In the context of medical tourism, circumvention tourism consists of traveling abroad with the intention of participating in a health-related activity that is prohibited in one’s own country but not in the destination country. This practice raises a host of legal and ethical questions that focus on how the traveler should be treated once they have returned home. Joshua Shaw1 deftly shows that the question of whether circumvention tourists should be punished in their home countries is (...) not something that can be answered in principle and without reference to the prima facie morality of the prohibition. This implicates formalist accounts of circumvention tourism developed by Pennings2 and Huxtable3 that argue against punishing travelers who access fertility treatments and medical assistance in dying abroad on the grounds that civic peace and stability require opportunities for individuals to travel internationally to access domestically prohibited medical services. (shrink)

Circumvention tourism is a form of medical tourism that occurs when individuals travel abroad to receive treatments that are a prohibited in their home county but permitted in a destination country. This paper explores this question: Should individuals be punished by their home countries for engaging in circumvention tourism? Guido Pennings, Richard Huxtable, and I. Glenn Cohen have all argued for what I call “formalist accounts” of circumvention tourism. That is, they try to (...) show that certain types of circumvention tourism should or should not be punished in principle. Against them, I show that questions about circumvention tourism’s punishability cannot be answered in the abstract. Whether individuals should be punished depends too much on the prima facie morality of the treatments being performed and the prohibitions being circumvented. (shrink)

It is a huge pleasure to engage with Prof. Shaw’s careful and close reading of my article. Though almost a decade old, many of the issues are becoming only more relevant as it seems that Roe v Wade will be overruled in the U.S. and travel for abortion will become a sad reality.1 I appreciate how deeply Prof. Shaw interacts with my article and am full of praise for his work, but given the small space allocated here I only focus (...) on our few places of disagreement. (shrink)

Four decades after the Baby M case that led to the prohibition of commercial surrogacy in New York, much has changed in the infertility industry. Advanced technologies including the advent of gestational carrier pregnancies had made it easier and more efficient to create IVF embryos at a distance and over time, accelerating a boom in cross-border, reproductive services and allowing compensated surrogacy to flourish in a growing number of surrogacy-friendly states and beyond. For international couples, the USA has become a (...) hot spot for “circumvention tourism” given its first-rate medical care, ample supply of willing gestational carriers, burgeoning interest in family building among gay couples, and immediate USA citizenship for the child. This commentary reviews selected sociocultural and global forces that helped set the stage for the passage of the Child-Parent Security Act in New York state in 2021, and the efforts by its opponents for stronger protections not only for gestational carriers, but for gamete donors and the donor-conceived offspring. I argue that despite more responsive medical and legal guidelines, the high market demand and economic profits, combined with the lack of regulatory teeth, faulty assumptions about health risks and decision-making autonomy, and inadequate research on long-term health outcomes, continue to make compensated gestational surrogacy in the state of New York a high-risk venture without adequate informed consent. Possible unintended consequences and future research questions are proposed. (shrink)

Reproductive tourism is a manifestation of a larger, more inclusive trend toward globalization of capitalist cultural and material economies. This paper discusses the development of cross-border assisted reproduction within the globalized economy, transnational and local structural processes that influence the trade, social relations intersecting it, and implications for the healthcare systems affected. I focus on prevailing gender structures embedded in the cross-border trade and their intersection with other social and economic structures that reflect and impact globalization. I apply a (...) social connection model of responsibility for unjust outcomes and consider strategies to counter structural injustices embedded in this industry. The concluding section discusses policy reforms and proposals for collaborative action to preclude further injustices and extend full human rights to all. (shrink)

Red tourism, as a form of special interest tourism (SIT), becomes widespread among Chinese tourists. This study aims to explore memorable tourism experiences (MTEs) in red tourism destinations and examines how country competence affects intention to visit similar destinations through the influences on MTEs, destination image, red tourism place attachment, and overall satisfaction. The partial least squares structural equation modeling (PLS-SEM) analysis is utilized to analyze the data from 556 tourists. Empirical results reveal that country (...) competence positively influences MTEs and destination image. Furthermore, both MTEs and destination image influence overall satisfaction and red tourism place attachment, but do not influence intention to visit other similar destinations; the relationships between overall satisfaction, intention to visit other similar destinations, and place attachment are all confirmed as well. This study represents one of the few studies that classify red tourism as a form of historical-based SIT, with the purpose of promoting country competence. The outcomes provide a better understanding of both scholars and practitioners of historical-based SIT planning and businesses on how to promote destination image and country competence. (shrink)

In this classic analysis of travel and sightseeing, author Dean MacCannell brings social scientific understandings to bear on tourism in the postindustrial age, during which the middle class has acquired leisure time for international travel. In _The Tourist_—now with a new introduction framing it as part of a broader contemporary social and cultural analysis—the author examines notions of authenticity, high and low culture, and the construction of social reality around tourism.

