Plane Thermoelastic Waves in Infinite Half-Space Caused FACTA UNIVERSITATIS Series: Economics and Organization Vol. 12, N o 1, 2015, pp. 69 - 81 WELLNESS SPA – A SPECIFIC FORM OF HEALTH TOURISM  UDC 338.48-6:615.8 Vukašin Šušić 1 , Dobrinka Dimitrijević 2 1 Faculty of Economics, University of Niš, Serbia, 2 Primary Health Centre, Ćuprija, Serbia Abstract. Health tourism implies a temporary change of place of residence for the purpose of preventive health care, rehabilitation, the use of different types of cosmetic services, as well as most complex medical procedures. According to the level of health services within health tourism, those that stand out as specific aspects of health tourism are medical, traditional spa tourism (thermal/mineral springs tourism), spa and wellness tourism. Traditional spa tourism is becoming increasingly intertwined with other aspects of health tourism, wellness in particular. Modern spas, through the provision of treatment and other professional services, are increasingly promoting wellness, so that today spa industry is considered to be part of the wellness sector. Wellness is one of the new trends, not only in health tourism, but also in modern tourism. It is defined as a state of complete physical, mental and social well-being and includes attitudes and actions that prevent disease, improve health and the quality of life and lead to physical and mental balance. Key Words: health, health tourism, spa, wellness, treatment and recreational function. INTRODUCTION The fast pace of life in the modern society leads to dissatisfaction, conflict and stress. The high level of stress increases the risk of colds, heart attack and various types of cancer. In addition, stress is connected with obesity, high blood pressure and a number of cardiovascular diseases. „Migraine headaches, rheumatoid arthritis, chronic fatigue, receptiveness to allergies, and other maladies are also related to chronic stress. Stress may both suppress the body’s immune system and lead to hormonal imbalances that increase production of abnormal cells“ (Godbey, 2009, pp. 3-4). For these reasons, the need for rest or recreation is nowadays more pronounced and important. However, it is not enough just to relax, but it is also necessary to confront the fatigue. If one takes into account that the decrease in physical activity in the labour process leads to chronic mental fatigue, then rest has to be physically active - recreational. The need  Received March 3, 2015 / Accepted April 10, 2015 Corresponding author: Vukašin Šušić Faculty of Economics, University of Niš, Trg kralja Aleksandra 11, 18000 Niš, Serbia E-mail: vukasingeo@gmail.com 70 V. ŠUŠIĆ, D. DIMITRIJEVIĆ for recreation is necessary in people’s permanent residence, at workplace, at home, or in other locations that are away from their place of residence. From the public health perspective, recreation has all the positive features that are characteristic of sports, as well as a few advantages - wider application possibilities both in terms of the age and health condition. Recreational tourism is of great importance for the preservation of health; therefore, in recent times there have been many discussions related to health tourism as a special form of tourism. In a narrow sense, health tourism implies trips that are organized for health reasons, without excluding the effects of spending related to meeting secondary needs of the tourist industry. According to Tabacchi (Ross, 2011) medical tourism represents „any kind of travel to make yourself or a member of your family healthier.“ All persons traveling for health reasons are not necessarily patients with serious illnesses. In a broader sense, medical tourism today includes classical healing by the factor of nature for the purpose of improving health, as well as therapies that are needed for man to preserve good health and fitness (wellness, sport, recreation, healthy meals, entertainment, etc.), as well as treatments in specialized health facilities that offer quality staff and medical equipment for the most complex medical procedures. Therefore, what is implied under health tourism in a wider context is a temporary change of permanent residence for health prevention, rehabilitation, use of various spa treatments, as well as the most complex medical procedures. Based on this, three groups of service users who meet their health care needs in various ways have been formed over time:  The first group - consumers of traditional medical tourism related to natural resources such as the healing properties of thermal mineral water, mud, peloids, waves, the climate and so on.  The second group - clients of wellness, which is a set of procedures for achieving physical and mental well-being with the use of natural factors, physical activity, fitness, therapies of classical and alternative medicine, etc.  The third group - patients with serious health problems which require complex medical treatments using the services of specialized medical facilities and superior medical personnel (Spasojevic, Susic 2010). Therefore, according to the level of health services that clients use, as special aspects of health tourism, there are treatments by natural factors - spa tourism (balneotherapy, climatotherapy, thalassotherapy, etc.), wellness and medical tourism. In this context, medical tourism should be viewed as a subset of health tourism. „While health and medical tourism could be separated on the seriousness of illness and disease and the consequent level of physical and surgical intervention required, this ignores how an individual constructs their own embodiment, condition and treatment, as well as how some treatments may traverse simple categorisation“ (Cook, 2008, p. 8). Medical tourism includes medical screening, hospitalization and surgery, while in other forms of health tourism the primary goal is to use different treatments to improve health and hedonistic enjoyment in spas and centers of alternative therapies (Henderson, 2004, p. 