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elated problems which includes the incidence and
aetiology of tourism-related disease, disruption of
travel and consequent impacts on consumer
enjoyment, the legal responsibilities of tour operators
and agents, provision of pre-travel advice on
health matters, adequate primary health care at
destinations and a wide range of preventative
measures.
Travel-related illness encompasses diseases, injury,
recreation and tourism-related hazards.
Diseases are related to food, water or air, or can
be insect �vector) and animal-borne or communicable
through human contact �including sexually
transmitted diseases). Injury includes transportrelated
accidents, occupational safety hazards and
animal bites. Recreational hazards are sunburn
and other skin conditions, water-related and sportrelated
accidents, or illnesses caused by recreational
drugs, alcohol and sex. Travel-related
hazards include air and sea sickness, exhaustion,
altitude, stress and personal security incidents. As
well as considering the type of illness, many factors
relate to the destination, the tourists and the
activity they undertake. Factors of destination
which impact on health are stage of development,
medical services, general sanitation, geographical
location and climate. The tourist's age, gender,
health status, special conditions, duration, tourism
style and recreational activity are all important.
Each grouping has high, medium and low risk
categories with specific advice, treatment and
associated requirements. Illness prevention/control
deals specifically with travel advice, insurance,
immunisation, prophylaxis, epidemiology, notification
and quarantine procedures. Travel health
counselling deals primarily with three major areas
of vaccine: preventable diseases, vector-borne
diseases such as malaria, and food and waterborne
diseases, especially diarrhoea. Infectious
diseases account for a very small fraction of deaths
occurring among tourists, but represents a major
cause of non-fatal illness. Cardiovascular disease,
more prevalent in the elderly traveller, accounts for
50 per cent of deaths; accidents and trauma for
around 25 per cent of mortality in overseas
travellers. A special branch of travel medicine is
the development of telemedicine which delivers
specialist advice and care to the tourist in situ.
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There has been a mixed response from various
sectors of the industry to issues relating to health.
Many are concerned that reports of illness linked to
tourism will be detrimental to business. The
Pacific Asia Travel Association and the
World Tourism Organization have led efforts
to educate and inform the industry employees.
International bodies such as the World Health
Organisation and national bodies have assumed
the work of educating health professionals and
tourists on health-related issues. There have been
several `travel safe' campaigns, provided initially to
respond to concerns about AIDS but expanded to
encompass the full range of issues.
The new public health integrates human health
into ecosystem well-being. Public health has its
origins in mid-nineteenth century Europe, introduced
to deal with urban problems of air and water
quality, food-borne infection and diseases arising
out of poor hygiene and poverty. The most
important solutions to these problems came from
changes to social conditions rather than advances
in medical technology. Environmental health,
preventative medicine and social reform were key
components of this notion of public health. In more
modern times, despite changes in the pattern of
illness from infectious disease to lifestyle-related
illnesses, this conception of public health began to
fade. By the 1970s, the emphasis shifted from
`public' to `individual' risk factors. The link
between social change and public health weakened.
Less emphasis was placed on the interdependence
of health and the social and physical
environments. Individuals were seen as responsible
for their lifestyles and health risk factors.
In the 1980s, the World Health Organisation
and other authorities recognised alarming trends in
health outcomes related to a reduction in health
equity. The Ottawa Charter of 1986 marked
another reorientation of public health away from
the dominant notion of the individual, simplistic
cause±effect interventions and surveillance approaches,
towards a more complex environmental
and social model. This ecological approach served
to emphasise the interconnections between humans,
their physical and social environments, and
their health.
Tourism is a modern phenomenon linked to a
number of positive causal factors, including a rise