With the rise of globalization, the debate around free trade versus fair trade and liberalism versus protectionism has become increasingly complicated. At times, the regulations of the World Trade Organization seem to pit developed markets against emerging markets as governments attempt to expand international trade while at the same time protecting local industry. To this end, antidumping measures have been extensively developed as a way to block foreign low-cost goods from entering domestic markets. In response, some exporters have begun to (...) circumvent these antidumping measures using strategies such as transhipment, assembly operations, and slightly modified products. While previous studies have addressed the ethical aspects of antidumping measures, this study will focus on the ethics of circumvention strategies with a special focus on the theories on legal compliance and, specifically, civil disobedience and conscientious evasion. (shrink)

In an economy that increasingly trades in electronic information products, the copy assumes a new reversibility, as a figure at once valued for its rapid exchangeability and vilified for of its associations with counterfeit and fraud. The incorporation of confidence measures into the design of electronic information products is symptomatic of a primary crisis of belief installed within empiricist epistemologies, of which anti-circumvention technologies and knock-off economies are merely the incorrigible children. The aesthetic strategies practiced by Albert Oehlen and (...) N.E. Thing Co., which mirror the information hiding techniques employed by steganography software and technologies of trust as well as the circumvention tactics employed to defeat them, register an emergent preoccupation in contemporary visual culture with structures of belief. They also disclose a Humean attention to processes of devivification, which figures in these artists’ work as an effect of the multiplication of the same. The trope of the ‘false bottom’ deployed in the 1930s novels of British artist and author Wyndham Lewis serves as intertext in this genealogical investigation of the politics of circumvention. (shrink)

“Medical Tourism” is the travel of residents of one country to another country for treatment. In this article I focus on travel abroad to purchase organs for transplant, what I will call “Transplant Tourism.” With the exception of Iran, organ sale is illegal across the globe, but many destination countries have thriving black markets, either due to their willful failure to police the practice or more good faith lack of resources to detect it. I focus on the sale (...) of kidneys, the most common subject of transplant tourism, though much of what I say could be applied to other organs as well. Part I briefly reviews some data on sellers, recipients, and brokers. Part II discusses the bioethical issues posed by the trade, and Part III focuses on potential regulation to deal with these issues. (shrink)

This study examines the connections among cultural tourism, spirituality, and associated factors among religious tourists in Saudi Arabia. It focuses on how cultural tourism impacts spiritual fulfilment, considering visitors' intentions to visit religious sites, while also factoring in cultural competence and trust in tourism brands as moderators. This study involved 244 participants, who were administered self-report surveys during their visits to religious sites and cultural attractions in Saudi Arabia. Data analysis employed Stata-SEM software, utilizing structural equation modelling (...) (SEM) to assess the hypothesized relationships among the variables. The results indicate noteworthy positive associations between cultural tourism and the spiritual experiences of tourists, with mediating effects observed through their intentions to visit religious sites. Additionally, the study identified that cultural competence and trust in tourism brands exerted a moderating influence on the relationship between cultural tourism and spiritual experiences. This research contributes to the advancement of knowledge and practical applications in the realms of spirituality and cultural tourism. It substantiates the proposition that cultural tourism has the potential to influence the spiritual dimensions of visitors. The results underscore the significance of incorporating cultural and spiritual components in tourism marketing and destination management strategies. Moreover, they provide insights for destination stakeholders seeking to enhance cultural tourism initiatives, not only in Saudi Arabia but also in other contexts. (shrink)

Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the louder the call for international measures to stop these movements. Three possible solutions are discussed: internal moral pluralism, coerced conformity, and international harmonisation. The position is defended that allowing reproductive tourism is a form of (...) tolerance that prevents the frontal clash between the majority who imposes its view and the minority who claim to have a moral right to some medical service. Reproductive tourism is moral pluralism realised by moving across legal borders. As such, this pragmatic solution presupposes legal diversity. (shrink)

A destination’s image is a critical factor in tourists’ perceptions and evaluations of said destination. This paper analyzes the formation of the tourist destination image of Segóbriga Archeological Park, a cultural destination located in the province of Cuenca (Spain) that holds great heritage value. To this end, the paper adopted a multidimensional approach and used PLS-SEM to analyze the destination image, taking into account not only its cognitive and affective components, but also the unique image component. The latter has received (...) less attention in the literature and is a novel factor among cultural destinations. The results show that this component is essential to the overall image of an archeological destination, but is not influenced by information sources. (shrink)

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration (...) given to more recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices. (shrink)

Despite the variety of banalities that are often associated with trips and vacations as mass consumption, the study of tourism – due to the commitment of social, economic, political and cultural energy - remains one of the predominant inputs for understanding contemporary society and the new social hierarchies that distinguish it. Tourism, which is increasingly seen as a process that has become integral to social and cultural life, also plays an essential role in the social and spatial dialectic (...) that gives meaning to the places. Focusing tourism through the lens of "productive consumption" developed by Cultural Studies, the paper moves from the assumption that responsible tourism can be analyzed in the broader paradigm of relational goods to explore the role of responsible tourism as a possible way of sustainable and responsible development.A pesar de la variedad de banalidades que a menudo se asocian con los viajes y las vacaciones, como el consumo de masas, el estudio del turismo –debido al compromiso de la energía social, económica, política y cultural– sigue siendo una de las fuentes predominantes para la comprensión de la sociedad contemporánea y las nuevas jerarquías sociales que la distinguen. El turismo, que se está viendo cada vez más como un proceso que forma parte integral de la vida social y cultural, también juega un papel esencial en la dialéctica social y espacial que da sentido a los lugares. Analizando el turismo desde el punto de vista del consumo productivo desarrollado por los estudios culturales, el artículo parte de la asunción de que el turismo responsable puede ser analizado en el paradigma más amplio de bienes relacionales para explorar el papel del turismo responsable como una forma posible de desarrollo sostenible y responsable. (shrink)