113). Therefore, the difference between medical and health tourism is only in the ways in which people improve their health. So, even though it involves complex medical procedures, medical tourism can be considered a specific market niche of health tourism. Health tourism, in the strict sense, in addition to the basic natural factors (mineral water, peloid, clay and climate), involves the use of other factors which improve the condition of the body as a whole. Modern balneology treatments include factors such as changes in the environment, dietary regimes, active and passive mental and physical relaxation. If Wellness Spa – a Specific form of Health Tourism 71 necessary, other forms of treatment such as medication and physiotherapy are also used during balneotherapy (Stankovic 2009). So, the main goal of health (and wellness) tourism is to improve physical health on one hand, and to improve and maintain mental, psychological and emotional well-being on the other hand (Danna, Griffin, 1999, p. 361). Modern health destination visitors are more mobile, less bound to the facility where they are staying, they eagerly visit local events, attractions and museums, are interested in the culture and traditions, gastronomy, even sports; travel facilities often include experiences of Eastern medicine-acupuncture and other forms of stimulation, sauna, Kneipp cures and more, as well as a healthy diet. In particular, all the more evident trend is the shift from the traditional thermal treatments towards more complete and broader health-recreation tourism. Therefore, there is a need for sketching a new approach that will emphasize preventive health tourism as a form of medical tourism. Qualitative and quantitative changes in the tourist demand and supply at the end of the 20th and throughout the 21st century have contributed to health tourism stepping out of the initial frame (natural healing factor) and increasingly involving in a variety of other services such as massage centers, beauty care, fitness, diet therapy, psychotherapy, anti-stress therapy, relaxation and so on. Therefore, modern health tourism is a form of tourism undertaken in order to promote, stabilize and, if possible, restore former physical and mental state with the use of natural healing factors, health services, sports and recreation as well as wellness facilities, implying thereby that people using these services do not have permanent residence at that location or destination. 1. TRADITIONAL SPAS AND SPA CENTRES AS HEALTH TOURISM DESTINATIONS There are numerous steps that can be taken to prevent ill health caused by stress. One of these ways is to visit different types of spas - spa centers. Today the term spa is not only a synonym for a spa in the traditional sense, but for institutions that use different therapies to regain health, slow down the aging process and relax a person. Spas in general are nowadays associated with two basic functions: treatment and recreational function. 1.1.Traditional spas - thermal/mineral springs spa The term thermal/mineral springs - mineral springs spa should be linked to the destination located near medicinal thermal and mineral water, mud, etc. The waters of these thermal springs have different therapeutic and recreational properties and are used for the treatment of many diseases. In Europe, thermal/mineral springs are still a significant resource and the basis for the development of health - spa tourism (Global Wellness Institute, 2014). The use of thermal/mineral resources in European countries has a long tradition and medically qualified professional staff is used for the treatment of a range of physical and mental conditions. The treatment is carried out so that a combination of balneological treatments and other therapies maximally improve the patient's health condition (Erfurt-Cooper Cooper, 2009). Apart from Europe, onsen mineral waters in Japan, thermal mineral pools and aqua parks in South America, China, Taiwan etc. are also used for swimming and recreation, and to a lesser extent for treatments. Therefore, traditional spas are sanatogenous areas and ideal places for meeting one's different recreational and health needs. These destinations have numerous and varied 72 V. ŠUŠIĆ, D. DIMITRIJEVIĆ natural features with significant health and recreational functions that give rise to increasing tourist demand. As already pointed, thermal mineral springs, rare gases and mud (peloid), climatic conditions, clean air and rich vegetation belong to natural elements, which are the basis for the development of spa tourism. In the past, these elements had a much larger role in the treatment of various diseases, as well as for the recovery after injury or disease. Today, spas around the world have completely changed their concept of medical treatment, as well as their appearance. They are less of hospitals and rehabilitation centers for older clientele, and more of multipolar centers with a variety of tourist supply. Generally speaking, the following types of thermal/mineral resources can be divided as follows, according to their use:  Geothermal Springs or Hot Springs, with water that has healing properties,  Mineral Springs with cold and hot waters that are used for balneological purposes;  Saline Springs with geothermal waters which contain a high percentage of salt and are used in health and wellness treatments,  Extreme Hot Springs, with water which needs to be mixed or cooled for safe use (Erfurt-Cooper, 2010, p. 1) European Spas Association (ESPA) recognizes the following spas according to the characteristics of natural resources which have a beneficial effect on human health:  Mineral spas;  Brine spas;  Thermal spas;  Peloid spas;  Spas at the seaside and in a healthy climate;  Kneipp spas. Traditional spas in many countries today are an indispensable segment of the health care system, important cultural heritage and an important economic factor for development. According to the Law on the spas of the Republic of Serbia (RS