How Wellness Tourism Contributes to the Global Economy

Intention to Visit Wellness Tourism in Thailand

Chapter Two: Review of the Literature

Chapter introduction

This chapter provides a general definition of wellness tourism and the underlying concept that is involved. In addition, the typology of wellness tourism is followed by an examination concerning how this kind of tourism contributes to the global economy. This examination is followed by an analysis of current wellness tourism in Thailand as well as its potential for the future. Finally, an assessment of the future potential of wellness tourism for Thailand is followed by a summary of the research and key findings.

Wellness tourism definition and concept

While there is no universally agreed-upon definition for wellness tourism, the following provide some definitional clarity concerning the concept:

· The Global Wellness Institute defines wellness tourism as travel associated with the pursuit of maintaining or enhancing one’s personal wellbeing (Wellness tourism, 2021, para. 3).

· DRI International defines wellness tourism as all travel associated with the pursuit of maintaining or enhancing one’s personal wellbeing (What is wellness tourism?, 2021, para. 2).

· Wellness tourism is travel for the purpose of promoting health and well-being through physical, psychological, or spiritual activities (Definition of wellness tourism, 2021, para. 2).

The common denominator of the foregoing definitions of wellness tourism includes the primary intended purpose of maintaining and/or improving individual health and well-being, but it is important to point out that wellness tourism and medical tourism are not synonymous, although they share certain characteristics. In this regard, one authority emphasizes that, “Wellness tourism should not be confused with medical tourism. Wellness tourists travel to improve or maintain their health and quality of life, whereas medical tourists travel to receive treatment for a diagnosed condition” (What is wellness tourism?, 2021, para. 6).

Some of the specific factors that distinguish medical tourism from wellness tourism include those set forth in Table 1 below.

Table 1

Differences between medical tourism and wellness tourism

Medical tourism: Reactive

Wellness tourism: Proactive

Travel to receive treatment for a diagnosed disease, ailment, or condition, or to seek enhancement.

Travel to maintain, manage, or improve health and wellbeing.

Motivated by the desire for the lower costs of care, higher quality of care, better access to care, and/or care not available at home.

Motivated by the desire for healthy living, disease prevention, stress reduction, management of poor lifestyle habits, and/or authentic experiences.

Activities are reactive to illnesses, medically necessary, invasive, and/or overseen by a physician.

Activities are proactive, voluntary, non-invasive, and non-medical in nature.

Source: Wellness tourism, 2021 at https://globalwellnessinstitute.org/what-is-wellness/what-is-wellness-tourism/

In other words, wellness tourism may or may not involve convalescing from a medical condition, but the primary focus of wellness tourism is on maintaining and improving individual health and wellbeing which includes people who are not suffering from a medical disorder but rather want to improve their quality of life at present and in the future (Malyshev, Khodasevich, Maznichenko et al., 2016).

Although the concept of wellness tourism is becoming more widely known today, its origins in both Eastern and Western medicine actually date to antiquity when people increasingly recognized the importance of rest and relaxation in an appropriate venue to facilitate the healing process or to maintain and promote individual wellbeing (Stara & Charvat, 2019). In fact, the origins of the wellness concept predate human history, but the formal notion of performing various absolutions and physical activities has been traced to both the ancient Greek and Roman civilizations (A Brief History of Wellness, 2005). For example, according to Rubinstein (2020), “Despite its new visibility, the idea of travelling with the express purpose of improving well-being is by no means novel. Think back to the pilgrimages taken to the Dead Sea, ancient baths in Rome and natural hot springs across Asia – or the yoga retreats and Thai colon-cleansing holidays of more recent decades” (para. 7).

