Proceedings of the 2009 northeastern recreation research symposium

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Table 2.—Assessment of the global sustainable tourism criteria How important are these considerations in your decision? (5 point scale, 1 = not very important, 5 = very important) The international or national legal protection of employees is respected, and employees are paid a living wage. The company has implemented a policy against commercial exploitation, particularly of children and adolescents, including sexual exploitation. The activities of the company do not jeopardize the provision of basic services, such as water, energy, or sanitation, to neighboring communities. The company is equitable in hiring women and local minorities, including in management positions, while restraining child labor. The company actively supports initiatives for social and infrastructure community development including, among others, education, health, and sanitation. Local residents are employed, including in management positions. Training is offered as necessary. South America. Th e respondents had traveled less often for business although 12 had taken business trips to Central America or the Caribbean, 9 had been to Asia or Africa, 5 had gone to Europe, 4 had traveled in North America, and 2 had been to South America. Despite economic concerns, 41 percent of respondents said that they were “very likely” or “somewhat likely” to vacation abroad in the next 12 months. Almost half of the survey respondents did not answer the demographic questions but, of those who did, more than half were male and the vast majority were more than 40 years old. Th e most frequently reported annual household income category was $25,000 to $49,999. More than 50 percent of the group had completed at least some college. Of the 52 respondents who provided their employment status, 25 were working full time, 9 were working part time, and 16 were retired. Of the 51 who answered the question about marital status, 36 were married. Approximately half answered the question about the country of their birth. Th e vast majority were born in the United States.; other listed countries of birth included India (2 people), Germany (1 person), New Zealand (1), Poland (1), and Taiwan (1). 5.0 DISCUSSION Th e survey data suggest that health tourists are costsensitive and care about the needs of local workers at health tourism destinations. Given this interest in supporting sustainable tourism, it is not too late to build sustainable practices into health tourism strategies. While the quality of patient care is important for health tourists, the local population should not receive substandard care at the same facilities. Human rights organizations often list “health” as one of the most important human rights. Dr. Margaret Chan, director general of the World Health Organization, asserts: “Our greatest concern must always rest with disadvantaged and vulnerable groups. Th ese groups are often hidden, living in remote rural areas or shantytowns and having little political voice” (World Health Organization 2007, p. 1). While the GSTC criteria about employing local residents were only moderately important to survey respondents, it is a real threat to local communities when a workforce is imported to work in the tourism industry. Imported workers compete with local employees and diminish tourism’s social and economic benefi ts in local communities (Smith and Puczko 2008). Proceedings of the 2009 Northeastern Recreation Research Symposium GTR-NRS-P-66 Mean Std. Deviation 3.72 1.14 3.67 1.17 3.64 1.14 3.63 1.13 3.42 1.28 3.30 1.21 Local and fair-trade services and goods are purchased by the business, where available. 3.14 1.21 A code of conduct for activities in indigenous and local communities has been developed, with the consent of and in collaboration with the community. The company offers the means for local small entrepreneurs to develop and sell sustainable products that are based on the area’s nature, history, and culture. 3.14 1.18 3.02 1.33 101
Countries also need to be careful about expanding health tourism too quickly. For example, according to Th e Travel and Tourism Competitiveness Report 2009 (Blanke and Chiesa 2009), Costa Rica has improved its overall ranking from 44 th (out of 130 countries) in 2008 to 42 nd (out of 133 countries) in 2009. But the report also notes there is room for improvement in the quality and availability of healthcare in Costa Rica; the country receives a 4.7 score out of a possible 7.0 for “health and hygiene.” In addition, Costa Rica is described as having a competitive advantage in the availability of hotel rooms and car rentals but a competitive disadvantage in the density of physicians (1.3 physicians per 1,000 residents) and of hospital beds (13 beds per 10,000 residents) (Th e Travel and Tourism Competitiveness Report 2009, p. 171). By comparison, the United States has 2.6 physicians per 1,000 residents and 32 hospital beds per 10,000 residents. Costa Rica may be well situated to expand general tourism but also needs to focus on the healthcare of its own citizens. Th e Global Sustainable Tourism Criteria are a work in progress and industry organizations are reviewing the criteria. Changes and refi nements can be expected as the criteria are applied around the world. Now is a good time for the health tourism industry to become a sustainable industry. George (2009) notes that this prospect is a challenge since hospitals are not necessarily attuned to—or accustomed to addressing—the needs of tourists. International hospital accreditation should have sustainability practices written into its standards. Th en health tourism can be both profi table and sustainable. 6.0 CITATIONS Blanke, J.; Chiesa, T., eds. 2009. Th e travel and tourism competiveness report 2009. Geneva, Switzerland: World Economic Forum. Online at http://www.weforum.org/en/initiatives/gcp/ TravelandTourismReport/index.htm. Bristow, R. 2009. Eco-medical tourism: can it be sustainable? In: Klenosky, D.B.; Fisher, C.L., eds. Proceedings of the 2008 Northeastern Recreation Research Symposium; 2008 March 30 - April 1; Bolton Landing, NY. Gen. Tech. Rep. NRS-P-42. Proceedings of the 2009 Northeastern Recreation Research Symposium GTR-NRS-P-66 Newtown Square, PA: U.S. Department of Agriculture, Forest Service, Northern Research Station: 158-164. Connell, J. 2006. Medical tourism: sea, sun, sand and … surgery. Tourism Management. 27(6): 1093-1100. Castonguay, G.; Brown, A. 1993. Plastic surgery tourism proving a boon for Costa Rica’s surgeons. Canadian Medical Association Journal. 