The evaluation of tourism competitiveness is an important tool for analyzing the potential of tourism in a specific context. Enshi Autonomous Prefecture in China is selected as a case through which to explore the potential of mountain tourism and its competitiveness in the tourism industry. This study develops EAP’s mountain tourism competitiveness model focusing on three criteria: core competitiveness of mountain tourism, the economic environment’s competitiveness, and infrastructure competitiveness. Context-specific customized evaluation index has been (...) applied to data collected from EAP Statistical Yearbook for 2005–2014. The study reveals that the value of EAP’s mountain tourism core competitiveness, economic and environmental competitiveness, and infrastructure competitiveness are 84.292, 13.4, and 2.308%, respectively. When tourism core competitiveness is increased by one unit, EAP’s mountain tourism competitiveness will increase by 0.84292 units. Similarly, when economic environment competitiveness is increased by one unit, EAP’s mountain tourism competitiveness will increase by 0.134 units. EAP’s mountain tourism competitiveness increases by 0.02308 units when infrastructure competitiveness increases by one unit. The major reasons for low levels of competitiveness were lack of awareness of the county authority, a low level of cooperation, and weak infrastructure. The recommendations from the study’s findings are as follows. Firstly, the county authority should appropriately improve the relationship between competition and cooperation, maintaining cooperation in competition, and competition in cooperation. Secondly, the county authority should strengthen communication by establishing an effective coordinated mechanism. Thirdly, the county authority should improve the sense of cooperation and jointly develop the mountain tourism market. Fourthly, the county authority should improve the construction of tourism infrastructure and break down the barriers to tourism cooperation. The study’s findings help develop a “win-win” cooperation mechanism within the competition and support the sustainable development of the mountain tourism industry while reducing poverty and promoting the revitalization of the mountains of China. (shrink)

Tourism literature has shown there is a disagreement amongst academics conducting tourism research as to whether tourism is an academic community, academic study, and/or academic discipline. These three terms are used loosely and change in meaning depending upon the author, source, context, and discipline of the author(s). The following paper identifies tourism’s current position in academia using these three ideas of academic acceptance as tools to guide the discussion. Also guiding the discussion are ideas from (...) class='Hi'>tourism scholars and Kuhn’s ideas of what constitutes a discipline. The discussion leads to a debate about “truths” in tourism research. Recommendations regarding the advancement of tourism in academia via theory construction in the academic field of tourism are presented. (shrink)

While the clinical promise of much stem cell research remains largely theoretical, patients are nonetheless pursuing unproven stem cell therapies in jurisdictions around the world—a phenomenon referred to as “stem cell tourism.” These treatments are generally advertised on a direct-to-consumer basis via the Internet. Research shows portrayals of stem cell medicine on such websites are overly optimistic and the claims made are unsubstantiated by published evidence. However, anecdotal evidence suggests that parents are pursing these “treatments” for their children, despite (...) potential physical and financial risk. Physicians are in a unique position as they can be expected to be involved in, or privy to, such decisions. In this paper, we consider what duties physicians may have toward minor patients whose parents/guardians wish to engage in stem cell tourism on their behalf. We use the Canadian perspective to address the broadly relevant issues raised by this trend. (shrink)

A tourist village is a form of industry which is a tourist trip that encourages tourists to use the various products offered by the tourist village, consisting of culinary tourism, educational tourism, natural tourism, and so on. Data on tourist visits to Sumedang Regency during 2022 was 1,293,953 people and in 2023 there were 1,738,502 people. Based on this data, it is known that the number of tourist visits has increased but the number of visits is not (...) spread across all tourist attractions or tourist villages in Sumedang Regency. Therefore, the Sumedang Regency Tourism, Culture, Youth and Sports Department is targeting an increase in the number of tourist visits by 17% from 2023. So it is necessary to develop a promotional strategy for tourist villages in Sumedang Regency. Thus, the aim of this research is to develop a tourism village promotion strategy in developing local wisdom-based tourism in Sumedang Regency. In determining a tourism promotion strategy, it is necessary to pay attention to several dimensions of tourism promotion which consist of: image marketing, atraction marketing, infrastructure marketing, and people marketing. The research method used was qualitative research methods. Data collection was carried out through literature and field studies. Meanwhile, data processing is carried out by referring to data processing procedures which consist of data reduction, data presentation and data verification. (shrink)

The motivation of the study is to explore the nexus tourism-led sustainable human capital development in Brazil, Russia, India, China, and South Africa for the period 1984–2019. The study applied several econometrical techniques for exposing the empirical association between tourism and HCD, such as the conventional and structural break unit root test, the combined cointegration test, long-run and short-run coefficients detected through implementing the Augmented Autoregressive Distributed Lagged, and directional causality by following Toda-Yamamoto with Fourier function. The unit-roots (...) test established variables are integrated in mixed order, wherein variables are stationary at a level or after the first difference. The estimated test statistics from the combined cointegration test and AARDL confirmed the long-run association between tourism, gross capital formation, financial development, and HCD. Tourism revealed a positive and statistically significant tie with HCD in the long run. Moreover, the joint effects of interactive terms TOR*GCF and TOR*FD established a positive and statistically significant relationship with HCD. In addition, the causality test revealed the feedback hypothesis available between tourism and HCD in all sample countries except India. In conclusion, the role of tourism development is critically important for sustainable HCD in BRICS. Therefore, in case of a policymaking concern, it is inevitable to address the tourism issues with care for capitalizing on the benefits for tourism development. (shrink)

In this article we analyze the social memories of the Vietnam War afforded by tourism at the Cu Chi battlefield. Specifically, we explore the experiences of tourists at the site in order to address the under-theorized relationship between carnivalesque and dialogical discourses. Drawing on field interviews and ethnographic engagement with young adult Western tourists who took tours led by Vietnamese guides, we document how the tourists’ playful engagement with the past at Cu Chi facilitates the development of new dialogical (...) memories of the war. Our interviews reveal a strong concern with the suffering of both occupying forces and the Vietnamese communist forces, a finding that points to the need for scholars to better appreciate the multiplicity of ways that social performances function in shaping social memory. Ultimately, we challenge social performance theories whose explanations reduce shifts in social memory to audience interpretations of authenticity. (shrink)