More recently, however, researchers have studied the concept of wellness tourism in a scholarly fashion to in order to provide a better understanding concerning what it involved and the rationale in support of this approach to healing and wellness promotion. For instance, in 1959, a physician, Halbert L. Dunn, was among the first medical authorities to study the efficacious aspects of wellness tourism in which he “emphasized the impact of the environment in which people live” (Stara & Charvat, 2019, p.4). During the late 1950s, Dunn used a weekly series of lectures at a Washington, D.C.-based Unitarian Church to promote his conceptualization of wellness and how ordinary people could use his philosophy about health to improve their lives and even live longer (A Very Brief History of Wellness, 2000). Based on the feedback he received during his early research, Dunn subsequently wrote and published a booklet called, \\\\\\\"High Level Wellness\\\\\\\" in 1961 in which he conceptualized wellness in terms of being a multidimensional lifestyle approach that emphasized personal responsibility and environment awareness (What Is Wellness, Anyway?, 2006).

In reality, the connection between the environment in which people live and their degree of wellness is fairly intuitive as evinced by its recognition by ancient medical practitioners. Since this seminal research by Dunn was conducted, however, numerous other authorities such as Mueller and Kaufmann (2001) have also investigated the appropriateness and effectiveness of wellness tourism for a wide range of individual wellness applications (Stara & Charvat, 2019).

Indeed, at present, the wellness tourism industry encompasses a veritable cornucopia of attractive offerings that are all intended to maintain and/or promote individual wellbeing. Some indication of this wide array of offerings can be discerned from a typological breakdown of the wellness tourism industry which is presented below.

Typology of wellness tourism

Just as the specific definitions of wellness tourism differ but include numerous overlapping points, the types of tourism that are subsumed under the wellness tourism umbrellas vary in type and purpose as well. Some of the representative types of wellness tourism and examples of their associated activities are set forth in Table 2 below.

Table 2

Types of wellness tourism

Wellness tourism type

Examples of wellness tourism activities

Health (integrative health centers, complementary and alternative medicine centers and wellness centers)

? Check-ups

? Integrative medicine

? Diagnostics

? Healthy eating

Nutrition (organic restaurants, health food stores)

? Weight management

? Detox

? Culinary experiences

Fitness (gyms and fitness centers)

? Gym visits

? Fitness classes

? Stretching

? Pilates

Eco and Adventure (parks, wildlife sanctuaries and nature preserves)

? Hiking

? Biking

? Taking walks

? Nature visits

Personal growth (lifestyle retreats and wellness retreats)

? Retreats

? Life coaching

? Stress reduction

? Reading

? Music and arts

Spiritual and Connection (yoga retreats, spiritual retreats and ashrams)

? Prayer

? Volunteering

? Time with friends and family

? Time alone

Mind-body (yoga studios and martial arts studios)

? Yoga

? Tai chi

? Qigong

? Biofeedback

Spa and Beauty (healthy hotels, wellness cruises, health resorts, spas, salons, bath and rings)

? Massage

? Bathing

? Body treatments

? Facials

? Hair and nails

Source: Adapted from What is wellness tourism?, 2021

The typology of wellness tourism set forth in Table 2 above includes a number of both leisure and non-leisure activities. This means that wellness tourism offerings span the continuum of just sitting back and enjoying the solitude of the moment accompanied by a dazzling sunset or perhaps reading a long-set aside novel to actively engaging in a rigorous physical fitness regimen (Luo, Kim, Tang et al., 2018). The important aspect of these offerings is the fact that they can be combined in countless ways depending on the individual preferences, abilities and wellness goals of wellness tourists.

Taken together, the foregoing examples of wellness tourism underscore the attractiveness of this approach to maintaining and improving individual wellbeing and most include an entertainment and fun factor that makes these activities all the more enjoyable for wellness tourists. While some of the wellness tourism-type activities that are set forth in Table 2 above can be performed at home or in community-based centers, the fact that wellness tourism typically involves visiting new and exciting destinations makes these types of activities far more attractive, authentic and palatable for those individuals who might otherwise be reluctant to, for example, take long hikes, practice yoga, receive a massage, or engage in other types of physical fitness activities (Sheldon, & Park, 2008). Moreover, because wellness tourism includes all of the expenditures that tourists make during their visits, including transportation, the contribution of this industry is already substantial and is projected to increase in value in the years to come as discussed below.

