The Ministry of Tourism and Sports of Thailand (MTST) recently defined health tourism as: ‘to travel to cultural and natural place to learn the way of life and take a rest in order to archive promotion of health and restoration of health’ (MTST 2010). Furthermore, MTST divides heath tourism into two categories, ‘health promotion tourism’ and ‘health healing tourism’. The latter involves a stay in a hospital or health resort for the purpose of recovery and treatment of illness or injury. Rather, it might be more appropriately referred to as ‘medical tourism’. On the other hand, health tourism aims to instruct visitors on the specifics of how to live and rest while staying in an authentic cultural milieu situated in a rich natural environment.

According to material offered by MTST, a tourist can take part in the following programs during their sojourn in health promotion tourism: Massage, sauna, herb massage, aroma therapy. hydro therapy, hot-spring bath, Rusie Dat Ton, Buddhism meditation, and diet therapy. The Thai Government apparently assumes that almost all spas facilities offer such programs. The next section deals with what a spa actually is.

According to the Oxford English Dictionary, a place named ‘spa’ first appeared in the sixteenth century. It was located in what is the Liege prefecture in Belgium today, and flourished with natural hot springs that had a therapeutic effect. In the seventeenth century, the term spa came to be used as a word that meant ‘good health’ or ‘natural hot spring’. Thus, the English word spa had begun to be used as a term that meant ‘a watering place’ and was not limited by only being linked to the names of particular places.

For a long time, people in the Hellenistic culture, which includes Europe and the Middle East of today, as well as people in Japan, had ‘watering places’ where disease was treated by taking advantage of the therapeutic effects of mineral springs. While different regions built resorts according to the prevailing cultural style, the general approach of creating health centers based on ‘watering places’ could be encountered all over the world. For example, in England and France in the eighteenth century, gorgeous hotels, gardens, restaurants, music salons, dance halls and casinos were built around ‘watering places’. These health resorts also functioned as places for social interactions among the gentry. Such social meeting places were termed ‘water place’ in the English language of the time.

At least until the eighteenth century, spa was a term that referred to watering place. Spa was thus deeply connected with the element of water, especially natural hot springs. However, modern spas do not necessarily have a hot spring, although this statement applies more to Asian countries like Thailand––and excludes Japan—than others. Today’s emphasis tends to be focused more on relaxation, health, and beauty treatments as well as the spiritual aspects. To achieve this, today’s spas offer exercises such as Yoga, Tai chi and Thai Massage. The International Spa Association defines spas as places ‘devoted to overall well-being through a variety of professional services that encourage the renewal of mind, body and spirit’. Today’s spa offers more broadly-ranging therapeutic services than ever; this seems to have become a global standard of the spa.

The modern spa now has a large market. According to a report in The Global Spa Economy 2007 (Global Spa Summit 2008) the total size of the global spa economy in that year was $254.7 billion (Table 11.1). A revenue of this magnitude helps one realize the importance of health tourism and also highlights the strong relationship between spas and health tourism. Table 11.2 shows a comparison of spas and other global industries. The market value of spas is small compared to that of the golf industry and the sports industry, but is larger than the combined market value of the motion picture industry and the cruise industry.

We see from Table 11.3 that there are now 71,673 spas in the world and that about 90 % of them are in Europe, Asian-Pacific and North America. Table 11.4 shows spa facilities in the Asia-pacific region. A feature of the Asian-Pacific region is that spa facilities classified as ‘other spas’ are remarkably numerous. The 2008 Global Spa Summit report notes that ‘While the Asian spa industry is considered to be “new” based on its modern/Western conceptualization, the region has a remarkable number of culturally-based healing and wellness therapies that have evolved over thousands of years. Facilities and practitioners that offer these traditional services are beginning to see the value of adding spa services and amenities and aligning themselves with the spa industry. The category for “other” spas of the Asian-Pacific region reflects an attempt to capture this trend by quantifying the number of traditional practitioners that have crossed into the more modern spa market’. Other spas include ‘Japanese onsens, Indian Ayurveda centers, Thai and Chinese massage practitioners, and other culturally-rooted wellness traditions that have morphed into the spa sphere (ibid)’.