HEALTH

AND
WELLNESS
TOURISM
Name: Avantika Kashinath Patil

Admission number: HPGD/OC15/XXXX

Specialization: TRAVEL & TOURISM

L.N. Welingkar Institute of Management Development & Research

Year 2017

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 CERTIFICATE FROM THE GUIDE

This is to certify that the Project work titled Health and Wellness tourism is a confide work
carried out by XXXX XXXXX (Admission No.) HPGD/OC15/XXXX a candidate for the /Post
Graduate Diploma examination of the Welingkar Institute of Management under my guidance
and direction.

SIGNATURE OF GUIDE : Geeta Dasri

NAME : Geeta Dasri

DESIGNATION : Senior Executive, Yatra.com

WORK EXPERIENCE: 5 years

ADDRESS : Dahisar East

STAMP/SEAL OF THE ORGANIZATION : Yatra.com

DATE: 11/10/2017

PLACE: Mumbai

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Acknowledgement letter
I, Avantika Patil from HPGD/OC15/2279, have taken efforts in this project. However, it would
not have been possible without the kind support and help of many individuals and organizations.
I would like to extend my sincere thanks to all of them.

I am highly indebted to Geeta Dasri from yatra.com for her guidance and constant supervision as
well as for providing necessary information regarding the project & also for their support in
completing the project.

I would like to express my gratitude towards my parents & member of Prin. L. N. Welingkar
Institute of Management Development & Research for their kind co-operation and
encouragement which help me in completion of this project.

I would like to express my special gratitude and thanks to industry persons for giving me such
attention and time.

My thanks and appreciations also go to my colleague in developing the project and people who
have willingly helped me out with their abilities.

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Contents

Introduction -----Page 5 to Page 12

Health and wellness -----Page 13 to Page 19

Medical tourism -------Page 20 to Page 34

Wellness tourism -------Page 35 to Page 48

Popular forms of wellness tourism--------Page 49 to Page 61

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Introduction
Before engaging in a study of Health and Wellness tourism, let‘s have a closer look at what the
term tourism means.

What Is Tourism?

There are a number of ways tourism can be defined, and for this reason, the United Nations
World Tourism Organization (UNWTO) defines tourism as ‗Tourism is a social, cultural and
economic phenomenon which entails the movement of people to countries or places outside their
usual environment for personal or business/professional purposes. These people are called
visitors (which may be either tourists or excursionists; residents or non-residents) and tourism
has to do with their activities, some of which imply tourism expenditure.

Brief history

Travel for leisure purposes has evolved from an experience reserved for very few people into
something enjoyed by many. Historically, the ability to travel was reserved for royalty and the
upper classes. Through the Middle Ages, many societies encouraged the practice of religious
pilgrimage.

Cox & Kings, the first known travel agency, was founded in 1758 when Richard Cox became
official travel agent of the British Royal Armed Forces. Almost 100 years later, in June 1841,
Thomas Cook opened the first leisure travel agency, designed to help Britons improve their lives
by seeing the world and participating in the temperance movement. In 1845, he ran his first
commercial packaged tour, complete with cost-effective railway tickets and a printed guide.

The continued popularity of rail travel and the emergence of the automobile industry presented
additional milestones in the development of tourism. Fast forward to 1952 with the first
commercial air flights from London, England, to Johannesburg, South Africa, and Colombo, Sri
Lanka and the dawn of the jet age, which many herald as the start of the modern tourism

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industry. The 1950s also saw the creation of Club Méditérannée and similar club holiday
destinations, the precursor of today‘s all-inclusive resorts.

The decade that followed is considered to have been a significant period in tourism development,
as more travel companies came onto the scene, increasing competition for customers and moving
toward ―mass tourism, introducing new destinations and modes of holidaying‖.

Industry growth has been interrupted at several key points in history, including World War I, the
Great Depression, and World War II. At the start of this century, global events thrust
international travel into decline including the September 11, 2001, attack on the World Trade
Center in New York City (known as 9/11), the war in Iraq, perceived threat of future terrorist
attacks, health scares including SARS, and more.

At the same time, the industry began a massive technological shift as increased internet use
revolutionised travel services. Through the 2000s, online travel bookings grew exponentially,
and by 2014 global leader Expedia had expanded to include brands such as Hotels.com, the
Hotwire Group, trivago, and Expedia Cruise Ship Centers, earning revenues of over $4.7 million.

Impacts of Tourism

Tourism impacts can be grouped into three main categories: economic, social, and
environmental. These impacts are analysed using data gathered by businesses, governments, and
industry organizations.

Economic Impacts

According to a UNWTO report, in 2011, ―international tourism receipts exceeded US$1 trillion
for the first time‖. UNWTO Secretary-General Taleb Rifai stated this excess of $1 trillion was
especially important news given the global economic crisis of 2008, as tourism could help
rebuild still-struggling economies, because it is a key export and labour intensive (UNWTO,
2012).

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Tourism around the world is now worth over $1 trillion annually, and it‘s a growing industry
almost everywhere. Regions with the highest growth in terms of tourism dollars earned are the
Americas, Europe, Asia and the Pacific, and Africa. Only the Middle East posted negative
growth at the time of the report (UNWTO, 2012).

While North and South America are growing the fastest, Europe continues to lead the way in
terms of overall percentage of dollars earned (UNWTO, 2012):

 Europe (45%)
 Asia and the Pacific (28%)
 North and South America (19%)
 Middle East (4%)

Growth in terms of dollars earned

4%
4%

Europe
19%
45% Asia and the Pacific

North and South America

Middle East
28%
Others

Global industry growth and high receipts are expected to continue. In its August 2014
expenditure barometer, the UNWTO found worldwide visa applications had increased by 22
million people in the first half of the year over the previous year, to reach 517 million visits
(UNWTO, 2014). As well, the UNWTO‘s Tourism 2020 Vision predicts that international
arrivals will reach nearly 1.6 billion by 2020. (Tourism 2020 Vision: http://www.e-
unwto.org/doi/abs/10.18111/9789284403394)

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Social Impacts

In addition to the economic benefits of tourism development, positive social impacts include an
increase in amenities (e.g., parks, recreation facilities), investment in arts and culture, celebration
of First Nations people, and community pride. When developed conscientiously, tourism can,
and does, contribute to a positive quality of life for residents.

However, as identified by the United Nations Environment Programme (UNEP, 2003a), negative
social impacts of tourism can include:

 Change or loss of indigenous identity and values

 Culture clashes
 Physical causes of social stress (increased demand for resources)
 Ethical issues (such as an increase in sex tourism or the exploitation of child workers)

Environmental Impacts

Tourism relies on, and greatly impacts, the natural environment in which it operates. Even
though many areas of the world are conserved in the form of parks and protected areas, tourism
development can have severe negative impacts. According to UNEP (2003b), these can include:

 Depletion of natural resources (water, forests, etc.)

 Pollution (air pollution, noise, sewage, waste and littering)
 Physical impacts (construction activities, marina development, trampling, loss of
biodiversity)

The environmental impacts of tourism can reach outside local areas and have an effect on the
global ecosystem. One example is increased air travel, which is a major contributor to climate
change. Whether positive or negative, tourism is a force for change around the world, and the
industry is transforming at a staggering rate.

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Different types of tourism

After a brief introduction into tourism sector and the basics of the industry, it‘s time to delve
deeper into different types of tourism. Traveling is one effective way to see the world,
experience new cultures and meet new people at the same time. For many tourists, however,
traveling accomplishes many other purposes that don‘t even have anything to do with the joy of
visiting a new place. This is why there are many different types of tourism that explain why
tourists choose a particular destination and the things that they expect to do when they are there.

Business Tourists

Tourist traveling with relation to

business is known as a business
tourist. Business tourism is part of
the business world. During business
tourism (traveling), individuals are
still working and being paid, but are
doing so away from both their
workplace and home. Most of the
cities feature conference centers that
cater to the needs of business
tourists. A proper example of a
business tourist is a salesman, who makes trips to different places to attend trade shows, to
display and promote his own products also.

Incentive Tourists

Incentives tourists are those few lucky individuals, who get a holiday package as a reward from
his company, for good work or achieving targets, set by the company. Incentive tourists draw
inspiration from such tours to work harder, improve work relations and focus on team bonding.

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Religious Tourists

Religious tourists are the individuals who

travel to sites of religious significance.
The World is dotted with a number of
religious locations like Hajj in Mecca,
Jerusalem in Israel, Varanasi in India,
and the Vatican in Rome. During Easter,
a huge conglomeration of Christian
pilgrimage takes place in Zion City.
Catholics, for example, go on
pilgrimages to the Holy Land to experience the paths where Jesus walked.

Cultural Tourists

These types of tourists travel to

experience the essence of assorted
cultures. Cultural tourists also prefer to
witness the World Heritage Sites of the
traveled country. Tourists may visit
different landmarks of a particular
country or they may simply opt to focus
on just one area. They may also attend
festivals and ceremonies in order to
gain a better understanding of the people, their beliefs, and their practices.