How wellness tourism contributes to the global economy

Current estimates concerning the contributions of the overall global travel and tourism industry are based on a sustained growth pattern that was enjoyed for the past several decades, but things have changed significantly since the onset of the Covid-19 pandemic. As shown in Figure 1 below, the global travel and tourism industry is already shaking off the adverse effects of the travel bans and ubiquitous lockdowns that have been used by governments around the world in an effort to combat the Covid-19 pandemic and current projects indicate that the industry will return to its pre-pandemic levels within the foreseeable future.

Figure 1. Market size of the global tourism sector from 2011 through 2020 with a projection for 2021

Source: Statista (2021) at https://www.statista.com/statistics/1220218/tourism-industry-market-size-global/

As the term connotes, wellness tourism involves travel to a destination, typically abroad, in order to convalesce from some type of injury, surgery or other medical procedure that requires rest and relaxation to facilitate recovery. In some cases, though, wellness tourism also refers to travel and stays in accommodations in a given destination that are intended to maintain or improve individuals’ sense of well-being (Erfurt-Cooper & Cooper, 2009). For instance, according to a timely article by Rubinstein (2021), wellness tourism is “travel associated with the pursuit of maintaining or enhancing one\\\\\\\'s personal well-being” (para. 4). The contributions of the wellness tourism industry include all expenditures that are made by tourists during a wellness-related trip that is intended to improve or maintain their individual wellbeing (What is wellness tourism?, 2021).

Because all of the expenditures for travel and the patronage of various elements of the hospitality industry are integral parts of wellness tourism, it is not surprising that this emerging trend already accounts for a significant contribution to the global economy. In this regard, Rubinstein (2021) emphasizes that, “The world of wellness – a global economy of care and workout offerings, nutrients, alternative medicine and more reached $4.5 trillion in 2018” (para. 2). As discussed further below, Thailand’s travel and tourism industry has suffered a serious blow due to the ongoing Covid-19 pandemic, but this sector still represents an integral part of the nation’s economic development planning (McGough, 2021).

In addition, the multiplier effect means that the monies that are currently being spent on wellness tourism are increased substantially throughout communities, and current signs indicate that this type of tourism is well situated to continue to increase in popularity for the foreseeable future (Rubinstein, 2021). Indeed, as Rubinstein points out:

Wellness tourism has witnessed a triumphant ascension over the past decade. Popular perceptions of the importance of diet, fitness and healthy practices have transformed, powering vibrant new business sectors. And as wellness evolves and expands, auxiliary markets from food and drink to hospitality are starting to provide products that reflect the values of today’s health-conscious consumers. (para. 5)

Further, one of the unexpected concomitant outcomes of the ongoing Covid-19 pandemic has been a groundswell in consumer interest in tourism destinations that can help them live healthier, longer lives. Moreover, this increased interest was already evident even prior to the onset of the Covid-19 pandemic in early 2020. For instance, according to Market Business News (2021), “The wellness tourism industry has grown at a fast rate because of a boom in global interest in fitness, health, wellbeing, and consumer having more disposable income” (What is wellness tourism?, 2021, para. 9).

In sum, then, wellness tourism is already a major contributor to the global economy and it is reasonable to conclude that it will continue to increase in popularity as the beneficial effects of this type of tourism become more widely publicized. While the precise effects of the ongoing Covid-19 pandemic on individual mental and physical remain under study, a growing body of evidence suggests that more and more people are focusing on finding new ways to make their lives better while they still can and to live as long as possible despite the wide range of existential threats that are currently arrayed against humanity.

