare include a warm and tender environment attention to each individual patient's needs respect of cultural roots alimentary traditions and religious beliefs and patient participation in musical and theatrical groups.

Accreditation and Certification

In medical/aesthetical tourism it is important to attest to the excellence and safety of healthcare services for clients from other countries. The most important international accreditation institutions are the Joint Commission International (JCI) Canadian Council on Health Services (CCHSA) Deutche Akkreditierrungasstelle Chemie (GMBH) Commission on Laboratory Accreditation of the College of American Pathologists Clinical Laboratory Accreditation Certificate ISO 15189 and ISSO 9001:2000 Medical Tourism Association (MTA Certification) International Society for Quality in Healthcare (ISQUA) European Society for Quality in Healthcare (ESQH) International Organization for standardization (ISO) Trent Accreditation Schemes (TAS) King's Fund Health Quality Services (KFHQS) and International Society of Aesthetic Plastic Surgery (ISAPS).

High Standard of Ethical and Professional Deontology

In health and wellness tourism quality/excellence safety and ethics are deeply connected. The aesthetical surgeons must avoid making several surgical operations while informing the client/patient of the dangers of multiple aesthetical surgeries.

Importance of Branding Destinations

Health and wellness brand destination becomes more important to promote the image of high-quality healthcare in a location (city region country). Seeking to attract international patients from around the world partners and stakeholders should work together to develop network synergies health and wellness clusters. Hotels and resorts become healthcare facilities for prior and post-surgery medical travellers.

Attractive and Competitive Advantage of a Destination

The attractiveness and competitive advantage of medical/ aesthetical tourism are competitive prices on a global scale international accessibility and proximity international accreditation/certification and excellence.


Excellence is defined as a high-level of holistic quality (several levels and parameters) which exceed expectations including accredited hospitals qualified doctors certified surgeons qualified anaesthesiologists qualified nurses and others professionals advanced technologies efficacious therapeutic procedures faster medical services affiliation with universities and research centres humanization of healthcare beautiful hospitals hospitality/hotel structure linguistically competent teams healing climate pleasant environment/ landscapes healthy gastronomy and partnership with luxury hotels and resorts.

About the Authors

João Viegas Fernandes is a founder and president of the Associação Portuguesa de Turismo de Saúde e Bem  Estar  APTSBE (Health and Wellness Tourism Portuguese Association). He is also the architect and advisor to Algarve Region Health & Wellness Tourism Cluster and Destination Branding. He is considered a visionary pioneer and expert in health and wellness in Portugal.


As a professor he conceptualized a discipline in health and wellness tourism which he teaches in the School of Management Hospitality and Tourism of Algarve University. He has lectured in various universities in Portugal Spain and Brazil and is researching health and wellness tourism around the world.


Fernandes is a consultant in this area both nationally and internationally. Fernandes has spoken at several conferences in Portugal Spain Brazil Turkey Cape Verde and Monaco on sustainable health and wellness tourism. He is the author of the book ThalassaThermae SPA-Salute Per Aqua (Lisboa Portugal 2006).


He also is co-author of several articles and books including SPAS Centros Talasso e Termas: Turismo de Saúde e Bem-Estar (Lisboa Portugal 2008) and Turismo de Saúde e Bem-Estar no Mundo: Ética Excelência Segurança e Sustentabilidade (São Paulo Brazil 2011).


Fernandes was the chairperson of the I International Conference on Health and Tourism (Faro Portugal 2012) and the II International Congress on Health and Tourism (Albufeira Portugal 2014). He is an advocate of increased cooperation in health and wellness tourism among the eight countries which speak Portuguese.

Filomena Maurício Viegas Fernandes is a medical doctor and specialist in public health. She was the health delegate in several municipalities in the Algarve region and has been responsible for a number of programs on public health.


She has delivered presentations at various international conferences and is considered an expert in health and wellness tourism. Fernandes has been researching and teaching health and wellness tourism in the School of Management Hospitality and Tourism at Algarve University.


She is the co-author of several articles and books including SPAS Centros Talasso e Termas: Turismo de Saúde e Bem-Estar (Lisboa Portugal 2008) and Turismo de Saúde e Bem-Estar no Mundo. Ética Excelência Segurança e Sustentabilidade (São Paulo Brazil 2011).


Fernandes was a member of the organizing committee of the I International Conference on Health and Tourism (Faro Portugal 2012) and is coordinating the II International Congress on Health and Tourism in Albufeira Algarve Portugal in 2014.