Sport and Recreation Tourists

This type of tourists travels to either participate in recreational sporting or just watch sports
events. Some of such popular sports events are the Soccer World Cup, Wimbledon Tennis
Championship, Comrades Marathon, and Fisher River Canoe Marathon or signing up for leisure

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interests. As long as a sport (soccer, baseball, golf, football, cricket, competitive knitting, etc.) is
the primary reason for one‘s travels, it can be considered sports tourism.

Adventure Tourists

Adventure tourists look for some

unusual or bizarre experience.
They seek adventurous activities
that may be dangerous, such as
rock climbing, river rafting,
skydiving, shark cave diving and
bungee jumping. Tourists prefer
to go for trekking to places like
Ladakh, Sikkim, and Himalaya.
Himachal Pradesh and Jammu
and Kashmir are popular for the skiing facilities they offer. Whitewater rafting is also catching
on in India and tourists flock to places such as Uttaranchal, Assam, and Arunachal Pradesh for
this adrenalin-packed activity.

Leisure Tourists

To these people, travel is about fun

and excitement, about rest and
relaxation, and about whatever they
want it to be about. These tourists
want to rejuvenate and revitalize with
comfort while enjoying a break from
the mundane routine of life. Leisure
travel is often characterized by
staying in nice hotels or resorts,
relaxing on beaches or in a room, or
going on guided tours and experiencing local tourist attractions.

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Health and Wellness Tourist

The main focus of

health or medical
tourists is improving
one‘s health, physical
appearance or fitness,
which is only possible
away from home. Some
of these tourists avail
medical assistance in
other countries, for they may be expensive in their own country. Many health or medical tourists
also make trips simply to stay for few days in healthier climate. For instance, certain countries
promote the expertise of their doctors and surgeons in the field of cosmetic surgery and invite
foreigners to have their liposuction, facelift, nose lift and other forms of cosmetic procedures to
be done there. Medical tourism also incorporates aspects of recreation tourism where the patient
goes to a relaxing getaway to recover from the procedure.

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Health & Wellness
In the earlier section, we were introduced to tourism and different aspects of tourism. In today‘s
global world, where everything is just a click away, health and wellness tourism has gain
impetus. One of the fastest emerging trends in tourism, health and wellness tourism has started
penetrating almost all the continents. In this section we will understand what meaning is the
health and wellness and its transformation into tourism.

What is health and wellness?

Health and wellness are two extensively complex yet important words. Though frequently used
together, these two terms have individual and interdependent meanings that are difficult to
define. The complexities of these terms are vast and means different to different individual
depending on their psyche and understanding of the environment around. For some it means the
mental well being, while for others it might mean spiritual well being and so on.

Considering a broader perspective, health typical refers to the absence of illness, whereas
wellness refers to not just physical health but emotional, spiritual, social wellbeing as well.
Improving your 'health and wellness' generally refers to promoting good health and reducing risk
of disease with a holistic approach which takes into account many factors including physical and
emotional issues.

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.

Wellness is a modern word with ancient roots. As a modern concept, wellness has gained
currency since the 1950s, 1960s and 1970s, when the writings and leadership of an informal
network of physicians and thinkers largely shaped the way we conceptualize and talk about
wellness today.

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Health and wellness tourism

The health and wellness tourism industry, broadly defined, includes products and services made
accessible to people travelling from their place of residence for health reasons. Although the
concept of health tourism is widespread, there is no consensus among fraternity experts
regarding this notion to this day. When speaking of travel based on some form of health-related
activities, the following terms are mostly used and often interchangeably — health tourism,
medical tourism, wellness tourism, spa tourism and medical travel. While some view these terms
as notions of independent tourist segments, others strive to combine all health-related travels
under one particular type of tourism. Nevertheless, a widely used approach suggests medical and
wellness tourism are both regarded as subcategories of health tourism. Wellness tourism is
assumed to be pursued solely by ‗healthy‘ people whose main motive is to preserve or promote
their health, and medical tourists are seeking treatment for a specific medical condition or
ailment. More specifically, medical tourism covers a comprehensive range of therapeutic
services including general surgery, cosmetic, orthopedics, urology, gynecology, ophthalmology,
dialysis, cardiology and cardiac surgery. Wellness on the other hand includes products and
services that works towards the holistic wellbeing on an individual. Wellness tourism includes
domains like spa resorts, yoga retreats, meditation centres and so on. The diagram below
explains health and wellness tourism.

Health and wellness tourism has become an emerging market segment directed to those seeking
illness prevention, physical improvement and spiritual balance or even for those eager of cultural
and relaxation programs. In this sense, wellness tourism has become more complex and creative,
demanding high quality equipments and infrastructures, providing a wide range of products and
services related not only with the diversity of spa treatments but also with complementary
recreational activities regarding the connection to nature and to cultural patrimony as well as to
other regional resources, creating effective links to the territory and becoming a significant force
that will shape the regional development, by creating a positive pressure on local economic bases
with spillover effects on the territory.

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History

The surge in health and wellness tourism is the current trend; however, the origins of it are far
older – even ancient. Aspects of the health and wellness concept are firmly rooted in several
intellectual, religious, and medical movements in the United States and Europe in the 19th
century. It can also be traced to the ancient civilizations of Greece, Rome and Asia, whose
historical traditions have indelibly influenced the modern movement.

In 3,000-1,500 BC Ayurveda – originated as an oral tradition, later recorded in the Vedas, four
sacred Hindu texts. A holistic system that strives to create harmony between body, mind and
spirit, Ayurvedic regimens are tailored to each person‘s unique constitution (their nutritional,
exercise, social interaction and hygiene needs) – with the goal of maintaining a balance that

15
prevents illness. Yoga and meditation are critical to the tradition, and are, of course, increasingly
practiced worldwide.

In 3,000 – 2,000 BC traditional

Chinese Medicine, one of the
world‘s oldest systems of
medicine, develops. Influenced by
Taoism and Buddhism, traditional
Chinese Medicine applies a
holistic perspective to achieving
health and wellbeing, by
cultivating harmony in one‘s life. Approaches that evolved out of traditional Chinese Medicine,
such as acupuncture, herbal medicine, qi gong and tai chi, have become core, modern Health and
wellness- and even Western medical - approaches.

Ancient Greek physician Hippocrates – is possibly the first

physician to focus on preventing sickness instead of simply treating
disease, and also argued that disease is a product of diet, lifestyle
and environmental factors. In 50 BC, ancient Roman medicine
emphasized disease prevention, adopting the Greek belief that
illness was a product of diet and lifestyle. Ancient Rome‘s highly
developed public health system with its extensive system of
aqueducts, sewers and public baths that helped prevent the
spreading of germs and maintained a healthier population.

In the 19th century new intellectual movements, spiritual

philosophies and medical practices proliferated in the United States
and Europe. A number of alternative healthcare methods that focus on self-healing, holistic
approaches, and preventive care – including homeopathy, osteopathy, chiropractic, and
naturopathy – were founded during this era and gained widespread popularity in both Europe and
the United States. Other new philosophies were more spiritually oriented such as the ―mind-cure
movements,‖ including New Thought and Christian Science and were instrumental in

16
propagating the modern idea that a primary source of physical health is one‘s mental and
spiritual state of being. The philosophies embodied in these 19th century systems – that a healthy
body is a product of a healthy mind and spirit – are now considered precursors to the current,
thriving Health and wellness and self-help movements. In addition, although these approaches
fell out of favor with the rise of modern, evidence-based medicine in the mid-20th century,
several of them are now regaining favor within the mainstream medical community and the
general public.

In 1650s, the use of the word ―wellness‖ in the English language, meaning the opposite of illness
or the state of being well or in good health came into being. German physician Christian
Hahneman developed Homeopathy; a system that uses natural substances to promote the body‘s
self-healing response. In 1860s, German priest Sebastian Kneipp promotes his ―Kneipp Cure‖,
combining hydrotherapy with herbalism, exercise and nutrition. The New Thought movement
also emerges, around Phineas Quimby‘s theories of mentally-aided healing.

In 1880s, Swiss physician Maximilian Bircher-Benner pioneered nutritional research, advocating

a balanced diet of fruits and vegetables. The YMCA was launched as one of the world‘s first
Health and wellness organizations, with its principle of developing mind, body and spirit.

Our modern use of the word ―wellness‖ dates to the 1950s and a seminal – but little known –
work by physician Halbert L. Dunn, called High-Level Wellness (published1961). Although
Dunn‘s work received little attention initially, his ideas were later embraced in the 1970s by an
informal network of individuals in the U.S., including Dr. John Travis, Don Ardell, Dr. Bill
Hettler, and others. These ―fathers of the wellness movement‖ created their own comprehensive
models of wellness, developed new wellness assessment tools, and wrote and spoke actively on
the concept. Travis, Ardell, Hettler and their associates were responsible for creating the world‘s
first Health and wellness center, developing the first university campus Health and wellness
center, and establishing the National Wellness Institute and National Wellness Conference in the
U.S.

The Health and wellness movement began to gain momentum, and was taken more seriously by
the medical, academic and corporate worlds. For instance, Hettler‘s National Wellness Institute

17
caught the attention of Tom Dickey and Rodney Friedman, who then established the monthly
Berkeley Wellness Letter (1984), designed to compete with the Harvard Medical School Health
Letter, pointedly using ―wellness‖ in the title as contrast. This influential academic publication
presented evidence-based articles on Health and wellness approaches, while also debunking
numerous health fads. More medical establishment validation: in 1991 the U.S. National Center
for Complementary and Alternative Medicine (NCCAM) was established, as part of the
government-funded National Institutes of Health.