Official Gazette 80/1992): " A spa is an area where there is a benefit of one or more of natural healing factors and that meets the requirements in terms of the development and equipment for their use. A spa is a natural resource of public interest controlled by the government. Natural healing factors in terms of this Act shall include: thermal and mineral water, air, gas, mud (peloid), whose medicinal properties are scientifically tested and proven. " Traditional spa tourism is connected to thermal/mineral springs. According to Hall, “spa tourism is a component of health tourism that relates to the provision of specific health facilities and destinations which traditionally include the provision of mineral waters" (Hall, 2011, p. 3). The importance of this aspect of medical tourism is growing with the increasing elderly population in the total population and ever more present awareness of the need to preserve health. The essence of the strategy of development of modern spas is a tendency to activate self-awareness of the responsibility for one’s own health and create offers that are user-oriented. Growing needs and a comprehensive approach towards the user have resulted in a complex offer defined as well-being. This term implies the renewal of the mind, body and soul, which is the essence of the orientation of modern spa tourism. Wellness Spa – a Specific form of Health Tourism 73 According to the conclusions of the International Congress on spa tourism held in Galicia in 1999, the concept of strictly specialized and unipolar spa centers is now obsolete. There are two important features of the modern spa - spa tourism:  health and recreation, as well as tourist facilities and services that are intended for people of different ages are based on short-term stays and suppress the traditional and other classic spa treatments;  the contemporary development of spa tourism is increasingly based on a wide range of attractions (health services, recreational activities, monumental, event, conference tourism, entertainment and arts facilities, casinos, etc.) which are used to attract a more heterogeneous structure of guests (Jovicic 2008). According to the new concept, the features of traditional spas are people-oriented regardless of their age and state of health, since the emphasis is on prevention. Staying in these centers is the most convenient for busy people who can not go on longer holidays, and wish to be in a good mood and excellent health, despite a lot of work. The basic concept of the offer of spa products is "Health with the help of water" but also beauty, pleasure and the opportunity to renew their internal energy. Spas are not only useful for the treatment of diseases or their prevention. These are ideal places for rest and relaxation, recovery of health and strength in contact with unspoilt nature, surrounded by peace and quiet, away from the stress of the modern lifestyle:  Tradicional clinics to take the cure or the waters,  Hot spring spa resort with medical as well as leisure and wellness facilities,  Modern aqua parks using mineral spring water to attract families as well as individuals, both locals and foreigners; and  Treatments for healthy and not so healthy visitors (Erfurt-Cooper, Cooper, 2009, p. 9). The significance of traditional thermal/mineral springs lies in the fact that in more than 100 countries around 27,000 spa facilities were built in addition to thermal and mineral springs for the provision of various health and recreational services. These spa facilities and institutions around the world generated revenues of approximately 50 billion dollars in 2013. However, only ¼ of these facilities (6500) provided classic spa services, but nevertheless generated about 2/3 of the total global revenue of this industry. Most of these buildings were intended for recreation, swimming and different entertainment activities. The most numerous objects of this type (onsen) are in Japan (about 17,000) and China. Traditional spa tourism is the most developed in Europe, where, in 2013, about five thousand institutions and facilities generated approximately 45% of the total global revenue of this form of tourism (Global Wellness Institute, 2014). Despite many changes, traditional spa tourism is still considered an important component of modern medicine. The biggest changes spa tourism has experienced occurred in Germany, France, Austria, etc. The changes are mainly due to the fact that employees have been given the right to be absent from work for the purpose of medical treatment, without affecting their holiday. According to the new development trend of health tourism in the Republic of Serbia, spas can be divided into three basic categories:  spas-hospitals receiving patients whose costs are covered by their health insurance (they are not market-oriented and tourist-oriented);  tourist spas, which, in addition to offering treatment and rehabilitation, offer other forms of rejuvenation and health perservation (treatments that are carried 74 V. ŠUŠIĆ, D. DIMITRIJEVIĆ out here are designed as tourist services and are offered on the tourism market, thus representing a mixed type of spas in terms of funding sources)  market-oriented spas, which are organized as wellness spa centers (destinations). Most spas in the Republic of Serbia are of mixed type. 1.1. The concept of modern spa centres In contemporary literature spas are increasingly called spa centers, due to the abbreviation of an old Latin saying Salus per aquam (health with the help of water). In this view, it follows that treatments in spa centers are based on the healing properties of water and peloids (mud). According to the European Spas Association the word spa stands for "a mineral source or a healing place where there is a mineral spring", but this is also the name of a Belgian health resort with numerous thermal springs that have attracted visitors since the 17th century. However, ISA - International Spa Association in 2004 provided their own definition: "A spa is an institution dedicated to improving man through a wide range of professional services that promote the renewal of mind, body and spirit" (www.fitnese.com.). Similarly, in the report of The Global Spa Economy 2007, spas are defined "as establishments that promote wellness through the provision of therapeutic and other professional services aimed at renewing the body, mind, and spirit" (Global Wellness Institute, 2014, p. 3 ). Thus defined spas - spa centers are the most numerous in the United States. Specifically, health (spa) services of different levels are provided in about 23,000 health, recreation, accommodation and other facilities (Global Spa & Wellness Economy Monitor, 2014, p. 7). Most of these facilities are based on providing beauty treatments, and less on traditional spa services, as is the case today in Europe. In fact, the demand for spa and wellness services is focused more on improving the exterior (obesity, beauty), and less on solving health problems and the preservation of health. This is illustrated by the fact that daily spas, resorts, hotels and medical spas in the USA (professional health care services - botox injections, laser hair removal, etc.) generate about 95% of revenue, whereas in classic spas it amounts to only 5%. In the USA, about 80% of total spa capacities belong to day spas that offer a variety of massages, food therapies, aromatherapy, hydrotherapy and alike. (Erfurt-Cooper, Cooper 2009). It follows that the "spa industry is a melting pot for a range of products and services that enhance health and well-being" (Cohen, 2008, p. 5). Therefore, practice has shown that the term "spa" can not be compared with the traditional concept of a "spa" since the mentioned spa centers are not necessarily related to thermal mineral water. For instance, within the spa center division just the medical spa and mineral spa use thermal mineral water. After all, in the Republic of Serbia, especially in larger cities, following global trends, numerous spa and wellness centers having nothing to do with the use of thermo-mineral water spa have been formed. ISPA, International Spa Association was founded in 1991 as a worldwide federation of professional organizations of the spa industry, and as already noted, it defines a spa as a place dedicated to the promotion of the quality of life through a variety of professional services to support the renewal of mind, body and spirit. Depending on the level, quality and types of therapy International Spa Association - ISPA distinguishes between several types of spas:  Club SPA - the offer is based primarily on fitness and the daily use of spa services,  Day SPA - the offer is based on the daily use of services, mostly beauty treatments of the face and body, massages, sauna, etc. Wellness Spa – a Specific form of Health Tourism 75  Destination SPA – where there is a choice in creating healthy habits. This transformation is achieved with the help of professional spa services, fitness, educational programs, healthy food and special interests,  Medical SPA - Medical spas are a combination of a clinic and day spa centre and treatments are carried out under the supervision of professional staff. In these centers, apart from spa services, there is a choice of conventional and special treatments and services.  Mineral springs SPA - spa centers that use mineral, thermal or seawater for the purpose of hydrotherapy treatments. This type of spa centres is the most typical for the European spa and wellness sector. The basis of this offer, besides the use of thermo- mineral waters, consists of various massages, sauna and other treatments.  Resort/hotel SPA - spa centers within hotels and resorts, with fitness and wellness components under the supervision of professional experts. These centers are often located within luxury hotels that have large capacities and richer clientele (e.g. business people). Also, their offer includes day spa services for the local population. These spa centers, apart from spa and wellness services, offer a wide range of other recreational and sports activities: golf, swimming, water sports, tennis, horseback riding, skiing and others. In addition to these types of spas, scientific literature also recognizes Cruise ship spas (treatments on cruise ships, which include fitness and wellness components, as well as programs of proper and healthy diet), Cosmetic Spa (providing cosmetic treatments that are not too invasive), Airport Spa - located on significant international airports and usually provide relaxing massages. From the previous division, it follows that spas can be defined as centres that promote wellness by providing therapeutic and professional services in order to renew the body, mind and spirit. As they are not related to thermo-mineral and other natural resources, the number of these spas is constantly increasing and rose from 72,000 in 2007 to 106,000 in 2013. Observed by types, Day spas with around 60,000 objects and Resort/hotel spas with around 22,000 are the most numerous. In other words, these two types accounted for over 85% of the total number of spa centers in the world. There were around 6,500 spa centers related to thermal mineral water (mineral springs spas). Observed by continents, spa centers are the most numerous in Europe and Asia where, in 2013, there was about 2/3 of the global spa centre supply. The largest number of spa centers in 2013 was located on the territory of the United States - about 23,000, China around 9,500, followed by Japan with 6,000, etc. In Europe, the leaders in the number of spa centers are Germany (5,500), France, Great Britain and others. The previous analysis shows that spa centres are becoming an increasingly important segment in the health tourism supply. According to the data for 2013, spa centers employed around two million people and generated a turnover of over $ 94 billion. 