The use of organs obtained from executed prisoners in China has recently been condemned by every major transplant organization. The government of the People's Republic of China has also recently made it illegal to provide transplant organs from executed prisoners to foreigners transplant tourists. Nevertheless, the extreme shortage of transplant organs in the U.S. continues to make organ transplantation in China an appealing option for some patients with end-stage disease. Their choice of traveling to China for an organ leaves U.S. (...) transplant programs with decisions about how to respond to the needs of patients who return after transplantation. By discussing two cases that raised this dilemma, we argue for upholding medicine's commitments to traditional principles of beneficence and nonjudgmental regard in sorting out the policies that a transplant program should adopt. We also explain how position statements that aim for the high ground of moral purity fail to give appropriate weight to the needs and suffering of present and future patients in the U.S. and in China. (shrink)

Understanding Tourism introduces tourism students to concepts drawn from critical theory, cultural studies and the social sciences.

Organ availability for transplantation has become an increasingly complex and difficult question in health economics and ethical practice. Advances in technology have seen prolonged life expectancy, and the global push for organs creates an ever-expanding gap between supply and demand, and a significant cost in bridging that gap. This article will examine the ethical implications for the nursing profession in regard to the procurement of organs from an impoverished seller’s market, also known as ‘Transplant Tourism’. This ethical dilemma concerns (...) itself with resource allocation, informed consent and the concepts of egalitarianism and libertarianism. Transplant Tourism is an unacceptable trespass against human dignity and rights from both a nursing and collective viewpoint. Currently, the Australian Nursing and Midwifery Council, the Royal college of Nursing Australia, The Royal College of Nursing (UK) and the American Nurses Association do not have position statements on transplant tourism, and this diminishes us as a force for change. It diminishes our role as advocates for the most marginalised in our world to have access to care and to choice and excludes us from a very contemporary real debate about the mismatch of organ demand and supply in our own communities. As a profession, we must have a voice in health policy and human rights, and according to our Code of Ethics in Australia and around the world, act to promote and protect the fundamental human right to healthcare and dignity. (shrink)

The tourism industry is a significant driver of the global economy and impacts societies all over the world that are currently experiencing radical change. Responding to these changes requires economic paradigms and educational systems based on new foundations. Humanistic tourism proposes a values-based disciplinary perspective for tourism at the intersection between humanistic and tourism management, and is rooted in human dignity and societal wellbeing. Integrating humanistic management principles into higher education tourism management programs, and changing (...) the nature of what is taught and how, would benefit students, future managers and all stakeholders. This paper aims at improving higher education tourism programs by combining humanistic management education and the Tourism Education Futures Initiative’s values-based tourism education. It draws on an integrated Humanistic Tourism Education framework to help develop future tourism managers’ skills and abilities to adopt alternative leadership models within the sector and to foster critical and responsible tourism thinking and practice. With best-practice examples from three universities in three different countries, this study illustrates new pedagogical approaches and proposes recommendations for implementing humanistic tourism management in higher education with the aim of training ethical and responsible managers equipped with an awareness of the social, cultural, and environmental challenges – and possible solutions to these – in their respective destinations. (shrink)

Richard Rorty’s “Deconstruction and Circumvention” is a sobering reminder of how far we have to go before anything like a real dialogue between deconstruction and philosophy can take place in this country. Our literary critics ignore too much of what is specifically philosophical in philosophical texts; and our philosophers equally blind when they read literary language. Perhaps it is laughably undeconstructed to make the distinctions I had just made. But perpahs, too, it is not so easy to get beyond (...) certain oppositions as is beginning to be widely taken for granted. It is surprising to see Rorty encouraging such complacency, for Rorty himself generally thinks hard and to good purpose. He is a figure of unique distinction on our intellectual landscape, a bridge, perhaps, our only one, between deconstruction and the American philosophical establishment. But for that very reason it is sobering to see how this philosopher reads Jacques Derrida: very much as a philosopher reads. The overall result is ambiguous , but is it not finally to “encapsulate and circumvent” Derrida, leaving the native speech community immune to his critique? Let us see. Henry Staten is associate professor of English and adjunct professor of philosophy at the University of Utah. He is the author of Wittgenstein and Derrida and is currently working on a study of mourning and idealization in Western literature from Homer to D. H. Lawrence. (shrink)

Technology innovation has changed the patterns with its advanced features for travel and tourism industry during the outbreak of COVID-19 pandemic, which massively hit tourism and travel worldwide. The profound adverse effects of the coronavirus disease resulted in a steep decline in the demand for travel and tourism activities worldwide. This study focused on the literature based on travel and tourism in the wake global crisis due to infectious virus. The study aims to review the emerging (...) literature critically to help researchers better understand the situation. It valorizes transformational affordance, tourism, and travel industries impacts posed by the virus COVID-19. The study proposed a research model on reviving the international tourism activities post COVID-19 pandemic to gain sustainable development and recovery. The scholars have debated seeking the best possible ways to predict a sustainable recovery of travel, tourism, and leisure sectors from the devastating consequences of coronavirus COVID-19. In the first phase, the study describes how the current pandemic can become transformational opportunities. It debates the situation and questions related to the emergence of the COVID-19 outbreak. The present research focuses on identifying fundamental values, organizations, and pre-assumptions related to travel and tourism revival and help academia and researchers to a breakthrough in initiating the frontiers based on research and practice. This study aims at exploring the role of technological innovation in the crisis management of COVID-19 tourism impacts, tourists’ behavior, and experiences. The travel and tourism industry’s main stakeholders include tourism demand and organizations that manage tourists’ destinations and policymakers. They have already experienced the stages of responses, recovery, and resetting tourism recovery strategies. The study provides valuable insight into the coronavirus consequences on travel and tourism and practical implications for global tourism and academic research revitalization. (shrink)

