|The Courier N° 122 July - August 1990 - Dossier Tourism - Country Report: Mali (EC Courier, 1990, 104 p.)|
by George ALLEYNE
The image of the tourist as a member of a very select group of very rich individuals who travel in luxury to very exotic places no longer obtains. Indeed, that fiction may never have existed as the mass movement of man is as old as man himself. Tourism is now one of the fastest growing exports in the world - currently second only to oil. International tourist arrivals in 1980 amounted to 285 million and this figure is projected to increase by 40% during the decade of the 90s. The developing countries which see their primary products declining in value, and facing ever more restricted outlets for them are increasingly marketing their natural resources and the services which go along with these. However, relatively little attention has been paid to the inter - relationship between health in general and tourism even though health and health services, as we will show, are important considerations for tourists.
The aspect of health which is most commonly considered in relation to tourism is the health of the tourist, and a special discipline emporiatrics deals with this. It has been estimated that 20 - 50 % of tourists suffer some ailment during their travel. This aspect of tourist health has been so important that an international Association of Tourist Health has been formed, and tourist health has been promoted as a new branch of public health. The illnesses of tourists are in the main very mild, with the most important being diarrhoea which may be caused by bacteria, parasites or viruses. The illness is usually self - limiting and short - lived, and it is rarely necessary to resort to antibiotics. Travellers are usually warned about simple precautionary hygienic measures, and are usually advised not to take prophylactic antibiotics. The provision of safe food is of great concern to the tourist industry as there are few things which impact more negatively on a tourist establishment than an outbreak of food - borne illness - usually diarrhoea.
The types of diseases or disorders which affect the tourist more severely are those which result from the risktaking behaviour that accompanies the change from the normal routine and the assumption of a holiday or leisure behaviour. There are problems associated with excessive use of alcohol and acquiring sexually transmitted diseases. It has been reported, for example, that sex tours to Thailand have been promoted, and as a result of the tourist boom the numbers of male and female prostitutes increased in the major tourist destinations of that country. Whereas the diseases of major concern were formerly gonorrhoea and syphilis, today the threat of AIDS make illicit sex even more unsafe for the tourist.
Drug abuse is another form of risktaking behaviour which may be associated with tourism. In one study from the Caribbean, 30% of tourists on the beaches were offered drugs of one sort or another. Drug - taking is not only damaging in its own right, but intravenous drug use is associated with the transmission of the AIDS virus.
The health of the tourist is not only important in terms of his or her own welfare, but there is always the concern that the returning tourist may introduce diseases into his or her country of origin. This transmission of disease by travellers is an ancient concern - it was responsible for many of the plagues and scourges of ancient times, and gave rise to the development of the quarantine law and conventions. This introduction of exotic diseases applies not only to the traveller, but sometimes to their pets which introduce animal diseases such as rabies into countries free of such diseases.
The effect of the tourist on the health and health services of the destination country is also important. This is usually considered from the point of view of the environment. Many of the tourism developments have taken place with scant regard for their environmental impact, and it has not been unusual to find tourist destinations which have become so popular that the environment cannot support the visitors density, and deteriorate, ultimately becoming unattractive to the tourists themselves. With the growing concern for sound ecological management, more governments in developing countries are weighing carefully the extent to which they mortgage their long - term development by allowing depreciation of the natural environment with the object of short - term gain. The thrust has to be towards tourist development which is ecologically sound.
Tourism has an impact on the health services of the destination country. Not only are the local health services called upon to treat many of the minor aliments which occur, but, with an increase in age of the tourists, they sometimes have to manage more severe illnesses. It is not infrequent to have patients being repatriated by flight ambulance for severe medical problems such as myocardial infarction, severe trauma, etc.
In small countries with a high tourist density there may be a significant demand on the local health services, and the availability of such services has to be taken into account when tourist destinations are promoted. Mention must also be made of patients with special problems, e.g. patients on chronic haemodialysis who travel and have their treatment in the local health facilities. Various associations provide, on request, information about the availability of health facilities.
It should also be noted that the local population is at risk of having diseases transmitted by tourists. If the term tourist is extended to mean traveller, it is highly probably that the deadly AIDS virus was introduced into some countries in this manner.
The third and perhaps most neglected aspect of the health and tourism interaction is health tourism, i.e. persons travelling for health reasons. It has even been said that health was the original motive for tourism as we know it today, as ancient travellers were attracted to the various spas which were thought to have healing characteristics. It has also been argued that, to the extent that rest and relaxation contribute to good mental health, most tourism has a health motive. Several tropical destinations are promoted in exactly this way - the peace and tranquillity to isolation which contribute to mental recuperation.
There is, however, health tourism related to specific health - care interventions. Large metropolitan countries promote centres for specialised health care. A not insignificant part of the practice in Londons famous Harley Street comes from visitors. Centres such as Houston and Miami in the United States attract visitors for health care. But health tourism is also growing in the developing countries as the cost of medical care rises in the developed countries. There needs to be a more aggressive approach to the research and development of this aspect of tourism.
These points of interaction between health and tourism need to be explored further. There are some data on the health of the tourist, but very sparse information on how the health of the national population is affected by tourism, and almost no information on the impact of tourism on the local health services in the developing countries.
There is laudable concern for the health of the tourist; this should be matched by research on and attention to the impact of tourism on local physical and environmental health and the extent to which health tourism can be a part of the tourism product which makes the developing countries attractive to tourist visitors.