More government-sponsored programs to promote healthier lifestyles launched in U.S.

cities/states. The modern concept of Health and wellness also spread to Europe, where the
German Wellness Association (Deutscher Wellness Verband, DWV) and the European Wellness
Union (Europäischen Wellness Union, EWU) were founded in 1990.

At the latter end of the

20th century, many
corporations began
developing workplace
wellness programs.
The fitness and spa
industries globally
experienced rapid
growth. And an ever-
growing line-up of
celebrities and self-
help experts started
bringing Health and wellness concepts to a mainstream audience. However, despite all these
disparate developments, this momentum had not yet coalesced under the formal banner of a
―Health and wellness industry.‖

In the 21st century, the global wellness movement and market reach a dramatic tipping-point:
fitness, diet, healthy living and wellbeing concepts and offerings proliferate wildly – and a
concept of wellness transforms every industry from food and beverage to travel. By 2014, more

18
than half of global employers are using health promotion strategies, while a third have invested
in full-blown wellness programs. Medical and self-help experts who promote wellness like
Deepak Chopra become household names. "Wellness," essentially, enters the collective world
psyche and vocabulary, and firmly arrives with the media and more medical institutions and
governments.

With a chronic disease and obesity crisis raging worldwide in this century, leading to
unsustainable healthcare costs, the traditional medical establishment and more governments are
shifting the focus to prevention and wellness. For instance, if, in the 90s, most academic medical
centers had an adversarial stance towards complementary medicine, now many of the most elite
institutions in the world feature Integrative Medicine departments.

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Medical tourism
For an industry with an annual global value estimated to reach over US$100 billion in 2012,
there is surprisingly little empirical literature on the topic of medical tourism, although this is
slowly beginning to change. In this chapter we review what evidence there is, with a focus on the
cross-border pursuit of more conventional or customary forms of healthcare (dental, surgical and
diagnostic).

Travel for health reasons is not new. ‗Taking the waters‘ has long been a pursuit of those who
could afford the travel to spa destinations, often crossing borders to do so. There are numerous
18th century accounts of wealthy Europeans traveling to famous French spas or to the medicinal
waters of Bath and Vichy for treatments for gout, skin ailments, liver disorders and other
maladies, a practice that, by the 19th century, had trickled down to the middle classes. It was also
customary in the pre-antibiotic era for people with certain infectious ills to be encouraged to rest
in less stressful or polluted locales, an early form of enjoining ‗medical‘ to ‗tourism.‘ Travel for
disease treatment was also commonplace, especially if few or no services were at hand and one
had the means to be a mobile patient. But a literal sea change has been occurring in recent years.
Growing technological sophistication and low labour costs in developing countries, combined
with cheap airfares and a growing global demand for healthcare services, has created a
burgeoning new entrepreneurial sector: medical tourism.

The scope

The data available on Google about on medical tourism is hard to come by, and the physical
scale of the industry is difficult to grasp. There are at least several hundred elaborate interactive
websites that allow prospective patients to schedule their out-of-country services, contact their
surgeon or other specialists, book airfare and accommodation, and arrange for tourist excursions.
Some of these are managed by providers themselves, others by medical brokerage firms; almost
all are commercial in nature. There is no agreement on the size of the medical tourism market.
Few countries track inbound or outbound medical travellers, and there are powerful vested
interests in projecting a large market as one means of creating it. The Bumrungrad International
Hospital in Thailand, as one example, claims to admit 400 thousand foreign patients annually
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(Bumrungrad International Hospital). One such research report estimated global cross-border
patients at not more than 60,000 to 85,000 per year, with most travelling to the United States
(US) from Latin America, the Middle East, Europe and Canada respectively.

Growth factors

Medical tourism can be defined as the combination of patients‘ travel to a vacation destination
for a potential leisure experience and a specific medical intervention. This intervention can
include surgery, treatment of a disease, cosmetic surgery, dental services, fertility care, reju-
venation programmes and many others. Medical tourism is growing for one of the five reasons –

Reasons why people take medical tourism

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First, medical services in other countries/states are cheaper than those available in the medical
tourism generating country, and/or may be available in a timelier manner. This has certainly been
a major factor behind the growth of ‗dental tourism‘. Second, services can be consumed in
conjunction with a holiday. Third, as a result of migration, expatriates may return to their country
of origin for medical treatment for cultural, family and language reasons. For example, citizens
of the former Soviet Union come to Russian sanatoriums for the treatment. Fourth, the regulatory
structures that restrict availability of a medical service in the generating country do not exist in
the destination country. For example, women have to cross-border travel so as to have an
abortion procedure (‗abortion tourism‘) that would not be legal in their country of origin or
where procedures are regulated because they are regarded as highly experimental in the country
of origin, as in the case of stem-cell medicine (‗stem-cell tourism‘) and some fertility procedures
(‗fertility tourism‘). A fifth reason may be related to a lack of an organ for transplant in the
country of origin of the medical tourist (‗transplanting tourism‘).

The motivations for medical tourism, although varying with each individual, usually derive from
a short list: affordability (lower cost), accessibility (reduced wait times), availability (services not
offered domestically) and quality (services superior to what is available domestically). The
industry that has grown up to meet this demand is increasingly linked with tourism activities to
ease ‗patients without borders‘ into new cultural environments and to occupy them and their
travel companions during the pre- and post-operative periods.

Cost is one of the main advertising lures, with countries in the South holding substantial cost-
advantages to those in the North. Lower labour and living costs, the availability of inexpensive
pharmaceuticals and the low cost or absence of malpractice insurance allow many developing
countries to offer some procedures at 10 percent of the American price, inclusive of travel and
accommodation. Similar price differences exist for other developed nations. A shoulder
operation performed privately in the UK would cost €10,000, compared to only €1,700 in India,
with only a little over a week‘s wait time in India from the initial contact. A more inclusive list
of procedures for which north-based consumers are known to travel abroad would have produced
a substantially higher estimate of savings. Cost is one of the most frequently cited reasons
medical tourists give for seeking healthcare outside of their countries.

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The table below indicates the cost of different surgeries in different countries.

Source: https://www.oecd.org/els/health-systems/48723982.pdf

23
The reputation of physicians and quality of the facilities compete with cost for most frequently
cited reasons for medical travel. Joint Commission International (JCI) has been responsible for
accrediting more than 400 medical facilities in over 50 countries across Asia, Europe, the Middle
East, the Caribbean and South America.

A number of developing country medical facilities have also partnered with Western medical
teaching facilities and hospitals to signal quality to prospective medical consumers with
prestigious and familiar names. Both Harvard Medical International and the Mayo Clinic are
partnered with the Dubai Healthcare City. Wockhardt Group medical facility, one of the
prominent chains of private healthcare facilities in India, has affiliated with Harvard Medical
International. Their main competitor in India, the Apollo Hospitals group, partners with Johns
Hopkins Medicine International.

Apart from cost motivations (either self-paying or via private health insurers), medical travellers
to facilities in developing countries sometimes pursue technologies and procedures that are not
yet available or approved in their home countries. Until 2006, hip resurfacing, a less invasive
alternative to hip replacement, was not approved in the US, although it was available in Canada,
Europe and in some (much lower cost) Asian destination countries. In India, the Wockhardt
Group of hospitals claims to have been the first in the world to perform COPCAB (conscious,
off-pump coronary artery bypass), a heart surgery designed for individuals who are not good
candidates for surgery using anesthesia.

Medical travellers from the developed world sometimes also seek medical procedures that are
unavailable domestically due to legal constraints, which may include transplantation using living
donors who are motivated by poverty or assisted reproduction using legally restricted
technologies or paid surrogates. Several countries specifically advertise transplantation tourism,
notably Colombia, India, Pakistan and the Philippines; although China, Bolivia, Brazil, Iraq,
Israel, Moldova, Peru, South Africa and Turkey are also significant exporters of commercially
donated organs. Normatively, cross border organ transplantation is deemed ‗transplant tourism‘
only when travel for transplantation ‗involves organ trafficking and/or transplant commercialism
or if the resources (organs, professionals, and transplant centres) devoted to providing transplants

24
to patients from outside a country undermines the country‘s ability to provide transplant services
for its own population.

Tourist flow

Where do the medical travelers come from and where to do they go? These routes have been
described and categorized as North-North (flows between developed countries north of the
equator); South-North (the more traditional flows from developing to developed countries);
South-South (the often ignored flows between developing countries south of the equator); and
North-South (the newer flows from developed to developing countries). Although these routes
are somewhat oversimplified, they are based for the most part on a characterization of the
development status of nations, with an understanding that some southern medical tourism source
and destination countries are highly developed while several northern source and destination
countries share economic characteristics with many of the poorer countries in the south.

25
Image courtesy: http://www.medicaldaily.com/organ-trafficking-international-crime-
infrequently-punished-247493

The North-North route generally encompasses travel from one high-income country to another.
The majority of this traffic occurs between nations of the EU. National boundaries became
substantially more porous with the creation of the EU, with one outcome being an increase in
cross border healthcare, primarily involving adjacent countries. A 2002 poll found that to avoid
lengthy wait times 15 percent of British citizens indicated willingness to travel anywhere in
Europe for medical care.

