Major challenges

Tourism development and health of the local population

Increased tourism arrivals generate more revenues for a region. To what extent this leads to better health care for locals (and tourists) has not been studied well. There is little evidence that taxes generated from tourism are to a large degree invested into reforming public health care systems in order to improve the health of local residents, especially those previously left behind. On the contrary, examples of negative impacts of tourism on locals’ health dominate.

Tourism increases competition for scarce resources such as clean drinking water, access to traditional farm land or fisheries, or existing health care services. Tourism can displace local people and destroy traditional livelihoods. Resulting poverty potentially fuelled by tourism induced inflation can increase malnutrition, morbidity and mortality – most severely among vulnerable groups such as minorities, youth and the elderly as well as women.

Environment and health

Frequently tourism planning does not provide adequate solutions to harmful effects of tourism on the environment that pose health hazards for local communities (as well as tourists). Inadequate waste and sewage management not only damage the environment, but may also spread waterborne diseases.

On a global scale, tourism is responsible for about five percent of all CO2 emissions (UNWTO, 2016) that are severely impacting the world’s climate. “Climate change affects the social and environmental determinants of health – clean air, safe drinking water, sufficient food and secure shelter. Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress”, according to the World Health Organization (WHO, 2016).

Health and working conditions

Tourism may offer jobs to local people. However, many jobs are not complying with health and safety standards and can therefore have detrimental effects on employees’ physical and mental health and even result in death. There is a lot of informal employment in tourism, leaving poorly paid workers with no health insurance and social security. The density of trade unions in the sector that could advocate for workers’ rights to fair pay and health coverage is low. (>> Goal 8)

Interaction between hosts and tourists

The bigger the financial disparities between travellers and hosts, the more hosts may per- ceive tourists to embody progress, wealth and a desirable lifestyle. This can lead to cul- tural changes and the erosion of traditional social protection mechanisms, such as care for the elderly and sick. Tourists may introduce new forms of food, tobacco and drugs to a destination. Studies indicate that tourist destinations can be epicentres of demographic and social change as transactional sex, elevated alcohol and substance use, as well as internal migration can increase the risk of infection with sexually transmitted diseases, such as HIV (Padilla et al, 2010).

Globalization, tourism and health

The growing mobility of tourists is a risk factor, as it can contribute to spreading infectious diseases and epidemics. Via international air travel infection risks can reach nearly every corner of the world within hours or days, as could be witnessed during the Ebola outbreak in Western Africa in 2014/15. A total of 28,616 Ebola cases were reported in Guinea, Liberia and Sierra Leone, with 11,310 deaths (WHO, 2016b). The first case of an infection outside of Africa was reported in September 2014 in the US. The patient travelled form Liberia to Dallas, Texas. He was treated in a hospital and died a couple of days later. Two nurses caught the Ebola infection while taking care of the patient, but could be cured and the disease was prevented from spreading further (Robert Koch Institut, 2016).

Patients without borders

Today, a growing number of patients (in 2014: over one million by conservative estimates according to Lundt et al,2014) mainly from industrialized countries seek medical care in developing countries. Motives for medical tourism include relatively cheaper prices, shorter waiting lists or (experimental) procedures that are prohibited in the patients’ home countries. While medical tourism has the potential to create jobs and encourage invest- ments and innovation in the medical system, the risks for local communities and question- able ethics predominate.

Medical tourism diverts scarce health care resources from local people to tourists. Heavily subsidized institutions catering to the needs of well-paying tourists drain public health care systems of skilled staff. Medial tourism threatens to further commercialize and pri- vatize the health sector in the host countries and increase inequalities in accessibility and affordability of health care. Medical tourism also reduces the pressure on governments to provide affordable health care for their citizens that integrates preventative measures, if medical treatment can be outsourced at low costs.

Medical tourism raises moral and ethical issues, especially in the fields of reproductive health and organ transplants. Because of the lack of available donors, every day 18 individuals worldwide die while waiting for a transplant of a vital organ (Smith 2012). Organ trafficking as a black market activity is lucrative. Affluent recipients often “buy” organs from the most disadvantaged and vulnerable, who may be forced or may technically give their consent, but may not be aware of the risks. Studies show that a donor’s health often worsens after the surgery, costing them more in lost employment or out-of-pocket reme- dial care than the minimal ‘donation’ they receive for offering their organ to a broker (Hop- kins et al, 2010). Organ trafficking and transplant tourism clearly violate the principles of equity, justice and respect for human dignity.