2. THE MODERN CONCEPT OF WELLNESS The imposed pace of life caused by technological progress contributed to the occurrence of wellness as the concept that allows the satisfaction of certain human needs for rest and relaxation. Wellness represents a higher level of awareness of one’s own health, whose primary role is that of maintaining the body and mind, physical and mental relaxation, fitness and preservation of inner peace. 76 V. ŠUŠIĆ, D. DIMITRIJEVIĆ Wellness occurred as a product of the new age and needs of the modern man to rest in nature after hard and stressful work, through physical activity, healthy food in a healthy natural environment and favorable social environment. The term wellness was first used in 1961 by Halbert Dunn in his book "High level wellness" combining the abbreviations of two English words: wellbeing, which means good mood, and fitness, the ability for physical activity (to be fit). So, wellness appeared in order to satisfy certain human needs for active rest and relaxation imposed by the manner and pace of life in modern society. As the most significant segment in health tourism supply, wellness started developing in the 1990s in European countries, especially in those which had already had significant health spa offer, such as Germany, Italy, Austria, Switzerland, Hungary and others. Bearing in mind that traditional spas (spa and thermal/mineral springs) are destinations for treatment, rest and relaxation, they can also represent significant centres of wellness tourism and contribute to its development. On the other hand, wellness enables spas to reshape their image and become important destinations for wellness tourism (Global Spa Summit, 2010). Therefore, the concept of wellness is often equated or used in conjunction with spa treatments (Spasojevic, Susic 2011). The concept of wellness in scientific literature is interpreted in different ways. In Europe, the beginnings of the wellness concept are linked to Greek and Roman culture, when some parts of the population (mostly men, athletes, soldiers, wealthy people, etc.) were interested in health, fitness and hygiene, as well as socializing, which resulted in the use of public baths and fitness temples. The wellness concept, as currently being discussed in scientific literature, aims to prevent disease through the promotion of health, education and encouragement. Today, it is considered to be an adequate method for the prevention and preservation of health in the aging society (Weiermair, Steinhauser, 2003, p. 5). In addition, wellness encompasses a holistic approach to nutrition and aims at mental and spiritual harmony of man (Erfurt-Cooper, Cooper, 2009). So, not only does it include exercise and movement, but wellness also fills the entire human life with a certain content that may assist in solving everyday problems (Bartoluci, et al. 2007, p. 196). Unlike Western medicine, which focuses on disease and pathology, wellness is based on well-being and the absence of disease and weakness in man. Basically, wellness can be equated with "health" which was defined as early as 1948 by the World Health Organization (WHO) as "a state of physical, mental and social well-being and not merely the absence of disease or infirmity." Therefore, there are many definitions which explain the concept of wellness in a similar way, but most of them emphasize that it is a state of optimal well-being combined with energy, vitality, strength, stamina and fitness. According to Hettler (1976) wellness is "an active process through which people become aware how to fight for successful existence. Wellness is a state of complete well- being; a lifelong journey towards holistic health" (www.hettler.com). It is a continuous process that asks man to devote time to himself and his existence. So, wellness is an ongoing process of learning and cognition that allows one to build a lifestyle that leads to a more successful and longer life. The basic concept of wellness is based on the emphasis on positive and proactive approach to life that will increase and enhance all the dimensions of human existence. Generally speaking, wellness means a healthy balance of mind and body, resulting in a general positive feeling and quality of life. Therefore, we can say that wellness represents the opposition to disease, i.e. a positive component of good health (Bartoluci, et al. 2007, p. 198). Thus, the main objective of wellness is to improve the mental, physical and spiritual balance. But, wellness is also the ability to Wellness Spa – a Specific form of Health Tourism 77 "find your desired balance between family, work and environment" (Weiermair, Steinhauser, 2003, p. 6). Despite significant differences in the definition of the wellness concept, several common features can be distinguished:  Wellness is multi-dimensional,  Wellness is holistic,  Wellness changes over time and along a continuum,  Wellness is individual, but also influenced by the environment,  Wellness is a self-responsibility (Global Spa Summit, 2010, p. 2). From these characteristics it can be concluded that the concept of wellness can be expanded and that, in addition to physical, mental and social dimensions, it can also include sexual, emotional, cultural, spiritual, educational, professional, financial, environmental, ethical and existential dimensions. The holistic concept indicates that the normal functioning of wellness implies the presence of all those dimensions. It is interesting to note that the environment wellness is not of a personal nature, but involves the respect of nature and all the beings surrounding it. It also implies the awareness of the individual about the importance of the environment for the health and survival of the human species. Each individual must be aware that clean water, clean air and other components of the environment are the necessary prerequisite for the health of mind and body. In developed countries of the world today wellness has become a lifestyle that includes various aspects of human well-being and happiness. In other words, wellness is a higher level of awareness of human