The Changing Face of Spa

The sauna is perhaps a key feature of the modern spa and like many other spa treatments today the historical development is difficult to accurately trace back to one specific location, which highlights its significance to multiple cultures, shaping the diversity of its current usage (Sauna Organisation, 2006). Today, the most prevalent is the Finnish sauna, reported to have been based on the earlier Savusauna (Aaland, 1998).

The idea of "cleansing" with water dates back to biblical times, while the connection of water with medicine and health may be Greek in origin (Van Tubergen & Van der Linden, 2002). Hippocrates was arguably the forerunning proponent of hydrotherapy, believing that diseases were caused by imbalances in body fluids, curable through activities such as drinking, bathing and exercising. It was only later that the Romans anticipated medical links with bathing, primarily in the recuperation of wounded military personnel and for the recreation of soldiers (Jackson, 1990).

During the Renaissance there was renewed focus on medical usage of water, not only on the effects but also on the composition of the water itself. Hydrotherapy spread from Europe to the USA as a popular treatment in the 1800's. At this time Priessnitz and Kneipp, with their holistic approach to medicine, further developed hydrotherapy and linked the treatment with applications such as mud packs, exercise, massage and diets as used in the spa today (Van Wijk, 1989).

In many cultures throughout many times spa therapies have been at the very heart of society including Britain in the 18th Century. Historically English baths were famous for treating paralysis caused by lead poisoning. The spas in Britain popular in Jane Austen's time (as characterised by her book Northhanger Abbey) were not unlike today; they were often frequented by both ladies and gentlemen in groups, although in those times they were much more associated with the dating scene than today (though I'm sure Cilla Black still attends as spa every now and again!). Nevertheless several factors, led to a decline in British spas and eventually to their exclusion from the NHS treatments (Bacon, 1997).

Many spa towns in Britain today are very proud of their heritage and make prominent display of spa equipment historically used, demonstrating how spa therapies combined with medical institutions are not entirely a new concept. Indeed European spas have traditionally always been very medically orientated.

Today 'medi' spas are an emerging trend, with clients visiting spas for surgery and after surgery for recovery. Many factors have contributed to the popularity of this trend; rising levels of obesity and stress, the growing lack of faith in the healthcare system and longer waiting lists.

Advent of medical 'medi' spas; Preventative and curative approaches

Looking into the histories of the multitude of therapies available in spas it is clear that spa treatments have traditionally been used as both preventative (to maintain wellness) and curative (to restore wellness). Their value in such areas has somewhat diminished over time and is only just beginning to be rediscovered as modern day science begins to research and demonstrate the amazing benefits behind the therapies.

In medical practice today hydrotherapy is regaining popularity as a cost effective possible means to reduce symptoms and improve a patient's quality of life (Lange et al. 2006). Consequently, governments such as those in France, Netherlands and Switzerland assist with funding hydrotherapy treatments as part of national health care packages (Polikowski & Santos-Eggimann, 2002).

While spa treatments appear to be increasingly recognised by the medical profession and by governments, they are still mainly seen as curative solutions (Vestraci, 2004). With the apparent current increase in 'stress related diseases' such as cancer and heart problems, alternative treatments may be considered to have a value as preventative treatments for healthy individuals too. There is certainly room for both in the advancement of health care as they both fundamentally have the same goal.

Different types of spa that exist today

Medical spas are just one of the branches of spa and while there is no broad scale categorisation the International Spa Association (ISPA) and others have loosely accepted that spas fall into the different categories demonstrated below.

Different Types of Spa

(Adapted from ISPA 2006b; Crebbin-Bailey et al. 2005; Smith and Jenner 2000; De la Barre et al. 2005).

*Although members can be categorised into more than one spa type

Each of these may themselves have their own specific focus, i.e. Asian treatments or a specific 'signature' ingredient such as wine in a vinotherapy spa.