Introduction. Modern times are characterized by independence from financial support for travel due to introducing an ordinary region with its daily surrounding into tourist circulation, focusing not on distance, but on the depth of emotions when choosing a place to visit. The aim of the study is to assess the factors of transforming the tourist environment in a region, which might result in a number of challenges for managing the regional development. Methods. In the framework of the study, both general (...) logical methods and empirical methods are used. In particular, the analysis of approaches to managing a tourist region in the post-tourism era, as well as new tourist practices are based on classification and periodization. When choosing the factors of the tourist region new format, the case method and comparison were applied. The scientific novelty of the study. The authors substantiate that the new era will be determined by changes in the labor–leisure ratio, new tourist practices and new tourist region format. The new tourist region format involves a transition to understanding the tourist as a temporary resident of the region and actualizes the need for coexistence. Results. The state of post-tourism for such a region may be due to the emergence of new residentsowners of second homes and business migrants, as well as the social effect of deliberate tourism practices. The competition of such regions is based on intangible resources. The factors of transforming the tourist environment made it possible to give a new look at assessing the effectiveness of an event for the territory. The authors propose threshold values that will allow making decisions on the co-financing of the event from the regional or local budget. Conclusions. Hybridization of tourism and leisure does not provide a complete answer about a possible reduction in work hours, however, indicates a short-term leisure mobility of individuals. New tourism practices are based on awareness and desire to increase self-efficacy. Such transformations open up new opportunities for the territory development. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Tourism:Crossing Borders to Access Health CareHarriet Hutson Gray (bio) and Susan Cartier Poland (bio)Traveling abroad for one's health has a long history for the upper social classes who sought spas, mineral baths, innovative therapies, and the fair climate of the Mediterranean as destinations to improve their health. The newest trend in the first decade of the twenty-first century has the middle class traveling from developed countries to (...) those with emerging economies to avoid treatment delays, prohibitive costs for life-saving procedures, or simply high costs for elective surgery. Others leave to have access to assisted suicide in countries that have legalized it: Belgium, The Netherlands, and Switzerland. This new era of globalization in health care has arrived without the benefit of international standards, government oversight, or ethical and legal review.Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the Taj Mahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital (I, Milstein and Smith 2006).At first blush, the outsourcing of medical care to India seems to be a particular solution for a particular problem. However, the particularity of Mr. Staab is not unique. His experience is emblematic of those patients in the United States with a medical need for major and elective procedures, but who also must bear the total cost of these procedures. These middle-class, under-insured Americans go abroad.In tandem with increasingly aggressive marketing campaigns, American hospitals and companies have begun to leverage their connections in Asia to grow the medical tourism business into a major economic force. What are the consequences of this?Several authors point to the effect on the host country's population, particularly the poor, to be pushed farther down the queue to receive adequate, affordable care. Resources are applied to the foreign trade instead of building the local [End Page 193] medical infrastructure. Another potential problem is the obligation of the home-country physician to provide follow-up care. What are the legal ramifications when the procedure was illegal to begin with? Are there opportunities for redress for medical errors?These factors may be converging into a "perfect storm" for health care in the U.S., in which the potential participation of the major insurance companies in promoting offshore care will be the tipping point in the precarious structure that represents the economic currents in health care. Third-party administrators and self-funded employers may be on the cutting edge in 2009 by providing incentives to employees to travel overseas for care.I. Economic ConsiderationsConnell, John. Medical Tourism: Sea, Sun, Sand and... Surgery. Tourism Management 27: 1093–1100, 2006.As evidence of the interest of traditional tour operators in this newer twist on the industry, the author explores medical tourism as an element of the growth of world tourism. In promoting medical tourism, he urges consideration of such issues as the privatization of health care, the foundational role of technology, and uneven access to health resources.Dunn, Philip. Medical Tourism Takes Flight. H and HN: Hospitals and Health Networks: 40–44, November 2007.Writing for U.S. health care executives, Dunn emphasizes that the reality of medical tourism competes with the local medical center for patients and their insurance dollars in a significant way. He examines the possibility that U.S. insurance plans soon may offer to pay for what is currently a cash only business and that the economic impact to the local medical center could be significant or even devastating.Frontiers of Health Services Management [Selected Articles] 24 (2), Winter 2007.In "Managing Healthcare Services in the Global Marketplace" (pp. 3–18), Bruce J. Fried and Dean M. Harris consider legal, ethical, and financial implications of the international workforce. In "Globalization of Health Care" (pp. 19–30), Lynn Schroth and Ruthy Khawahja point out that the transfer of comprehensive management expertise and intellectual property from U.S. medical centers to international sites is driving the success of collaboration between U.S. and foreign health care centers. In "Is... (shrink)

Tourists, Travellers and Hotels in Nineteenth-Century Jerusalem. By Shimon Gibson; Yoni Shapira; and Rupert L. Chapman III. The Palestine Exploration Fund Annual, vol. 11. Leeds: Maney Publishing, 2013. Pp. xv + 286, illus. $78. [Distributed by the David Brown Book Co., Oakville, Conn.].