needs, where the health of the individual is the wealth which one has yet to learn to deal with (Bartoluci, et al. 2007, p. 199). Therefore, the explanation of wellness comes down to Maslow’s concept of "the hierarchy of needs." People whose primary needs ("deficient needs") are of psychological, financial and social character, such as food, drink, housing, social contacts, etc are turning to other values and motives of the so-called "needs to increase" social recognition and self- realization (Hrabovski-Tomic, 2006, p. 20). Today, it is primarily the case of individual values and motives, which both men and women consider to be extremely important. Wellness is an interactive process, which involves the acceptance and implementation of healthy and proper choices in life, with the aim of creating a successful and balanced lifestyle. The basis of the philosophy of wellness consists of: process, acceptance, choice and success. The process means that in every moment of a man’s life there is an opportunity to improve the way of life and lifestyle. The acceptance implies that every man, naturally and continuously, seeks new information and more knowledge about the ways to improve one’s life. The choice means that there are several options before a man and one should choose the one that seems most advantageous. The success depends on the achievements in life. Closely related to wellness is wellness tourism. In accordance with the general definition of tourism, wellness tourism is a collection of all relationships and phenomena resulting from the travel and stay of people in destinations that allow the preservation or improvement of their health. It includes their stay in specialized institutions that offer professional knowledge and individual care, as well as a service package which includes fitness, care, healthy food, relaxation/meditation and mental activities/education" (Mueller & Kaufmann 2001, p. 3). Wellness tourism can be treated as a special form or niche market of health tourism. "Wellness tourism is a collection of all relationships and phenomena arising from the 78 V. ŠUŠIĆ, D. DIMITRIJEVIĆ travel and stay of people whose main motive is to preserve and improve their health. They require a thorough package of services that includes professional knowledge, fitness, beauty care, healthy nutrition or a diet, relaxation or meditation, physical and mental activity and education" (Mueller, Kaufmann, 2001, p. 3). A few available studies suggest that those who practice this type of holiday seek not only a physical change of location but also the way to greater self-awareness and satisfaction. Unlike traditional spa tourism, wellness tourism is related to clients in good health, who try to maintain their existing health status through a variety of treatments. According to some opinions, wellness is a more comprehensive and broader concept than the concept of spa. The concept of wellness, as already noted above, can be expanded so as to include sexual, emotional, cultural, spiritual, educational, professional, financial, environmental, ethical and existential dimensions in addition to physical, mental and social dimensions (Cohen, 2008). While the spa can be based on only one of the elements of wellness (emotional, intellectual, physical, social, etc), the holistic concept of wellness can not function if one of these elements (dimensions) is missing. According to Hettler, elements or dimensions of wellness and health function as a whole, like a wheel on a bicycle or a car. As with the bicycle, if all the wires or dimensions function at an optimal level, the wheel will roll easily, i.e. the man will live happily and harmoniously. On the other hand, if a wire or dimension is weak, there will be a balance disorder (www.hettler.com). The increased demand for wellness is especially pronounced at the beginning of the 21st century. The promotion of wellness centres, holistic resorts, spa centers, spiritual pilgrimage and alternative medical treatments is becoming more aggressive. According to many authors, the reason for that expansion in most cases is the result of the process of globalization, a social and economic crisis in developed countries, the breakdown of traditional religion and community fragmentation. In addition, the development of science and medicine has led to the better preserved body, physical health and fitness, whereas in the field of mental, emotional and psychological health satisfactory results have not been achieved. On the basis of numerous programmes and wellness content, a new form of tourist supply addressed to more affluent customers is being created in tourism. Actually, wellness includes "travel with the intention of achieving balance and harmony of mental, emotional, physical and spiritual value of man" (Health and Wellness Tourism, 2004, p. 9). "The broadest scope for the development of wellness is provided by health tourism supply, as it already possesses certain objects, facilities and professional staff for providing wellness services" (Bartoluci et al. 2007, p. 199). However, in addition to spas and other natural healing resorts, wellness facilities can be developed by other tourist centers and facilities that are in the function of health, entertainment, relaxation and other similar activities. The largest number of wellness and spa programmes is based on the natural potential, considering the fact that the environment itself reduces stress and helps relax man. Besides natural and attractive scenery (mountains, spas, rivers, seas, etc.), other facilities used for the development of wellness tourism are indoor and outdoor facilities for sports and recreational purposes, facilities for prophylactic services (massage, sauna, etc), facilities for medical care (diagnosis, therapy, etc) and so on. (Spasojevic, Susic, 2011). The organizational form of wellness in which classical medical methods are complemented by the principles of alternative medicine, wellness philosophy, eastern methods of treatment, as