By Vivek Pattanayak in Bhubaneswar, May 4, 2022: Public health is a multidisciplinary subject. So is tourism. In the area of public health central theme is about community health which includes prevention of ailment, sickness, disease among the people, prophylactic action against epidemic, pandemic , and global scourge of deadly virus,promotion of hygiene and sanitation, looking after maternal, child, adolescent health and in recent times health of the aging population.

In tourism there have been areas of interest starting from visiting religious places, it has covered cultural tourism to include visiting ancient temples, archaeological excavations, witnessing various kinds of dances,listening to music,and watching plays and other forms of pantomime.The area has expanded to cover beach tourism, environmental and forest tourism, and adventure tourism. Although medical tourism is often considered as new category of tourism it has been there even since ancient times.The connectivity between public health and medical tourism has created a new branch of study in science of public health and also in the study of tourism management.

At this stage one should make a distinction between travel and tourism. All travels whether by bullock cart,on horse’s back, on camel’s back or on foot or by automobiles, rail, ship, or aircraft is not tourism although tourism itself has travel as its major component.The first body to define tourism was the League of Nations, the predecessor of the United Nations. Tourism includes stay, leisure, and additional activities.

From the ancient times there has been medical tourism in Greece, Egypt and also in India when people travelled long distance for healing,baths in hots springs and yogic exercises. Health tourism in Europe sprang up with introduction of railways when people from one part of the continent could travel to have hot water treatment at spas.

After Second World War tourism made phenomenal progress with advent of air transport more particularly with jet aircraft and large bodied aircraft like Boeing 747 and now the mega sized aircraft like A380. Trans-oceanic flights with substantial number of passengers thus became popular.

Many wealthy people from the Middle East visited Mumbai for medical treatment in absence of facilities in their respective countries.India was in close proximity, and they could be treated at reasonable cost and in familiar surrounding. Cultural link between India and Gulf countries was very strong due to business and trade between Saurashtra (Gujarat),Travancore and Cochin (Kerala), and Bombay (Mumbai) on one side and Aden and UAE at other , with Rupee as a legal tender during the British days.

Hospitals and hotels got accustomed to meet the needs of this group of clients. They also flourished with flow of petrodollars. Medical tourism began in a big way in the last forty years when the patients from the developed countries like Canada and US started going to countries like India, Thailand, Costa Rica, Jordan and Singapore for treatment firstly because the cost of treatment was very high in their own countries and waiting time for surgeries was too long. Shortage of doctors is a big challenge even now.

This branch of tourism also created huge employment opportunity through downstream activities like tele-medicines, laboratory and diagnostic services, medical devices, and services (airport pick up,travel arrangements coordinating all appointments, interpreters, and cuisine.

Expansion of medical tourism has taken place to other parts of India.Wherever good hospitals and hotels exist, there is scope of medical tourism. Even Odisha has scope.What is needed is entrepreneurship supported by handholding by government and its agencies during start up phase.

The rise of middle class, increase in aging population and advancement in medical science and supported by expansion of both international and domestic air transport will play a significant role in growth of tourism in the world in next decade and half.Middle class will constitute one third of the global population. This category of people with better income than their parents and grandparents had in the past would like to explore the world and they are looking for better life which includes rest and recreation, in addition to leisure and pleasure.

People even above the age of seventy-five travel due to better physical health condition.Retirement of “baby boomers,”those born after the World War II in North America and Europe with substantial savings will push tourism expansion.Medical tourism will increase as the middle class will have a large number of middle-aged people who will have many health problems.Lifestyle of the newer generation creates its own problems.

Aging population will also have their typical age-related health problems.For this category, travel to places which have good medical facilities and comfortable places to stay with good beaches, historical monuments and unexplored culture will be their destinations. Centre of gravity of economy is shifting to Asia.No wonder air transport development of this region is spectacular.Middle class here is growing so also aging population.

Aging population in USA, Canada, and Europe with prohibitive cost of living and even higher cost of medical care would like to visit less developed economies and emerging markets for recreation and treatment.

From this one can easily visualize how the growth of medical tourism will take place in the Asian region. India can leverage this trend to its advantage.The government and private sector should create condition for development of infrastructure like hotels, hospitals, roads, airports and clean pollution free environment, regulatory mechanism, and financing institutions.

In spite of these favourable trends of growth of tourism, there are formidable challenges ahead like development of ultra-nationalism like “America for Americans” with immigration restriction, xenophobia in Europe with rightist governments coming to power all across Europe and rise of fundamentalism in the Islamic world like ISIS and their infiltration to developed countries

In India there is disturbing trend of rise of violence against women, intolerance to differences in culture, religion, and language group. Financing institutions in India are going through historic stagnation due to non-performing assets.In addition,big business houses are risk averse. A comprehensive approach is essential to confront these challenges and take advantage of the opportunity created by rise of middle class and aging population.