A useful introduction to the critical study of tourism, this brief text applies semiotics and cultural theory to deal with some of our most iconic global destinations. It offers accessible analyses of 18 famous tourist locations from the Taj Mahal to Red Square, and from the Eiffel Tower to Antarctica. Written in Berger’s friendly style, it allows students to critically examine the political, cultural and economic significance these locales and understand their importance to tourism. Study questions add more (...) pedagogical value to the highly readable text. (shrink)

This article illustrates the ways in which visual representations construct the meanings of norms governing the spaces we commonly inhabit. I argue that norms regulating public spaces such as streets, parks, plazas, and beaches arise within the process of conceiving tourist representations of space that benefit hegemonic groups in society. My argument is empirically grounded on evidence from a case study on public space regulation in Acapulco, Mexico. By means of a semiotic analysis of tourist materials such as maps and (...) postcards, I show that images related to tourism represent urban space in a way that includes some elements and excludes others. By doing so, they portray a very specific image of the city and its public spaces. Because representations of space are performed upon the entire society, the imagery reproduced by tourist materials is part of the expectations that surround social actors’ actions. This is one of the mechanisms through which the tourism industry influences the regulation of public spaces. (shrink)

Space tourism is an emerging field where few people have direct experience. However, considering the potential in the near future, it is beneficial to better understand how related information influences people’s attitudes about this new form of tourism. Employing information-processing-based Bayesian Mindsponge Framework (BMF) analytics on a dataset of 361 respondents consuming content related to space tourism on Chinese social media, we found that induced happiness and impression are positively associated with willingness to try space tourism. (...) Information authenticity positively moderates these two associations. Our findings emphasize three aspects of information during the processes of reception and filtering: meaning, intensity, and trust. Since promotional materials for space tourism rely heavily on mental simulations rather than objective feedback, creative uses of digital technology are advantageous. However, precautions must be taken to prevent exploitation, such as false advertising, exaggeration, and emotional manipulation. (shrink)

Generation Z people are a significant force driving the modern world. They lead educated lifestyles, enjoy expressing themselves creatively, and prefer to seek out new ideas or approaches to achieve the finest results. The research study aims to examine the tourism motivation and the image that affects the cultural tourism decisions of tourists of Generation Z. The study employed quantitative research techniques to gather data from 385 Thai Generation Z tourists. The research findings revealed that status and prestige (...) significantly influenced cultural tourism decisions, followed by cultural, emotional, affective, physical, and interpersonal motivation. Moreover, the pre-conceptualized image of the tourist destinations has the most significant influence on cultural tourism decisions, followed by tourists' perceptions and the tourists' feelings. This has practical implications for economic development at both the national and regional levels. At the same time, it reflects much about Generation Z's needs and expectations, calling for the urgency to preserve the cultural heritage of the locality and the country as a whole. This is expected to maintain the value of cultural tourism, generating a balance of development in the future. (shrink)

School tourism constitutes a source of learning to strengthen the cultural identity of students. The objective was to compare the development of school tourism in the educational institutions San Pedro Chanel and Carlos Augusto Salaverry. The Leiper space approach was used. The exhibition was constituted by 200 high school students and 20 teachers. The results show that there is statistically significant differences regarding the knowledge of the tourist resources of the province of Sullana. It was concluded that educational (...) tourism is a strategy that tries to bring the student closer to knowledge, awareness and assessment of tourist resources. (shrink)

The article is a presentation and analysis of the main provisions of 16 works of the world's leading experts on religious tourism and pilgrimage, published in a special issue of the International Journal of Religious Tourism and Pilgrimage. 2020. Vol.8. This special issue was dedicated to the impact of the COVID-19 pandemic on religious tourism, and in particular pilgrimage, in the world. Religious tourism has a strong socio-cultural potential and demand - it is the value status (...) of any person who feels the need for cultural, religious and recreational facilities important for spiritual, ideological and physical existence. It is also the availability of opportunities to meet the social and cultural needs of people in tourism services, because it has such a socio-cultural characteristic as a social practice that changes a person and positions him in the social space. Religious tourism became in the XXI century. significant, socially significant phenomenon. But the current pandemic has dealt a very painful blow to the entire tourism sector of the world economy, including religious tourism. Under the influence of the pandemic, the country banned pilgrimage. So the question arose: what's next? Is there a radical transformation of the religious life of mankind, including religious tourism? Isn't this the beginning of the end of religions, as some sociologists of the past predicted? This article is devoted to finding answers to these and other, no less complex, questions. The author set a goal - based on the analysis of the latest research on the impact of the COVID-19 pandemic on religious tourism to identify and present those important points that are already relevant for religious tourism in Ukraine, as well as those that are just beginning to appear and will be relevant in the post. -pandemic era. In almost all articles of this Special Issue, the authors emphasized that religious tourism and pilgrimage are very sustainable and will meet the challenges posed by the pandemic. The question for the religious tourism and pilgrimage industry is how they will develop and transform new approaches that will help the growth strategies of key stakeholders. However, due to pandemic restrictions, it may not be possible to resume travel to holy sites and pilgrimage sites and trails without the assistance of national governments, international agencies, and relief organizations. Thus, the authors predict that the religious tourism industry will face very difficult circumstances in the near future. All articles in the special issue of this journal express extremely relevant, deep and valuable opinions of scientists, which make us all think about what lessons Ukraine should learn about religious tourism, and in particular pilgrimage, and what should be its state policy and public opinion in this regard. further. And the author in the conclusions expresses her point of view on the content of these lessons, based on the views set out in this article of the world's best experts in religious tourism and pilgrimage. (shrink)