well as the use of natural medical resources, is called medical wellness in scientific literature. The basic requirement for providing medical wellness services is medical supervision. Wellness Spa – a Specific form of Health Tourism 79 Despite being a new product, wellness within health tourism generates by far the largest turnover. According to the data of the Global Wellness Institute, 2014, the number of clients who used the services of wellness centers in 2013 was estimated at around 585 million. The total consumption in wellness amounted to 494 billion dollars. In national wellness tourism, there were around 490 million users of wellness services, or about 85% of the total wellness traffic around the world. The share of domestic in global wellness tourism was around 70%, which indicates that the consumption of foreign tourists is considerably higher. The highest participation in wellness traffic is of the so-called secondary tourists, the clients for whom wellness is not the main motivation for travel. It is estimated that the share of secondary wellness clients accounted for 87%, 84% in consumption (Global Wellness Institute, 2013). Of the total number of users in the world, Europe accounted for over 35%, North America 30%, Asia and the Pacific about 25%. The number of employees in wellness tourism is estimated to be about 14.5 million. The total economic effects of wellness tourism (multiple effects) are estimated at $ 1.5 billion. CONCLUSION Today, different scientists claim that the accumulated stress is the number one disease of our time. A significant number of people, particularly the employed, suffer from physical, mental and emotional overload, which threatens to destroy their bodies. Numerous studies have shown that people with chronic accumulated stress live shorter and suffer from anxiety and depression. Therefore, it is now considered that escape is one of the main motives of tourist movement (Goeldner, Ritchie, 2006). „Escape from an everyday personal or physical environment to one perceived to be likely to give to the traveller all the elements of life he or she feels are missing from those everyday experiences“ (Erfurt-Cooper, Cooper, 2009, p. 6). The fulfillment of the desire for a healthy lifestyle is an essentially important motive for many tourist trips. The increasing need for rest and relaxation, and not only for treatment, have contributed to the transformation of classic spa tourism into the broader concept of health tourism, which, in addition to natural factors, includes other therapeutic methods in the treatment and prevention. There are many things that can be taken to prevent ill health caused by stress - one of them is a visit to spa centers, spas, resorts and wellness centers. The tendency to enjoy a relaxing environment turned into a global movement with a significant difference compared to the traditional concept of health spas as a destination mainly for specialized rehabilitation. The new emphasis lies in preventing disease and maintaining good health rather than treatments with high expectations concerning the improvement of health, even if there are no health problems. Therefore, there is a growing awareness of the usefulness of combining the classic spa with modern therapies such as wellness. By using modern treatments as well as traditional rehabilitation therapy, with a holistic approach to creating harmony in man, not only the needs of the body are met, but also those of the mind and soul, i.e. psychological needs. Traditional spas (thermal/mineral springs spa) are becoming destinations that promote wellness by providing therapeutic and other professional services in order to renew the body, mind and spirit. For these reasons, traditional spas within wellness centers, apart from health treatments, include cosmetic treatments, sports, fitness, relaxation, aromatherapy, reflexology, etc in their offer. Many traditional spas are already firmly grounded within the 80 V. ŠUŠIĆ, D. DIMITRIJEVIĆ growing wellness industry. The tradition of spas as places for healing, rejuvenation, relaxation and well-being, makes spa centers based on the use of the water from mineral springs increasingly important wellness destinations. On the other hand, traditional spas are trying to distinguish themselves from spa wellness centers and retain the characteristics of exclusivity in various ways, such as medical staff, traditional therapy treatment, certification of buildings, etc. Modern spa and wellness centers do not promote a healthy lifestyle and health preservation for the tourist clientele only, but also for the local population. Spa and wellness centers today offer everything a modern man needs: treatments for the face, body and soul, or therapies that aim to relax and enjoy. The programmes in these centers, in addition to classical balneotherapy, include: aromatherapy massage, traditional Chinese, Indian, Thai and other massages, hot and cold volcanic stones, acupuncture, various electro therapies, physiotherapy, diets, cosmetic surgery, as well as more complex medical procedures. Wellness, as already pointed out, is the concept of preserving and improving health that encompasses all the areas of healthy movement, physical exercise, a balanced diet, relaxation and overcoming stress in order to achieve the feeling of satisfaction. It is a journey with the basic motive to achieve balance and harmony of mental, emotional, physical and spiritual values of man. Unlike Western medicine, which focuses on disease and pathology, wellness is based on well-being and the absence of disease and weakness in man. In fact, modern spa wellness offers not only their own treatments, but also combines spas and spa therapy, thus offering a specific product that will improve both physical and mental state of man. „Spas and wellness resorts may therefore be conceptualised in cultural/sociological terms as modern day temples where people can experience rituals, learn to deepen their personal wellness