South-North route is the more historical medical route has been one of wealthy patients from
poorer countries seeking state-of-the-art medical care in richer ones (the US, UK, other European
nations). The dominant form of cross-border care in the 20th century, these flows continue but
may be declining. The UK saw its numbers of in-bound medical tourists, many from the Middle
East, peak in the 1970s and 1980s with the rush of petrodollars. The number has fallen somewhat
since, in the wake of 9/11 anti-terrorism concerns and the development of more sophisticated
treatment options within the Middle East region.

Germany, another destination and regarded as one of the UK‘s main global medical tourism
competitors, is attracting foreign patients primarily from Russia and Central European countries.
It will soon face competition from Poland, which is pursuing its own brand of medical tourism
and recently established its Polish Medical Tourism Chamber of Commerce and Association of
Medical Tourism. Polish facilities are often in the public sector, indicative of the blurring
between private and public that medical tourism is creating.

South-South flows are characterized by medically motivated travel from one low- or middle
income country into another, although three major ‗South‘ destinations (Singapore, Hong Kong
and United Arab Emirates (UAE)) are, in fact, high-income countries. Many low-income
countries lack a health system infrastructure with adequate provision for primary healthcare or
specialized health treatments and procedures. Given an ability to pay and to travel, individuals
from these locales may seek services in other countries. For wealthy individuals, destinations
such as the US and Western Europe are desirable (the South-North flow), although over the past

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two decades countries such as the UAE, Jordan, Thailand and Singapore have made significant
efforts to attract such persons. South-South medical travel (similar to North-North flows) is often
region-specific. As one example: Regional medical travel is a common experience for Yemeni,
since the treatment infrastructure for cancer, heart disease and other serious medical conditions
does not exist within their own country. Exact numbers of Yemeni medical travellers are unclear
but range from 40,000 to 200,000 annually (out of a population of 17 million). The most popular
destinations for Yemeni medical travelers are India and Jordan, with Mumbai in India being the
least expensive and most common destination of choice. The North African country of Tunisia,
as another example, has attracted an increasing number of medical tourists due to its relative
sophistication in healthcare, and is thought to have the most potential for providing medical
tourism services for Europeans and West African patients.

To encourage medical tourism, the Cuban government formed Servimed, a company that
facilitates foreign access to healthcare in Cuba; and continues to negotiate bilateral agreements
with neighbouring nations to further attract foreign patients. Operating entirely within a public
system (an anomaly in the privately dominated industry) Cuba‘s medical tourism also includes
the provision of sophisticated healthcare at no cost to poor individuals within Latin America and
other poor regions of the world as part of its international health solidarity work.

Turning to Asia, just three countries (India, Thailand and Singapore) are estimated to account for
90 percent of all medical tourism within the continent, much of it regional in origin. India has
been developing its medical tourism industry for over a decade, and is an established destination
for patients from neighbouring countries such as Sri Lanka, Bangladesh, Nepal, Bhutan and
Pakistan. The prevalence of English in India‘s healthcare facilities also lends itself to aggressive
marketing for foreign patients from English-speaking high-income countries (the UK, the USA,
Canada, Australia).

North-South flow that has captured most attention recently is the gold rush of primarily private,
but also some public, providers in low- and middle-income countries attempting to capitalize on
what they perceive to be an unfilled demand from the wealthier and demographically aging
North. The growth of such facilities is attributed, in part, to observations of private patient
hospitals in the US (and to a lesser extent private wings in UK facilities) catering to wealthy fee

27
paying patients through an emphasis on quality and consumer-focused service. While Asian
countries were first to embrace this new healthcare industry, many Middle Eastern and several
South American countries have begun aggressively promoting a range of medical tourism
services to markets well beyond their regions.

Empirical data on the North-South flow (how many are going from which country to which
destination) is sketchy, but some evidence is slowly trickling in. Medical tourism to South Africa
is dominated by people travelling from within the continent, but also records substantial numbers
coming from the UK, other European countries, the US and Australia. A recent study found that
the majority of medical tourists to India and China came from the North, although the pattern
reversed for Jordan and the UAE. The Bumrungrad Hospital in Thailand, which advertises over
200 US certified physicians, claims to have treated 55,000 patients from the US. Between 10
and 15 percent of India‘s medical tourists emanate from the US.

Current trends

In a just released report issued by VISA and Oxford Economics, the Medical Tourism industry
was valued at a staggering USD 439 billion, with a projected growth rate of up to 25% year-
over-year for the next 10 years as an estimated three to four percent of the world's population
will travel internationally for healthcare and health-related treatment.

For years the medical travel industry seemed undervalued, yet VISA's report accounts for
growth factors - like some 340 new international airports over the next decade - and the medical
travel market could soar to an astronomical USD 3 trillion by 2025.

In its 2016 report, Medical Tourism Index (MTI), listed the top 41 destinations for those seeking
value-added services and high quality of healthcare across the globe. In it, the similar pattern of
global growth emerges: that the United States leads in terms of market share of healthcare travel
spending, but Asia's Thailand, Singapore and South Korea continue to thrive. Both VISA's and
MTI's findings expect China to overtake the US spot within the next 10 years due to the
population's demand for higher quality of care.

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The findings don't just span the global spectrum but also the age spectrum as well; VISA
expects 13 percent of all international travel by 2025 to be older travelers. Meanwhile, a recent
survey of 31,000 18-34 year olds from 134 countries by popular booking site TopDeck Travel
found that some 88% of them travel internationally between 1 to 3 times annually and that the
number only continues to grow.

―The borders to quality healthcare access have begun to dissintegrate.‖ MTI Co-Authors, Renée-
Marie Stephano, JD President of the Medical Tourism Association and Mark Fetscherin,
Associate Professor of International Business and Marketing at Rollins College, said a joint
statement. ―Speculation about the medical tourism industry as a 'phenomenon' is over. This
report and the rankings of the Medical Tourism Index provide a unique opportunity for investors
seeking new ventures to make smart choices in destinations driving patient travel.‖

The entire medical tourism and health tourism industry will descend upon Washington, D.C.,
September 25-28, 2016 for the 9th World Medical Tourism & Global Healthcare Congress. Over
3,000 attendees from 50+ countries brought USD 1 billion in new deals last year paving the way
for leaders this year to catch the next wave in partnerships and medical tourism investment.

In a conclusion, VISA said, "We believe that medical tourism is primed for accelerated growth
as more of these travelers seek new treatments, as well as lower cost or higher-quality care not
available in their home country."

Following image explain the Medical tourism trends in 2017. Information and image courtesy:
http://www.traveldailynews.asia/columns/article/50158/medical-tourism-industry-valued-at

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30
Limitations and problems

As it is the case with most sectors, medical tourism has its own set of limitations and problems.
Following are some issues that have created hurdles to the further growth of the medical tourism
segment in the health and wellness sector.

Insurance portability

The lack of insurance portability may be the greatest single damper on growth in medical
tourism. Unsurprisingly, the private health insurance industry, notably American, is being
encouraged to exploit the cost advantages of medical tourism. Some economists argue that a
combination of importing foreign trained health workers and exporting patients to developing
countries is the simplest and most cost-efficient solution to its healthcare problems. Medical
tourism brokerages operating out of the US have started negotiating with insurance providers to
develop policies for their client/patients, recognizing that the non-portability of insurance
coverage poses one of the most significant barriers to the growth of medical tourism. Both self-
insured companies and large insurance firms are attracted to the low-cost provider networks
offered by the medical tourism industry, but not without opposition.

More recently, Blue Shield of California and the health insurance company Health Net are now
selling discounted health insurance policies that encourage patients to get most of their care in
Mexico; and insurers in three other US states (Florida, Wisconsin and South Carolina) have
entered agreements to insure patients at JCI-accredited hospitals in India and Thailand.

South-South flows also involve insurance portability issues. Singapore now allows (indeed
encourages) its citizens to use their ‗Medisave‘ accounts to access healthcare in Malaysia, which
is considerably cheaper. Medisave is a legally mandated personal insurance program, with joint
contributions paid by employers and employees.

Malpractices

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The risks inherent in seeking healthcare outside their country apply to patients as well as to
insurers. There is little or no independent statistical data on complication rates from medical
procedures obtained in medical tourism destination countries, but anecdotal accounts of
malpractice or medical misadventure are frequent. A lack or lax enforcement of malpractice laws
in developing countries poses another risk. Little or no malpractice insurance costs allow
developing country practitioners and facilities to maintain low prices but leave medical tourists
with few options if malpractice is suspected. In Singapore and Malaysia, courts overseeing
malpractice suits defer to the opinions of attending physicians, essentially requiring a physician
to ‗confess‘ to malpractice in order for any compensatory damages to be awarded.

