Consider Prescribing Tourism

Estimates tell us that there are more than 1 billion tourists currently roaming around the planet.1 By the year 2050, one in two people on the planet is expected to be a tourist.2 Millions of travel movements every day affect millions of individuals, numerous societies, and environments in multiple ways. In the popular media and within the broader academic community, tourism is often, and arguably unjustly, marginalized and regarded as frivolous leisure, or simply, a big business.3 Yet, tourism could be seen equally as a human activity focused on the pursuit of greater well‐being away from usual domiciles.4 Until recently, potential health and well‐being benefits of leisure tourism have not received sustained, cross‐disciplinary empirical attention.5,6 I am approaching this editorial as a social scientist specializing in well‐being and tourism research. The purpose here is to put forward a case to the medical community that it is time to more seriously consider the role of diverse tourism activities in enhancing human health and well‐being. I will not be discussing health complications related to travel experiences, as they have been well documented in this journal;7 instead I will try to outline some potential benefits of vacations. While each vacation does not always work out as planned, on average, vacation experiences have positive effects on human well‐being.8,9,10 There is increasingly a pool of empirical evidence that vacation activities of well‐defined cohorts of tourists traveling in particular ways to specific places generate greater, in some cases, longer‐term well‐being after returning home11 and often more immediate declines in job‐induced stresses,12,13 and burnout.13,14 People arguably derive greater well‐being away from their usual domiciles (and everyday contexts and stresses) than in their usual environments. Sharpley3 comments that tourism has become an essential element of contemporary consumption practices, implicitly meeting a need or fulfilling a specific function within modern social existence. It had been argued that both freedom from ordinary labor and periodic changes of domiciles and settings are necessary for humans to achieve positive changes and greater well‐being.4 Each travel experience is clearly different; however, models, roadmaps, frameworks, taxonomies, and other similar valuable integrative devices serve as ways to study the complexities of tourism and well‐being. In a recent book, my colleague and I have argued for a more coherent view of appraising tourist well‐being.15 Core themes representing results of empirical studies reported in the book resembled Seligman's theoretical model of human well‐being, otherwise known as PERMA.16 These research studies collectively demonstrated that the personal, well‐being, benefits of diverse tourism activities neatly fall under each element of PERMA: P for positive emotions (enhanced pleasures); E for engagement (a sense of mindfulness and greater competence); R for relationships; M for meaning (personal transformation through vacations); and A for achievement (better health). It is beyond the scope of this editorial to examine each element of tourist well‐being; we can, however, single out the last pillar of well‐being, achievement, as it relates to our focus on health. The literature on the topic of health and tourism is diverse, but here I will highlight what I see as the three core health outcomes based on the literature: stress reduction, better sleep, and cardiovascular health. In a study conducted by Chang reported in this issue of the journal, relationships among nature‐based tourism, stress, and the function of the autonomic nervous system (ANS) were examined. It was found that the frequency of participation in domestic nature‐based tourism directly contributed to ANS function and that it indirectly contributed to ANS function through stress reduction. This finding can be supported with the literature on the role of tourism in stress reduction and burnout management.12,13 Complementing the stress reduction studies is research on sleep quality. De Bloom and colleagues' recent research showed that vacations enabled their Dutch cohort of tourists to sleep longer than during their working times at home. It was sleep quality rather than sleep quantity that was linked to improvements in health and well‐being across all types of tourism activities they examined.17 Another study revealed sleep quality as a benefit of tourist experiences in spa and wellness resorts.18 These fresh findings from the tourism literature complement similar results reported some time ago in this journal that vacation experiences are characterized by good sleep, especially among tourists reporting higher levels of pre‐holiday work stress.19 Further evidence points to more long‐term health gains, related to cardiovascular health. Gump and Mathews20 interviewed 12,338 men between the ages of 35 and 57 and asked them every year for 5 years whether or not they took a vacation. Compared with men who never took vacations, men going on annual vacations were 21% less likely to die over the next 9 years and 32% less likely to die of coronary heart disease.21 Some time ago, in another study, a cohort of 749 women, aged 45 to 64 who were followed up over a period of 20 years, showed similar results.22 The incidence of heart attacks and coronary death was measured among the women. The women who took fewer vacations had significantly more heart attacks.22 While we cannot infer causality in many of these studies, these relationships are nonetheless worth noting, as we examine possible cardiovascular health gains. Clearly there may be arguments in favor of prescribing tourism. At an individual level, tentative links can be drawn to theoretical pillars of human well‐being: positive emotions, engagement, relationships, meaning, and achievement.16 Correlational studies point to positive associations between diverse tourism activities and short‐term health gains (like improved sleep quality and stress reduction), as well as long‐term, cardiovascular health achievements. Chang's claim in this issue, that there is value in considering tourism as a key element in health programs, supports the argument in favor of prescribing tourism. The challenge of the future is to more fully map out benefits of vacations and widen our understandings to multiple domains of inquiry: subjective, biological, and functional.22,23 The wider focus would require the much‐needed further cross‐disciplinary collaboration between social and medical fields of research. Chen and Petrick5 explain that many studies pertaining to this topic are situated in organizational behavior journals, hence limiting opportunities for integration of knowledge with findings from other key fields, like travel medicine. It remains unclear if a more comprehensive map of vacation experiences and human health and well‐being is indeed possible, considering the subjectivities of tourism. While there is no strong evidence that expensive and long‐haul vacations will lead to higher well‐being, research supports Borins's assertion that vacations away from usual domiciles are, indeed, by and large, good for us.21 There is arguably no better reason than our own mortality20,21 to remind us that the time to prescribe a vacation to us and/or to patients is right now—not when we retire. This picture features the sunrise around Te Kuiti in the North Island of New Zealand, a country famous for amazing landscapes and beautiful scenery. New Zealand is a popular destination for many tourists, and is also where the author of the editorial about the benefit of prescribing tourism (see pages 150–152) is from. Photo Credit: Eric Caumes. The author states he has no conflicts of interest to declare.