practices, raise their consciousness, become open to enhanced ways of being and deepen their experience of being alive“ (Cohen, 2008, p. 8). Wellness nowadays focuses on people who are genuinely interested in health, healthy lifestyle, and its improvement and preservation. But wellness is also the possibility to combine recreation, fun and adventure with the medical protection for the purpose of restoring their life energy. Thus, wellness aims to improve the physical, mental and general health status of the individual, so it can be identified with health tourism. The increase in the number of old population and the high cost of health services in developed countries, as well as the growing need to use travel to improve one’s psychological condition, restore and preserve the life energy, but also radically improve their health are all the factors that have influenced the development of spa, health and wellness tourism in the new, mostly unknown tourism markets (Southeast Asia, South Asia, South America, etc). That is why today the tourist market of medical tourism promotes package holidays where, in addition to medical treatment, various forms of recreation, relaxation and entertainment, more complex medical examinations and procedures are on offer. REFERENCES 1. Global Spa & Wellness Economy Monitor ,(2014), Global Wellness Institute. 2. Global Spa Summit, Spas and the Global Wellness Market: Synergies and Opportunities, prepared by SRI International, May 2010. www.globalspasummit.org. (5. 01. 2015) 3. Danna,K., Griffin, R., W. (1999), Health and Well-Being in the Workplace: A Review and Synthesis of the Literature, Journal of Management, Vol. 25, No. 3, 357–384 4. Hall, C. M. (2011), Health and Medical Tourism: Kill or Cure for Global Public Health?, Tourism review, 66, Tourism studies and Global Health.de tuorism. 1-6. http://www.globalspasummit.org/ Wellness Spa – a Specific form of Health Tourism 81 5. Spasojević, M & Šušić, V. (2010), Modern medical tourism as a market niche of health tourism, Facta Universitates, Economics and organization, vol.7, N° 2, Niš, University of Niš. 201-208. 6. Spasojević, M. & Šušić, V. (2011), Savremene tendencije u razvoju zdravstvenog turizma u svetu i Srbiji, Teme, G. XXXV, br. 1, Niš, Univerzitet u Nišu, 149-162. 7. Erfurt-Cooper, P. (2010), The Importance of Natural Geothermal Resources in Tourism, Proceedings World Geothermal Congress 2010,Bali, Indonesia, 1-10. 8. Cohen, M. (2008), “SPAs, wellness and human evolution”, in Cohen, M. & Bodeker, G.(Eds.). Understanding the global SPA industry, London, Butterworth-Heinemann, 3-25. 9. Corbin, C.B. Pangrazi, R. P., Toward a Uniform Definition of Wellness: A Commentary, President’s Council on Physical Fitness and Sports, ResearchDigest, serie 3, No 15. 10. Mueller, H., Kaufmann, E. (2001), Wellness Tourism: Market analysis of a special health tourisam segment and implications for the hotel industry, Journal of Vacation Markenting, Volume 7 No 1. 1-13. 11. Ross, K. (2001), Health Tourism: An Overview (HSMAI Marketing Review) http://www.hospitalitynet. org/news/4010521.html. (20. 01. 2015). 12. Stanković, S. (2009), Banje Srbije, Zavod za udžbenike, Beograd. 13. Bartoluci, M., Ĉavlek, N. (2007), Turizam i sport – razvojni aspekti, Zagreb: Školska knjiga. 14. Joviĉić, D. (2008), Uvod u turizmologiju i turistiĉku geografiju, Beograd,Ton Plus. 15. Erfurt-Cooper, P & Cooper, M. (2009), Health and wellness SPA tourism, SPA and Hot Springs, Chennel view publications, Bristol, Buffalo, Toronto. 16. Hrabovski-Tomić, E 2006, Destinacije zdravstvenog turizma (Sa osvrtom na banje Vojvodine), Novi Sad, Prometej. 17. Hettler, B. (1976), Origins of the 6 Dimensional Model of Wellness created in 1976 by Bill Hettler,,www. hettler.com (21.01. 2015) 18. Goeldner, C. R., Ritchie, R B (2006), Tourism, John Wile & Sons, Inc. 19. International SPA Association – ISPA, Types of Spas, www.experienceispa.com/spa.. ./spa.../types-of- sp... (20. 01. 2015) 20. Henderson, J., C. (2004), Healthcare Tourism in Southeast Asia, Tourism Review International, 7 (3-4), 111-121. 21. Cook, P., S. (2008) What is health and medical tourism? In: The annual conference of the Australian Sociological Association, The University of Melbourne, Victoria, QUT Digital Repository: http://eprints. qut.edu.au/. 22. Health and Wellness Tourism Global, (2004), Travel & Tourism Analyst, London. 23. Godbey, G., (2009), Outdoor Recreation, Health, and Wellness:Understanding and Enhancing the Relationship, Washington, Re sourc es for the Future Ba ckground Study. 24. Weiermair, K, Steinhauser, K. (2003), New Tourism Clusters in the Field Of Sports And Health; The Case of Alpine Wellness, 12th International Tourism and Leisure SymposiumBarcelona, 1-16. WELNES SPA – SPECIFIČAN OBLIK ZDRAVSTVENOG TURIZMA Zdravstveni turizam podrazumeva privremenu promenu mesta stalnog boravka radi zdravstvene preventive, rehabilitacije, korišćenja različitih vrsta kozmetičkih usluga, kao i najsloženijih medicinskih zahavata. Prema nivou zdravstvenih usluga, u okviru zdravstvenog turizma, kao posebni vidovi izdvajaju se medicinski, trdicionalni banjski turizam (thermal/mineral springs turizam), spa i wellness turizam. Tradicionalni banjski turizam sve više se prepliće sa drugim vidovima zdravstvenog turizma, posebno sa wellnessom. Savremene banje, kroz pružanje terapijskih i drugih stručnih usluga, sve više promovišu wellness, tako da se danas spa industrija smatra sektorom wellnessa. Wellness je jedan od novih trendova, ne samo u zdravstvenom turizmu, već i u savremenom turizmu. Definiše se kao stanje potpunog fizičkog, mentalnog i socijalnog blagostanja i uključuje stavove i aktivnosti koje sprečavaju bolest, poboljšavaju zdravlje i kvalitet življenja i dovode do fizičke i psihičke ravnoteže čoveka. Kljuĉne reĉi: zdravlje, zdravstveni turizam, spa, wellness, lečilišna i rekreativna funkcija. http://www.hospitalitynet.org/news/4010521.html http://www.hospitalitynet.org/news/4010521.html http://www.experienceispa.com/spa