Organs trafficking

The growth in demand for various organs for organ transplantation, has also resulted in the
increase in crimes related to organ trafficking. According to Wikipedia Organ trade is the trade
of human organs, tissues or other body parts for the purpose of transplantation. There is a global
need or demand for healthy body parts for transplantation, far exceeding the numbers available.
As of 2011, about 90,000 people were reported to be waiting for a new organ in the United
States. On average, an individual will wait three and a half years for an organ to become
available for transplant. There is a worldwide shortage of organs available for transplantation,
yet commercial trade in human organs was at one point illegal in all countries except Iran. The
legal status of organ trade, however, is changing around the world. For example, in 2013, both
Australia and Singapore legalized financial compensation for living organ donors.

Trade in human organs is illegal in many jurisdictions in a number of ways and for various
reasons, though organ trafficking is widespread, as is transplant tourism. The data on the extent
of the black market is difficult to obtain. The question of whether to legalize and regulate the
organ trade to combat illegal trafficking and organ shortage is hotly debated.

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While all countries, except Iran, have banned payment for organs, ‗reasonable reimbursements‘
for costs related to organ donation or financial ‗donations‘ to those offering their organs are
permitted in many jurisdictions, effectively bypassing such legal restrictions. Both China and
India are considered ‗hotspots‘ in organ trafficking. In China, 90% of all organs come from
executed prisoners although this may now be decreasing due partly to international pressure.
New protocols have been implemented to bring organ donation more in line with stringent
medical and ethical policies in other countries although independent investigations cast some
doubt on compliance with these policies claiming that deliberate ‗harvesting‘ of organs from
prisoners is still occurring. The Indian government, despite legislation restricting the commercial
sale of organs, has been unable to monitor what is considered to be a sizeable market in illegal
organ trade. In Pakistan, where the transplantation tourism industry is unofficially sanctioned,
over 2,000 kidney transplants are performed each year on foreign patients. Although some
contend that a seller‘s decision to avoid extreme poverty in a properly regulated and remunerated
market should not be denied, the health status for the majority of financially-motivated donors
worsens after the procedure, costing them more in lost employment or out of pocket remedial
care than the (usually) minimal ‗donation‘ they receive for offering their organ to a broker.
Donors can also be subject to extreme forms of social ostracism. Of all forms of medical tourism,
transplantation tourism raises the largest number of immediate ethical questions.

Way ahead

Medical travel may not be new, but the shape it is now taking does differ from earlier eras. Our

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review of existing searchable knowledge about the different aspects of medical tourism allows
several summary points:

• a shift in the flows with developing countries becoming more prominent destinations
competing for wealthier patients from neighbouring nations or developed countries,
notably the US
• an emerging consensus that these flows are likely to increase as demographic pressures in
advanced economies create more wait-time problems in public healthcare facilities
• the creation of major ‗health cities‘ in many destination countries offering a large range
of state-of-the-art medical and surgical services
• persisting ethical issues related to who benefits most, and how controversial procedures
such as organ transplantation or surrogacy might be better managed
• the balance, if any can be achieved, between the global and entrepreneurial nature of
private medical tourism and the national and redistributive aims of public health systems.

There is a significant lack of reliable data on the scale of the revenues generated, both directly
and indirectly, and on detailed accounts of who is benefiting and who may be losing from the
likely (though not definitively established) growth of this industry. National health and economic
statistics can assist in developing metrics of public/private revenues, benefits and aggregate
welfare gains arising from medical tourism, although detailed within country studies would be
needed to ascertain the distributional impact of net health gains and losses.

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Wellness tourism
Wellness tourism is a holistic mode of travel that integrates a quest for physical health, beauty or
longevity, and/or a heightening of consciousness or spiritual awareness, and a connection with
community, nature or the divine mystery. It encompasses a range of tourism experiences in
destinations with wellness products, appropriate infrastructures, facilities, and natural and
wellness resources.

Most people who enjoy a spa vacation are repeat customers because it satisfies them in a way
that no other holiday does. Now, more people are looking overseas to have wellness experiences
that expand their cultural horizons

The key aspect of wellness tourism is the provision of alternative methods in order to attain
harmony among body, mind, and spirit, and scores of vacationers are heading abroad for
rejuvenating holidays and are achieving their goal by visiting medical spas and wellness centers
that incorporate treatments that refine and restore health. The means for achieving this highly
sought-after balance between the three components of our human existence are numerous and
specialized, and for people in the West, many of the world‘s finest providers of this delicate
approach to healthcare are found overseas.

Wellness tourism is popular in several Asian destinations such as Thailand, Singapore, and
Indonesia, and all over Europe as well, where some of the more common treatments include
things like therapeutic massage, detoxifying clay baths, balancing Ayurvedic treatments, and
colonic cleansings. Expertise and spirituality are often cited by wellness tourists as the reasons
for traveling great distances for care, as therapists in wellness facilities have mastered the
treatments they administer, and understand intrinsically the techniques they employ due to years
of practice and preparation.

Image courtesy: http://news.wtm.com/360-degree-value-wellness-tourism/

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Wellness tourism has shown impressive growth over recent years, and there appears to be no
slow-down in sight. As the health and wellness tourism industry as a whole continues to
proliferate, and as more information becomes available to the masses, the expectations are that
people‘s interest in the aforementioned procedures - plus many other wellness-center mainstays
like homeopathy, acupressure, yoga, reflexology, meditation, aromatherapy, and hydrotherapy -
will continue, and more likely, increase. And, as more people recognize the opportunities that

36
wellness tourism affords them for a sun-and-fun holiday plus alternative medical treatments all at
once, the potential for it to become a mainstream type of travel is high.

Other factors contributing to consumers‘ opting to become wellness tourists include significantly
lower costs, greater availability of care and a wider selection of treatments, and the recent trend
to travel with a higher purpose. Wellness tourism is perfectly suited to ―mindful‖ travel where
the health-conscious among us seek natural remedies implemented to promote healing, prevent
future illness, and of course deliver a certain measure of tranquility and stress relief. Providing
somatic, cerebral, and spiritual attunement, wellness tourism offers the best of both worlds for
healing and rejuvenation, well-being and relaxation.

History

Wellness, we hear this word almost every day but where did the concept come from? The term
was first used by an American doctor Halbert Louis Dunn, who studied the trends affecting the
health of population. He found out that as the life expectancy increased, Americans became more

37
endangered by civilization diseases than by other types of health problems. He then coined the
term wellness as an opposite to illness. Dunn‘s idea of wellness included not only the physical
health but also social and spiritual wellbeing. The concept gained popularity in 1970s when
people emphasized the importance of one‘s own responsibility for the person‘s. New programs
were created and offered to the clients who could there not only improve their physical condition
but also learn suitable eating habits and simple relaxation techniques.

Wellness then reached Europe where it has been usually associated rather with pleasure and
pampering than with alternative medicine. Today wellness is here connected mostly with
physical activities, beauty procedures and spas. As the time of the modern age seems to run
faster than ever before, even European spas adjust to this new situation by offering wellness
packages as well as shorter breaks. While in the past in the central Europe the term spas referred
almost solely to medical and healing procedures and months-long stays, today the offer of
rejuvenating weekend breaks is an essential part of any spa program.

The popularity of short wellness packages is quickly increasing. For instance, Czech spas that are
traditionally known for long-term therapies and effective medical treatments reported that only
10-20% of their guests opted for wellness stays five years ago. Today half of all spa guests come
to the spas to enjoy several days of pampering and relaxation.

Types of wellness tourism

With globalization and ever increasing demand of service quality blurring the lines wellness
tourism is classified in two major categories primary and secondary. According to the Global
Wellness Summit 2013, primary wellness tourism consists of those tourists taking a trip entirely
for wellness purposes. The secondary wellness tourist is where visitors seek wellness
experiences even when it is not the primary motivation for the trip. It is when visitors
add healthful destination activities, treatments, and mind-body experiences (spa treatments,
fitness or gastronomy and wines) into their overall leisure and business travel. This makes up the
bulk of wellness tourism and is growing even faster than tourism with it as a primary focus.
According to research presented recently at the 2016 World Travel Market in London, secondary
wellness tourists accounted for 89% of wellness tourism trips and 86% of expenditures in 2015,

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up from 87% of trips and 84% expenditures in 2013. The wellness stakeholder complex
includes, but is not limited to more healthful dining choices to state-of-the art gyms to a broad
range of special fitness activities and classes, hotel and spa fitness concierges and on-site sleep
experts.

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Geographical bifurcations of wellness tourism

Wellness tourism is heavily concentrated in the key markets of North America, Europe, and
Asia-Pacific. Europe is the destination of the largest number of wellness trips, while North
America leads in wellness tourism expenditures. Since 2013, Asia made the most gains in both
the number of wellness trips and wellness tourism expenditures, continuing a trend that is
propelled by a rising middle class, increasing intra-Asia tourism, and a growing consumer
interest in wellness. While most of the top markets have continued to grow, many emerging
markets have climbed steadily in the rankings since 2013, including China, Brazil, Mexico,
Vietnam, Indonesia, Malaysia, Chile, Argentina, and South Africa.

According to Wikipedia, Wellness tourism is now an identifiable niche market in at least 30

countries. Twenty countries accounted for 85 percent of global wellness tourism expenditures in
2012. The top five countries alone (United States, Germany, Japan, France, Austria) account for
more than half the market (59 percent of expenditures).