In fact, fewer people today are interested in accumulating wealth for the next generation and have redirected these resources to enjoy their lives to the maximum extent possible, including most especially participating in new experiences such as wellness tourism. This change in attitude concerning the importance of saving money for the next generation is widely attributed to the devastating effects that the ongoing Covid-19 pandemic has exacted on the mental and physical wellbeing of many people who have been reminded about their own mortality and the fleetness of their lifespans. One destination in particular which represents a highly desirable venue for wellness tourism is Thailand, a nation known for its beautiful beaches, warm climate, exotic foods, friendly people and comparatively low costs and these issues are discussed further below.

Wellness tourism in Thailand

Today, tourism accounts for 6.78% of Thailand’s economy, making it a vitally important for this nation’s continuing economic development (Share of tourism to GDP value Thailand 2017-2020, 2021). As can be seen from the trends depicted graphically in Figure 2 below, however, the decline in tourism attributable to the ongoing Covid-19 pandemic has hit Thailand’s tourism industry especially hard;

Figure 2. Share of tourism contribution to the Gross Domestic Product (GDP) value in Thailand from 2017 to 2020

Source: Statista (2021) at https://www.statista.com/statistics/1143467/thailand-share-of-tourism-to-gdp/

Despite the downturn in Thailand’s tourism industry due to the Covid-19 pandemic, the industry still represents a vitally important component of the nation’s GDP (Thailand economy, 2021) and tourism remains a fundamental part of Thailand’s national strategy for the period 2017 through 2037 (Tourism Authority of Thailand Annual Report, 2017). Moreover, the Thai government has recognized this downturn in tourism revenues and has developed both short- and long-term strategies to address the problem. Prior to the onset of the ongoing Covid-19 pandemic, though, Thailand’s respective share of the Asia-Pacific travel and tourism industry placed it 9th among 22 Asian nations as depicted graphically in Figure 3 below.

Figure 3. Asia-Pacific Travel and Tourism Competitivenes Index Score by Country/Economy: 2019

Source: World Economic Forum (2021) at https://reports.weforum.org/travel-and-tourism-competitiveness-report-2019/regional-profiles/asia/

In addition, Thailand also ranks 31st in terms of boasting South-East Asia’s largest travel and tourism GDP, and this factor in particular has been reinforced by “some of Asia-Pacific’s most attractive natural resources (10th) and most efficient tourist services infrastructure (14th)” (Asia-Pacific Travel & Tourism Competitive Index, 2019, para. 7). In sum, the public and private sectors in Thailand have embraced the tourism industry, including its various specialized subsectors, in major ways in recent years in ways that make this country well poised to take advantage of this growth industry in the future (Mutalib, Soh, Wong et al., 2017) and these issues are discussed further below.

Potential of wellness tourism for Thailand

As noted above, the travel and tourism industry is among the most important for Thailand’s continuing economic development, and the Thai government has determined that innovative approaches to creating new tourism opportunities is an essential component of this process. In this regard, Thailand’s Twelfth National Economic Plan for 2017-2021 specifically emphasized the need for “tourism that promotes unique touristic products to accommodate domestic and international markets” (p. 14). Likewise, the Plan also determined that the medical and wellness sector of the nation’s tourism industry was among the most promising for future investments and development.

Based on its importance to the Thai economy combined with the growing interest in wellness tourism destinations, there has been a growing body of scholarship directed at identifying future opportunities for wellness tourism in Thailand (Pathomsirikul, 2019). As shown in Table 2 above concerning the different types of wellness tourism, the most promising segment of Thailand’s wellness tourism sector involves spas and beauty destinations as well as lifestyle resorts, healthy hotels, wellness cruises, health resorts, and salons. In fact, the Thai travel and tourism industry even has a burgeoning subsector that specializes in providing non-traditional therapies in luxurious spa settings. In this regard, the industry experts at Explore Southeast Asia (2019) report that, “‘Wellness spa tourism’ is the common name for people who cross borders for preventive medicine and lifestyle improvement therapies” (Wellness spa tourism in Thailand, 2019, para. 3).