This article aims to explore a more suitable prediction method for tourism complex environment, to improve the accuracy of tourism prediction results and to explore the development law of China’s domestic tourism so as to better serve the domestic tourism management and tourism decision-making. This study uses grey system theory, BP neural network theory, and the combination model method to model and forecast tourism demand. Firstly, the GM model is established based on the introduction (...) of grey theory. The regular data series are obtained through the transformation of irregular data series, and the prediction model is established. Secondly, in the structure algorithm of the BP neural network, the BP neural network model is established using the data series of travel time and the number of people. Then, combining BP neural network with the grey model, the grey neural network combination model is established to forecast the number of tourists. The prediction accuracy of the model is analyzed by the actual time series data of the number of tourists. Finally, the experimental analysis shows that the combination forecasting makes full use of the information provided by each forecasting model and obtains the combination forecasting model and the best forecasting result so as to improve the forecasting accuracy and reliability. (shrink)

Stem cell tourism is a small but growing part of the thriving global medical tourism marketplace. Much stem cell research remains at the experimental stage, with clinical trials still uncommon. However, there are over 700 clinics estimated to be operating in mostly developing countries – from Costa Rica and Argentina to China, India and Russia – that have lured many patients, mostly from industrialized countries, driven by desperation and hope, which in turn continue to fuel the growth of (...) such tourism.While much research has focused on such dimensions as the promotions that allow such businesses to make their services known, media coverage, some patient research, and regulatory conditions for developing country clinics, little attention has been paid to the non-affected members of the general population, the future potential users of such services. This empirical study based on five focus group discussions with a diverse group of healthy adults in a Canadian city, explored participant views of patients who use stem cell tourism services, the likelihood they would avail themselves of such services if they were to suffer similar illnesses, and the conditions under which they might do so, and the impact that admonitions and advice from international expert bodies might have on their decisions. Our findings suggest that these healthy adults are sympathetic to the drivers of hope and desperation, and, despite cautions about research limitations, may seek such treatments themselves under similar conditions. These findings are discussed in the context of the policy and ethical issues raised by this form of medical tourism. (shrink)

Purpose of the article Exploring the nature of tourism behavior has traditionally been very complex. Adding to it the fast pace changing environment, the study becomes even more complicated. The purpose of this research is to shed light on the relationship between factors affecting tourist behavior and tourism demand in Albania. Methodology/methods Tourism demand has generally been measured in terms of ‘number of people entering and exiting the borders of a country’. In order to ensure the feasibility (...) of this study, ‘tourism demand’ is measured in terms of ‘frequency of travels’. To accomplish these objective, an online survey questionnaire was developed and administered across the population of Tirana and Durres, the largest cities in Albania, which also represented the population upon which the sample size was drawn. Scientific aim Scientifically, the research aims at testing the relationship between the sample’s monthly income levels, denoted as the independent variable and ‘frequency of travel’, denoted as the dependent variable. Findings The results of the research show that there is a significant association between these two constructs. That is, with x2 = 102,581, p=.000 < 0.01, the Null Hypothesis is rejected, and the Alternative Hypothesis is accepted. Conclusions From the study it is concluded that the higher the Monthly Income levels of the Albanian tourists, the higher the frequency of travels. Nevertheless, like in every other study there are also limitations involved with this particular study, as well. The lack of reliable quantitative data concerning the Albanian domestic tourism is one among the most crucial ones. (shrink)

The current research is based on Senninger’s Learning Zone Model applied to the tourists’ comfort zone. This model was created in 2000 and it proved to be useful in many applied areas: Psychology, Sociology, Marketing and Management. This modes is a behavioral one and shows how a person can justify his action based on previous tested experiences or dares to step beyond in fear, learn or growth zone. Our research is extending the existent area of expertise to tourism. We (...) aimed at exploring whether the tourists’ apprehension toward choosing their next destination from a comfort zone perspective or rather from the other zones’ perspectives such as fear, learning or growth. To meet this purpose we conducted a mixed method: firstly a qualitative one, an in-depth interview based on Delphi method with 10 tourism specialists and secondly an online survey on 208 Generation Z tourists. The interviews were meant to help developing a 20 items scale to measure from which of the 4 zones are the respondents making the choice of the future travel destination. Our conclusions show that Gen Z tourists display behaviors that can be associated with learning or growth zones rather than the comfort zone. This is relevant when choosing the next travel destination, because our findings could bring about a new approach to promoting tourist destinations as part of various products. As a result, a large range of managerial tools can better adapt the promotion messages to the target market from a new psychological perspective. (shrink)

Is it morally permissible for financially privileged tourists to visit places for the purpose of experiencing where poor people live, work, and play? Tourism associated with this question is commonly referred to as ?poverty tourism?. While some poverty tourism is plausibly ethical, other practices will be more controversial. The purpose of this essay is to address mutually beneficial cases of poverty tourism and advance the following positions. First, even mutually beneficial transactions between tourists and residents in (...) poverty tourism always run a risk of being exploitative. Second, there is little opportunity to determine whether a given tour is exploitative since tourists lack good access to the residents' perspectives. Third, if a case of poverty tourism is exploitative, it is so in an indulgent way; tourists are not compelled to exploit the residents. In light of these considerations, we conclude that would-be tourists should participate in poverty tours only if there is a well-established collaborative and consensual process in place, akin to a ?fair trade? process. (shrink)

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to (...) date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term ‘medical tourism’ and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces. (shrink)