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North America

As of 2014, the US is the largest wellness tourism market, with $180.7 billion in annual,
combined international and domestic expenditures. The US is the top destination for inbound
international wellness tourism, with 7.1 million international, inbound trips. Europe and high-
income Asian countries are primary sources of wellness tourists traveling to the US.

Domestic tourism accounts for the majority (94 percent) of wellness trips in North America.
Americans and Canadians receive—and take—few vacation days compared to workers in other
countries making domestic, weekend trips the most popular wellness travel option.

Europe

Europe is the second largest wellness tourism market, with $158.4 billion in annual, combined
international and domestic expenditures; the region ranks highest in number of wellness trips
with 216.2 million, compared to North America's 171.7 in 2013. Europeans have long believed
in health benefits derived from mineral baths, saunas, thalassotherapy, and other natural and
water-based treatments. Thermal resorts and hotels in Turkey and Hungary cater to wellness
tourists, many of whom are subsidized by host countries such as Norway and Denmark seeking
to mitigate costs of medical procedures for patients with chronic conditions requiring expensive
surgeries.

Asia-Pacific

The Asia-Pacific region ranks as the third largest with $6.4 billion in annual, combined
international and domestic expenditures. Wellness traditions date back thousands of years in this
region, and some of those wellness practices (e.g., Ayurveda, traditional Chinese medicine
(TCM), yoga, Thai massage) incorporate preventive, curative, and therapeutic aspects that lie in
the cross-over area between wellness and medical tourism.

Latin America-Caribbean

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Latin America-Caribbean is the fourth largest region for wellness tourism in terms of number of
trips and expenditures. Domestic tourism accounts for about 71 percent of wellness tourism trips,
and 54 percent of wellness tourism expenditures.

Middle East and Africa

The Middle East and Africa are currently the smallest regions for wellness tourism, where
international tourists account for the majority of wellness trips and wellness expenditures. The
Middle East has a long tradition of bathing associated with Turkish baths, and some older
facilities are being modernized to serve spa-bound tourists. Tourism in general is on the rise in
the region, and governments and private developers have been investing heavily in facilities and
amenities, especially those oriented to the wealthy traveler.

In Africa, wellness tourism is concentrated in a few regions and is dominated by international

tourists. South Africa reports significant domestic wellness tourism. Tunisia and Morocco have a
well-developed resort spa sector primarily serving leisure vacationers from Europe.

Future trend of wellness tourism

When 500+ wellness experts from 46 nations gather to debate the future of wellness, a uniquely
authoritative and global view of trends unfolds. That‘s what happened at the recent Global
Wellness Summit (GWS) in Kitzbühel, Austria, which brought together leaders from the travel,
spa, beauty, fitness, nutrition, technology, medical and architecture worlds to identify what the
top wellness trends in 2017 (and beyond) will be – and why.

The Global Wellness Institute has announced the eight key trends it says will shape the wellness
industry in 2017 and beyond. The trends, identified at last year‘s annual Global Wellness
Summit, examine future shifts across categories including travel, spa, beauty, fitness, nutrition,
technology, medicine, and architecture.

Providing a unique, authoritative and global view of the trends set to unfold, Susie Ellis, GWS
Chairman & CEO said of the report: ―No other forecast is based on the perspectives of so many

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wellness experts, from renowned economists, academics or futurists, to the heads of global
hospitality, spa and beauty brands. And it makes for a powerfully collective, global and informed
set of predictions.‖

With a focus on the future of the wellness industry, according to the Global Wellness Institute,
each of the eight trends identified have a ―get real‖ quality, with the potential to change the way
we live our everyday lives. From the democratization of wellness, to the health implications of
the indoor environment, for an overview of the trends set to transform the wellness industry.

Sauna Reinvented

According to the Global Wellness Institute, the disconnect between Northern, Central and
Eastern Europe, where sauna-going is a way of life, and the rest of the world, is beginning to
disappear. Set for a dramatic transformation, the rituals and facilities associated with sauna
culture will become far more creative and social, as the rest of the world catches up with the
benefits of the age-old practice.

Paving the way, Hot Box Sauna, located in Scotland, boasts panoramic views as well as a bar and
live music, while over in America, a number of trendy urban ‗sweat lodges‘ such as Shape
House are making headlines. Claiming to burn calories, deepen sleep and improve skin, Shape
House uses infrared sauna technology to get the body to sweat at a lower temperature in order to
boost the treatment, a practice that has already achieved a cult status.

The Global Wellness Institute argues that as the need for social and fun experiences intensifies in
our ‗Age of Loneliness‘, wellness experiences connected to sauna culture will increase, as
businesses look for new and innovative ways to meet consumer demands.

Wellness Architecture

As architecture begins to move away from its preoccupation with surface aesthetics, thanks to
new standards and technologies, architects are beginning to design buildings based on their
possible effects on human health.

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According to the Global Wellness Institute, this new ‗wellness architecture‘, will be one of the
biggest (and most impactful) future wellness trends, with strategies ranging from the inclusion of
more plant life in offices to the creation of entire homes built around the inhabitant‘s personal
wellbeing.

With innovation set to head in all directions, the report highlights ‗living‘ buildings, with algae
embedded in their walls that grow all their own energy, as well as Cradle to Cradle‘s buildings,
which are made of clay and wood, so they can return to the earth when their life is over.

Arguing that hotels and wellness retreats need to be leaders in the wellness architecture
revolution, the Global Wellness Institute predicts that in the future our buildings will be designed
from their blueprints up, in order to make us healthier, happier and more alive.

Silence

As digital noise and connectivity reaches an all-time high, the Global Wellness Institute predicts
that we will see a sharper focus on silence, mindfulness and nature. From new ‗silent spa‘
models to silent zones at restaurants, gyms and even airports, Tom Bauer, COO at Vamed
Vitality Resorts argues that time, space and silence will be the most precious future luxuries, and
that retreats like theirs will need to offer services that help people restore inner silence.

Answering the desire for silence, the Mandarin Oriental has already launched a brand-wide
―digital wellness‖ initiative, in which guests are encouraged to forgo their phones and follow a
wellness regime developed by the Mayo Clinic.

While future wellness-focused businesses will need to embrace technology, the report highlights
the opportunities present for brands to become ―one of the lone cultural (and therefore sacred)
spaces of silence, digital silence, unplugged human thought and nature.‖ For example, the first
completely ―Silent Spa‖ (with stunning church-inspired architecture) just opened at Austria‘s
Therme Laa Hotel.

Art & Creativity Take Center Stage

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Born of a storied history, but forgotten of late, the creativity-wellness-spa connection is making a
comeback: with more art, music, literature and dance (both as experienced and ―to do‖) at the
center of more wellness experiences. Taking inspiration from the phenomenon that is adult-
colouring, the Global Wellness Institute predicts that the practice of art and creativity will
become even more central to the future of wellness. Citing creative pursuits as key to mental
wellness, the report suggests that we‘ll start to see more classes and programming that
encourages people to embrace their creative side, whether that be dancing, drawing, writing or
learning.

According to the Global Wellness Institute, destination spas like Canyon Ranch have long
offered classes in creative arts, however as the trend toward more performance-based activities at
wellness destinations increases, more mainstream brands are taking steps to incorporate
creativity into their offerings too.

Driven by consumers having a better understanding of the relationship between creativity and
mental wellbeing, initiatives such as complimentary in-room colouring books found at hotels, or
nights of painting under the stars offered at retreats, will be given greater prominence by brands
when marketing their wellness offerings. For example, Germany‘s famed spa resort, Schloss
Elmau, where musicians and writers ―play-to-stay‖ (making possible 200+ concerts a year) – or
live classical violin while taking the waters at the UK‘s new Gainsborough Bath Spa Hotel.

Wellness Remakes Beauty

Beauty, the goliath industry ($1 trillion) of the $3.7 trillion wellness economy, is remaking itself
to meet the needs of a wellness-oriented population obsessed with authenticity and ―inner
beauty.‖ As the notion of beauty from the inside out continues to shake up the beauty industry,
the report argues that the convergence of beauty and wellness has created a new aesthetic of
beauty that has nothing to do with shape or size. Sparking a consumer revolution, looking good,
feeling good and even doing good is all part of today‘s beauty aesthetic, according to the Global
Wellness Institute. And, as such, demand for ethically sourced and natural products with a
personal story, is rising.

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The report predicts that ―big beauty brands will continue to acquire niche brands – like L‘Oréal‘s
$1.2 billion acquisition of IT cosmetics, and Unilever‘s purchase of premium, clinical brand
Murad,‖ in a bid to connect to today‘s consumers and help boost revenues. The ingestible beauty
market will also advance, as consumers turn to prevention rather than repair.

The Future Is Mental Wellness

When it comes to mental wellness, our world has a problem: depression and anxiety is
skyrocketing, and by 2030, the former will be the #1 health issue, outranking obesity (WHO). So
look for dramatically more ―healthy mind‖ approaches in coming years. Predicted to be the
biggest future trend of all, thanks to an ―alarming mental wellness crisis‖, the Global Wellness
Institute argues that spas, fitness studios, workplaces and governments will start putting more
emphasis on helping consumers to tackle stress, depression and anxiety.