Globalisation of the spa industry may lead to the development of closer links between spas and the business world, as working relationships are built up, and the industry becomes more motivated to manage employee health. In this sense, spas may become more intertwined with the daily routine of economic and social life. ISPA and SpaFinder (2005) confirm such suggestions by implying that spas will become more family orientated and a major vacation activity. Such forecasts for the spa industry may enable businesses that rely on international business to remain commercially viable should long haul flights cease due to increased fuel costs.

Modern day spa considerations

Modern day considerations for spas include the need to educate clients to ensure that spas' role as both a preventative and curative measure is as effective as possible. Spas also suffer the dilemma of ethical pricing and considering who their therapies should be available to, while balancing overheads.

Spas are not only a business, but in many ways a public service, so they need to focus on how they can serve the public better. They also need to consider the 'public' who enter their doors daily and provide the very heart of the spa through the treatments they deliver. This can be done by making sure that treatment rooms, equipment and working hours are all designed with therapists' well being in mind.

Furthermore, as well as ensuring such measures are in place to protect and preserve therapist and client well being, the well being of the community and the planet should also be at the heart of such selections. This can be done by ensuring that all equipment and products are from sustainable resources and will not negatively impact the environment. It should also be ensured that the waste from the spa, including water, is dealt with correctly and recycled where possible.

Growing accessibility and appeal amongst consumers

Spa though still associated with luxury has made a leap from being 'therapy available for wealth' to 'therapy available for health' by becoming more affordable and accessible to the general public. With the growing accessibility spas are able to cater to increasing demographics and so the range and types of spas are diversifying even further, appealing to more and more people.

Spas are responding to market trends through offering variations to traditional medicine to attract clientele, although currently in place, this approach may be considered to be short sighted and 'gimmicky', detracting from a long-term and sustained interest in a particular therapy. Although there is likely to be a degree of cultural interpretation, the danger is that spas will discredit the original approach of traditional medicine by only selecting what is convenient.

To avoid such labels, spas might seek to better understand the original intent and context of traditional medicine if included in the services offered; Spas can embrace and enhance traditional medicine, preferably with the support of the traditional medicine developers, to ascertain which elements should remain when adapting the treatment to their cultural context. Promoting traditional medicine products and services by reference to their historical origins does not in itself give a treatment validity.

While spas are business and need to generate revenues, their focus should remain on long-term health and education if the industry is to successfully grow and win more credibility within the healthcare sector. Financial gain need not be the sole motivation for including traditional medicine in the range of services offered at spas, and it may be argued that astute marketing strategies to promote the benefits of traditional medicine therapies will ultimately offer most benefit to the spa's success and the client's health.

Requirements for modern day spa worker

With the growth of the industry there has been a growth in the range and availability of jobs in the sector. Compared to the previous 'one man band therapist' roles, these jobs include reception staff, reception managers, spa managers, therapists, head therapists, spa coordinators, trainers and spa attendants to monitor the wet areas. Requirements for spa workers vary widely depending on the role and responsibilities to be filled and the location of the spa. However in most cases it is absolutely essential that all therapists and trainers have undergone formal training in the therapies that they administer in addition to health and safety.

Additionally the therapist performing traditional medicine treatments should have a belief in the therapy and provide the client with relevant information on the treatment, rather than just performing it out of duty and with no grounding in the traditional medicine concepts. The way a treatment is portrayed to the client may influence its effectiveness on a patient: if portrayed negatively a patient is unlikely to benefit from treatment. Therapists should, however, be open to the possibility that clients may not necessarily agree with information and theories surrounding the use of traditional medicine's, although this does not mean clients see the treatment as irrelevant, clients may for instance see another purpose for the treatment.

While clients should not be bombarded with information, it is important that they are given enough information to develop their own understandings and interpretations of the therapy's significance to themselves and they may thus be more willing to persevere with a course of treatment, particularly where a therapy is initially painful.

Evidence of a 'placebo effect' raises questions about the efficacy of traditional medicine's, as it could be argued that the more the client is aware of therapeutic benefits, the more benefits they may perceive, thus validating the need for the client receiving adequate initial information about the treatment. However the placebo effect is often more reflex than cognitive, meaning one does not have to completely believe in something to receive a placebo benefit.


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