This paper lists and discusses the fundamental characteristics of tourism, suggesting it is essentially a semiotic activity. In this respect, it deals with works such as Dean MacCannell's The Tourist and Roland Barthes's Empire of Signs. Considering the relationship between tourism and postmodern theory, it contrasts the everyday and the exotic, discusses Baudrillard's theories on simulations and hyperreality as they relate to tourism, and compares modernist and postmodernist perspectives on tourism, critiquing the widely held notion that (...) tourists always seek authenticity and situating tourism within consumer culture. (shrink)

The purpose of this paper is to offer a conceptual analysis of the space created by the Willing Workers on Organic Farms host as a part of the organic farming movement and how that space now collides with the idea of tourism heterotopias as the changing market sees WWOOFers who may be less motivated by organic farming and more by a cheaper form of holiday. The resulting contested space is explored looking at the role and delicate balance of WWOOFing (...) as a form of sustainable tourism in the context of socially constructed understandings of space. Poststructural concepts of space suggest that it is impermanent, fragile and under constant threat of change. Space is constantly produced and reproduced in the process, spaces become sites where struggle and contestation occur, in this instance as one discourse or discursive practice, namely WWOOFing, intersects with and is influenced by the more dominant capital centric discourse of mass tourism. (shrink)

Today, tourism, with its distinct and unique features, has become one of the largest and most profitable industries in the world economy and has provided a platform for changes in geographical spaces. This study was conducted with the aim of investigating the effects of religious tourism on the economic development of traditional settlements. The research method is descriptive and analytical. The independent variable is ‘religious tourism’, which is quantified by 10 components, and the dependent variables are ‘income’ (...) and ‘employment’ in tourist areas, which are studied with 10 components in Russia, respectively. Data analysis was carried out in SPSS software, then a Pearson’s correlation test and simple linear regression were used. Moreover, Geographic Information System (GIS) software was used to show the traditional spatial weighting of the study. The regression results show that religious tourism has been effective by 0.77 on income, 0.66 on employment, and 0.72 on the economy of traditional settlements. In fact, the development of religious tourism in areas with religious and traditional rituals has had a positive effect on creating employment, increasing income and economic prosperity. In general, religious tourism, with its structural and functional features, is considered an important factor in revitalising the economy of regions with this privilege. Contribution: This article has proven the strong role of religious tourism on the economy and tourism industry in Russia with a quantitative analysis, which deserves the attention of cultural and tourism policymakers. In addition, the results of this research can be considered by other countries with different religions. (shrink)

Tourism education plays a key role in shaping students’ engagement with sustainability by providing them with the knowledge and skills to address environmental challenges and encouraging them to promote sustainable practices in the industry. This study explores how four years of tourism education at Prince of Songkla University in Phuket, Thailand, influence students’ knowledge, attitudes, and intentions toward sustainability. Despite gaining theoretical knowledge of sustainability principles, the findings reveal a decline in students’ willingness to adopt environmental sustainability practices (...) as their years of education increase. This may reflect a disconnect between classroom lessons and practical application, potentially due to limited practical learning experiences and the prevalent “eco-deficit culture” within the tourism industry, which often prioritizes profit over environmental responsibility. As a result, students may filter out information regarding environmental sustainability despite their sustainability education at the university. To support long-term engagement in sustainability, the paper recommends revising curricula to include more experiential learning opportunities, interdisciplinary collaboration, and stronger partnerships with industry stakeholders. (shrink)

The article is dedicated to considering ethnic tourism in its importance to comprehend modern cultures that are Others to the traveler's experience. In this regard, ethnic tourism is presented from the Other's cognition, i.e., the way of life of a nation, its religious and ethnic values and traditions, historical past and legends, and geographical specificity of residence. Thus, the meaning of ethnic tourism is related to the human desire to discover other cultural and social spaces. Simultaneously, the (...) article shows how another culture's perception affects the awareness of a tourist's identity. The author notes that ethnic tourism aims at fixing the distinctive features and specifics of people's life. Therefore, this type of tourism is most conducive to forming images and perceptions of ethnic and cultural diversity. The author substantiates the role of ethnic tourism to establish a dialogue of cultures in the modern world. Distinctive features of globalization, particularly travelers' continuous mobility, the conversation of ethnic groups, and the value-based mutual enrichment of peoples, have been deduced. Some theoretical approaches of Russian philosophers to the study of ethnic tourism are defined. The researcher emphasizes the idea of a correlation between ethnic cultures and religions. In this regard, early Christianity's theological ideas are conditioned in terms of their impact on the subsequent formation of pilgrimages and the modern religious tourism organization. The contemporary unity of ethnic culture and religiosity is vividly manifested in the uniqueness of the Old Believers' tradition of the Kerzhak resettlers living in the Altai Mountains. The article concludes that ethnicity should be acknowledged in any tourism organization, especially religious and pilgrimage types. (shrink)

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding (...) of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. (shrink)

Purpose is to substantiate the ways of promotion sustainable tourism in the global economy. Methodology - To determine the importance of the sustainable tourism factors, the hierarchy analysis method of T. Saati was used. The method of expert estimations has been used for determining the significance level of the tourism sustainability factors. Findings - The conditions for promotion of the sustainable tourism to the world market and the factors of impact on its development in the global (...) economy have been determined. All impact factors were divided into 7 groups: political and regulatory environment, environmental sustainability, social and cultural strategy, economic sustainability, tourism service, safety, basic sustainability state. To assess the potential of the sustainable tourism by international destinations, it was offered to rank the factors of index of sustainable tourism development in the countries from the point of view of a tourist. Contribution - The structure of the factors of tourism sustainability index with the emphasis on the role of an immediate tourist was improved. The most importante factors of influence on the choose tourist destination have been identified: the factors of safety, tourist service and the factor of basic sustainability state of a country. (shrink)