Suggesting that, ―as wellness tourism developed alongside of, yet distinct from, medical tourism,
mental wellness will develop alongside, and distinct from, mental health,‖ the report argues that
mental wellness will form a new wellness category, with businesses creating innovative paths to
emotional wellbeing and happiness.

From sleep pods and drop-in meditation classes at MINDFL in LA, to mystical concepts such as
Shaman Purification Rituals at Tierra Santa Healing House in Miami, wellness for the mind is on
the cusp of a meteoric transformation, and these innovative concepts are already riding the wave.
Wellness retreats and spas are adding neuroscientists and psychotherapists (like London‘s ESPA
Life at Corinthia Hotel). Meditation is not only radically mainstreaming (even on-demand in
hotel rooms), but spawning creative new breeds (from ―dream‖ to ―floating‖ meditation). We‘ll
see everything from new part-mind/part-body workout brands to apps that track your mental
state (think MindBit, not FitBit). Because ―mind‖ will finally get equal billing with ―body.‖

Embracing the C-Word

The wellness world is waking up to the needs of a surprisingly underserved population: cancer
patients. According to Julie Bach, who heads Wellness for Cancer, an educational platform that

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trains wellness companies on how to work with cancer patients: ―The industry‘s mantra in the
past was ‗we serve well people‘ – a non-inclusive policy that is changing.‖ Although wellness
still has a long way to go in the inclusion of cancer care, initiatives such as ESPA‘s Nurture &
Support programme, which has been designed to help relax, nurture and support guests who are
dealing with cancer, are becoming more commonplace. And, in the future, the Global Wellness
Institute predicts even more wellness businesses will pursue cancer-focused education to train
staff, enabling them to offer models of wellness that cater to those with the disease.

Beyond the Ghettos of Wellness

In a world where rising income and ―wellbeing‖ inequalities are fueling a populist backlash, a
wellness industry that‘s become narrowly associated with rich elites (those $300 yoga pants and
Reiki sessions) will change. As the need for wellness to reach beyond the rich elite intensifies,
the Global Wellness Institute argues that: ―Governments and wellness businesses need to bring
more healthy services to more people. Because wellness businesses that only deliver $300
athleisure leggings or massages will start to seem increasingly inauthentic.‖

In doing so, the report suggests that more businesses will start to launch charitable initiatives,
more affordable products and services will emerge, and wellness tourism will shift from high-
end resorts within walls to destinations where more authentic experiences can be found.

Getting real about what true wellness is and should be, the wellness businesses of the future will
be more sustainable, with consumers driving the transformation. More wellness businesses will
give back to the other 99%, like ―Yoga Gives Back‖ helping poor women in India – or
Newfoundland‘s Fogo Island Inn, where every dollar of profit goes back to its economically-
challenged island community. A ―Wellness Tourism 2.0‖ will rise: a development model
thinking beyond the often elite, gated property to creating whole towns, regions and even
nations, where a comprehensive wellness vision (from protected nature to a sustainable, healthy
food supply) benefits BOTH locals and tourists. The new wave of low-cost ―wellness‖ is part of
this democratization: like more affordable healthy supermarkets and spa chains.

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Popular forms of wellness tourism
Though wellness tourism has many sub categories to it. Spa tourism, thermal or mineral spring‘s
tourism, yoga tourism and meditation tourism have gained popularity in the last few years. We
will take a look at these aspects in dept.

Spa tourism

The term ‗Spa‘ is derived from the Latin phrase, Salus per Aquam which means health by water,
in ancient time people used to travel to hot or cold springs in hope of effecting cure for some
illness. Even in modern times the therapeutic property of water is being used to treat various
health disorders. The international Spa Association has defined Spa as ―places devoted to overall
well-being through a variety of professional services that rejuvenates mind, body and spirit‖

Pamper your body, Nurture your mind and Rejuvenate your spirit. The trend of combining the
benefits of a spa visit with a holiday has increased. Awareness regarding the benefits of Healthy
eating, nutrition, exercise, beauty, relaxation and pampering is increasing and people love to
include those elements in their holidays or purposefully travel to achieve wellness. Either it is
visiting local spa or traveling overseas, more and more people are opting to take break from their
speedy life to pamper themselves, relax and rejuvenates.

Now a day‘s number of Spas and retreat associations are actively promoting and working
extensively on the further development of the wellness industry by coming out with specialized
spa including eco-friendly spas, luxury spas, romantic spas, pampering spas, stress management

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etc. In addition to this, to attract more people and satisfy their demands different spas are
promoting variety of wellness programmes and treatments including healthy lifestyles,
alternative therapies, fitness programs, weight-loss treatments, Detox diets, mineral and thermal
skin treatments, massage and yoga.

Different types of spa

Depending upon what your goals are, and what you are looking for in a spa experience, you
would like to know about the different types of spa and the treatment\therapies they offer. Below
are the primary types of spa with description about the kind of services that you could expect.

Club Spa

A facility whose primary purpose is fitness and which offers a variety of professionally
administered spa services on a day-use basis.

Cruise Ship Spa

A spa aboard a cruise ship providing professionally administered spa services, fitness and
wellness components and spa cuisine menu choices.

Day Spa

A spa offering a variety of professionally administered spa services to clients on a day-use basis.
Day spas offer many of the same services and procedures as cosmetic spas.

Destination Spa

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A destination spa is a facility with the primary purpose of guiding individual spa-goers to
develop healthy habits. Historically a seven-day stay, this lifestyle transformation can be
accomplished by providing a comprehensive program that includes spa services, physical fitness
activities, wellness education, healthful cuisine and special interest programming.

Medical Spa

A facility that operates under the full-time, on-site supervision of a licensed health care
professional whose primary purpose is to provide comprehensive medical and wellness care in
an environment that integrates spa services, as well as traditional, complimentary and/or
alternative therapies and treatments. The facility operates within the scope of practice of its staff,
which can include both aesthetic/cosmetic and prevention/wellness procedures and services.

Mineral Springs Spa

A spa offering an on-site source of natural mineral, thermal or seawater used in hydrotherapy
treatments.

Resort/Hotel Spa

A spa owned by and located within a resort or hotel providing professionally administered spa
services, fitness and wellness components and spa cuisine menu choices. In addition to the
leisure guest, this is a great place for business travelers who wish to take advantage of the spa
experience while away from home. In many cases resort/hotel spas also act as day spas for local
clientele and may offer special rates for people that live in the community. If you have a
resort/hotel spa in your area be sure to ask if they accept local clientele.

Airport Spa

It is located in an airport and specializes in short treatments aimed at the traveler, like 15-minute
chair massage and oxygen therapy. Some also offer longer treatment

Ayurvedic Spa

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A Spa in which all treatments and products are natural and it's often used as alternative medicine.

Mobile Spa

A Spa which provides services at home, hotels, or wherever you are.

Geographical segmentation of Spa Tourism

Asia-Pacific has the largest number of spas among all regions, and the region also saw the
greatest increase in spa revenues (in numerical terms) since 2013. Asia‘s spa industry has
experienced steady growth, driven by ongoing hotel and resort developments in popular
destinations, as well as new businesses and chains that cater to mid-income consumers –
especially in secondary and third-tier cities in the emerging markets such as China and India. All
across the Asia-Pacific region, spa-going is no longer viewed as just a luxury pampering activity
for the wealthy, but increasingly as a necessity for health maintenance and overall wellbeing. As
people turn to body work to relieve stress and chronic pain, the business and professional class –
both male and female – are taking up treatments to help maintain vitality and a youthful
appearance.

Source: GWI_WellnessEconomyMonitor 2017

In Europe, the rising number of spas in the region reflects an underlying trend of an expanding
customer base, with more businesses identifying themselves as spas and more mid-tier hotels
adding spa/wellness facilities and services (even on a small scale). More and more
establishments have emerged to provide specialized wellness services and treatments, from
massage, facials, and reflexology to reiki, flotation tanks, and so on. On the other hand, many

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spas are also adding expanded wellness offerings to attract and retain customers (e.g., yoga,
mindfulness classes, energy work, etc.), bringing themselves into competition with a set of new
rivals in fitness and other sectors. As more European hospitality establishments in the three to
four-star range are prepared to meet those needs. There is growing demand for trips that are built
around a specific wellness activity such as meditation or yoga retreats. Wellness-themed
getaways and short vacations are also on the rise – not only for couples and girlfriends, but
increasingly for families. Resorts that cater to the dual trend of wellness and short getaways,
such as Center Parcs and its Aqua Sana Spa, are gaining popularity in Western Europe.

Source: GWI_WellnessEconomyMonitor 2017

The North American spa industry is growing at a healthy pace, aided by steady economic
recovery and increased consumer interest in everything related to wellness lifestyle Fast-growing
franchises such as Massage Envy, Elements Massage, and Hand & Stone have popularized mid-
priced spa treatments and increased their accessibility in suburban neighborhoods. Their monthly
membership model is also promoting spa-going as a regular occurrence – that consumers deserve
it and should treat it as a constant budget item. Meanwhile, the proliferation of specialized
neighborhood establishments, such as reflexology centers and massage clinics, as well as their
aggressive promotion through social media and package discounting, have held down prices in
the lower-priced segments of the industry. The rise of on-demand massage services, pioneered
by startups such as Zeel and Soothe, is often viewed as the latest industry disruptor. Wellness
tourism continues to grow in North America, as more consumers look to travel as a break from
their stressful lifestyles and an opportunity to focus on their wellness. According to the State of
Wellness Travel Report, the fastest-growing U.S. destinations for wellness-driven bookings are
the West Coast, Southwest, and Hawaii.

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Among hotels, major brands such as Westin, Even, Hilton, Fairmont, and others are marketing
sleep-friendly room features, healthy food options, in-room fitness equipment, yoga classes, on-
demand exercise videos, bike rentals, and more to help travelers maintain their wellness routines
while on the road. This trend is expected to continue and accelerate in the years to come.

Source: GWI_WellnessEconomyMonitor 2017

Steady spa market growth in Latin America and the Caribbean reflects the underlying economic
conditions and travel trends in the region. In Mexico, the largest country market, there is a surge
in consumer interest in all things related to health and wellness, from organic food to fitness
clubs to spa-going. In the Caribbean countries, the spa market is driven by tourism and is
dominated by hotel and resort spas. Robust tourism growth and favorable economic conditions
have stimulated investments in both urban spas, hotel spas, and resorts in Mexico and the
Caribbean. South America‘s markets have a strong tradition of delivering beauty treatments in
small, neighborhood salons and esthetic clinics. The term ―spa‖ in South America is usually
associated with ―stay spas,‖ focusing on weight loss, fasting/cleansing, healthy foods, and
exercise/physical activities. Due to declining economic conditions and currency depreciation in
several oil-producing nations (Brazil, Venezuela, and Colombia), their spa markets experienced
some shrinkage.

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Source: GWI_WellnessEconomyMonitor 2017

Middle East-North Africa region‘s spa market reflects the latest developments in its economic,
demographic, and security situations, as well as broader global economic and lifestyle trends.
Spas, which have long been associated with beauty and pampering in this region, are gaining
ground with professional and middle class consumers who are living increasingly hectic, yet
sedentary lifestyles. In the hotel and resort spa markets, UAE and Qatar have benefitted from
significant investments in new hotels and resort properties, from both international and regional
brands, in anticipation of Expo 2020 and the FIFA World Cup 2022. Meanwhile, factors such as
lower oil prices, currency depreciation, and economic slowdowns in key tourism source
countries such as Saudi Arabia, Russia, and China have slowed the brisk pace of growth that was
experienced across the region a few years earlier.

Source: GWI_WellnessEconomyMonitor 2017

In Sub-Saharan Africa Developments robust growth in the spa industry has been fueled by rapid
expansion of African economies and a rising middle class. Across the continent, not only are
consumers spending their rising incomes on beauty, relaxation, fitness and sports, and healthy

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eating, but they are also showing increasing interest in products and treatments inspired by local
traditions. The day spa market has grown especially fast in countries such as South Africa,
Nigeria, Kenya, and Ghana, with variations of club spas, salon spas, and ―container spas‖
proliferating to cater to the middle income segment of the market. Growth in the hotel and resort
spa markets continues to be anchored by strong tourism inflows and investments in new and
existing properties, especially in the island resorts of Seychelles, Mauritius, and Madagascar, as
well as in popular destinations in Kenya, Tanzania, Namibia, South Africa, and Botswana.

With well-developed spas in the high-end island resorts and safari destinations, wellness tourism
is on the rise in Africa, especially from international visitors. Meanwhile, domestic wellness
travel in African countries remains a much smaller segment as compared to other regions. Many
international travelers, while on holidays that are primarily driven by interests in culture, nature,
and wildlife, are also eager to experience treatments and therapies rooted in African traditions –
from calabash massage to the izinyawo foot cleanse to drumming meditation and healing – and
these kinds of treatments are increasingly appearing in spas across the region.

Source: GWI_WellnessEconomyMonitor 2017

Thermal/mineral springs spas

The thermal/mineral springs industry is comprised of revenue-earning business establishments

associated with the wellness, recreational, and therapeutic uses of waters with special properties.
The thermal/mineral springs industry is positioned for rising investment and growth as
consumers increasingly seek out the healing and relaxing properties of water and nature. We
estimate that there are now 27,507 facilities built around thermal/mineral springs, located in 109

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countries, and earning $51.0 billion in revenues in 2015 (compared to $50.0 billion in 2013). A
research indicates that there is rapidly rising consumer, investor, and government interest in
springs-based activities, with most establishments experiencing solid growth in both attendance
and revenues. The countries with the largest thermal/ mineral springs industries – especially in
Europe and Japan – saw major currency depreciation against the U.S. dollar from 2013-2015,
and so the revenue growth rates in these countries were much higher in local currency than in
U.S. dollars.6 For example, global industry revenues grew by 10% annually in Euros as
compared to 1% annually in U.S. dollars. Just over one-quarter of all thermal/mineral springs
establishments offer value-added spa services (e.g., massage, facials, hydrotherapy, other
treatments) alongside their bathing offerings. These tend to be more developed facilities with a
wider range of offerings; therefore, they earn higher revenues than those facilities with bathing
only, and they account for nearly two-thirds of the industry‘s revenues. Include the revenues
generated by spa- and wellness-related treatments (such as massage, facials, hydrotherapy, etc.)
at the following types of establishments: day-use spa facilities and destination/health resorts that
incorporate an on-site source of natural mineral, thermal, or seawater into their spa treatments, as
well as other bathing/recreational springs establishments that offer complementary spa services.

The thermal/mineral springs industry is heavily concentrated in Asia-Pacific and Europe,

reflecting the long history and traditions of bathing. In fact, Asia-Pacific and Europe account for
96% of industry revenues and 94% of establishments. China‘s hot springs resorts and Japan‘s
onsen continue to dominate the market, representing 55% of global revenues and 71% of all
establishments. Japan alone, with its estimated 17,328 onsen, is home to nearly two-thirds of all
thermal/mineral springs establishments. Other top markets include a large number of European
countries with longstanding traditions of using thermal/mineral waters for curative and
therapeutic purposes (often subsidized by government insurance systems, although this practice
is declining in many countries), as well as the United States. Latin America also has a deep
history of thermal/mineral water bathing and recreation, but the size of its industry is a distant
third to Asia and Europe.

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Yoga and meditation getaways

With increased awareness in spiritual and holistic well being, yoga and meditation tourism has
gained popularity in recent times. Native to Asia and especially countries like India, Japan,
China, this form of tourism has been responsible attracting major tourist inflow from North to
south. The popularity of the segment has also lead to opening of yoga and meditation retreat
centres all over the world adding another major segment to the wellness tourism category.

The Asian advantage

There are a myriad of schools and centres in South East Asia which offer the chance to learn
about yoga, meditation, detox and other forms of holistic therapy, such as reiki, angel and crystal
healing.Even before the Beatles went on their famous pilgrimage to Rishikesh with Maharishi
Mahesh Yogi in 1969, India has been a popular travel destination for American tourists seeking

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serenity and spiritual growth. But in recent years, wellness travel to India has exploded. Mia
Farrow, Steve Jobs, and Oprah are just a few of the many Westerners who have flocked to India
for life-changing trips to visit meditation retreats and spiritual sites. Now, the Southeast Asian
country is the fastest-growing wellness travel destination, with a projected 22 percent annual
growth rate. In comparison, the United States -- the leading country for wellness travel -- has an
average annual growth rate of 5.8 percent. Many of Thailand‘s temples welcome foreigners onto
courses and retreats of up to 21 days, which offer an insight into Buddhist meditation and can
help to teach you how to still the mind.

A mountain retreat in the sacred home of yoga – Ananda in the Himalayas

Ananda in the Himalayas is a luxury destination spa in Narendra Nagar, Uttarakhand, set in the
Indian Himalayas. Set in a 100-acre Himalayan mountain estate set amidst sal forests,
overlooking the river Ganges, close to the towns of Rishikesh and Haridwar, it was established in
2000, and was India's first destination spa. Ananda focusses on Yoga and Ayurvedic practices,
combined with international spa therapies. It is considered one of the best spas in the world by
the The Telegraph and rated No. 1 destination spa in the world by Travel + Leisure magazine.
Well-heeled spiritual seekers (including Oprah) are drawn to Ananda in the Himalayas for its
polished spa treatments and eye-boggling Himalayan foothill setting.

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source: CNT

Western set-up

The explosion of yoga in western countries means there‘s a studio on every other street and such
a variety of styles and options. But taking advantage of the current tourism wave, many countries
form the West have also started to build their own yoga and meditation retreat. These retreats not
only focus on yoga and meditation but also offer holistic approach by incorporating healthy diet,
natural, serene environment and along with soothing atmosphere.

One such example is The Orange Tree Yoga Retreat, Yorkshire

The yoga weekends at The Orange Tree, a lovely small retreat in the North York Moors, are led
by personable owner Edward Harpin and his sister Helen. They teach hatha yoga and
mindfulness meditation in two or three sessions a day, which may include music, periods of
silence, mantras, breathing techniques and a gong bath to enhance relaxation. There‘s an outdoor

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jacuzzi and sauna, massages and time for moor walks before a three-course homemade veggie
supper and yoga nidra prior to bed.

Source: google.com

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