148(1): 74-76. Deloitte Center for Health Solutions. 2008. Medical tourism: consumers in search of value. Washington DC. Retrieved 6 November 2008 from http:// www.deloitte.com/dtt/cda/doc/content/us_chs_ MedicalTourismStudy%283%29.pdf. George, B. 2009. Medical tourism in India: A case study of Apollo Hospitals. In: Smith, M.; Puczko, L. eds. Health and Wellness Tourism. Burlington, MA: Elsevier Science and Technology Books: 367-372. Global Sustainable Tourism Criteria. 2008. Global sustainable tourism criteria. Retrieved 1 December 2008 from http://www.sustainabletourismcriteria.org. Hall, C.; Page, S. 2006. Th e Geography of tourism and recreation: environment, place and space. London: Routledge. Harvard Health Letter. 2008. Virtual hitchhiker’s guide to the medical universe. Harvard Health Letter. 33(12). Judkins, G. 2007. Persistence of the US - Mexico border: expansion of medical-tourism amid trade liberalization. Journal of Latin American Geography. 6(2): 11-32. Mathieson, A.; Wall, G. 1982. Tourism: economic, physical and social impacts. New York: Longman. Mieczkowski, Z. 1995. Environmental issues of tourism and recreation. Lanham, MD: University Press of America, Inc. 102
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United States Department of Agricul
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PROCEEDINGS OF THE 2009 NORTHEASTER
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OUTDOOR RECREATION—TRAILS Experie
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GIS APPLICATIONS AND RECREATION RES
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diff erent points along the spectru
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Proceedings of the 2009 Northeaster
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amount of bare rock. Camel’s Hump
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Larson, M. 2004. A Passive Approach
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THE ROLE OF IMAGINATION IN EXPERIEN
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Table 1.—Special places surveys L
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For some people, being in their spe
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CLIMATE CHANGE AND RESOURCE PLANNIN
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large geographical area (Fig. 1). T
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Divers seen = 4.4 Figure 2.—Norm
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Table 4.—Most-specialized divers
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Sarah Young Human Dimensions of Mar
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3.0 RESULTS AND DISCUSSION Th e FRR
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Table 4.—Divers’ perception of
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YOUTH AND OUTDOOR RECREATION
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A qualitative research design was u
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containers, instead of plastic bags
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WALK, RIDE AND LEARN: STUDENTS’ D
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school. Because of the large sample
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Table 8.—Observation of built str
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“I’M TOO OLD TO GO OUTSIDE!”
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Mean Eco-Affinity Score 5.0 4.5 4.0
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children. In: Klenosky, David B., F
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Cherie LeBlanc Fisher U.S Forest Se
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Page 77 and 78: Lynda J. Sperazza, Ph.D. Recreation
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Page 81 and 82: Dychtwald, K. 1999. Age power: How
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Page 87 and 88: Stillwater, OK: Oklahoma State Univ
Page 89 and 90: EXPERIENCE USE HISTORY AND ITS RELA
Page 91 and 92: Table 1.—Comparison of experience
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Page 97 and 98: 2.0 METHODS Data were collected at
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Page 121 and 122: trails, and asking others to stay o
Page 123 and 124: time/fi nances” in dune protectio
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Page 127 and 128: Jinhee Jun Texas A&M University jju
Page 129 and 130: Table 1.—Sample demographics Indi
Page 131 and 132: Grayson 1995). Th e fi t of this mo
Page 133 and 134: Stets, J.E.; Burke, P.J. 2003. A so
Page 135 and 136: Jiaying Lu Texas A& M University Ji
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William Valliere University of Verm
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��
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Manning, R. 2007. Parks and carryin
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mission is “...to promote and reg
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Figure 1.—Pedestrian walkway LOS
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Acceptability 4 3 2 1 0 -1 -2 -3 -4
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TOURISM TRENDS AND CHALLENGES
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the rankings of 12 attendance motiv
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Table 3.—Comparison of socio-econ
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Table 6.—Entertainment Seekers’
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PLACE MEANINGS
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Stedman (1999) posited that sense o
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points in a focus group session, Ne
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are not shared by current residents
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Ishwar Dhami Division of Forestry a
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Figure 2.—Model for the calculati
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Table 1.—Viewshed results for all
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land implies that planting vegetati
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Shafer, E.L.; Hamilton, J.F.; Schmi
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a setting’s ability to facilitate
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EUH Place Satisfaction Figure 1.—
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Table 4.—Regression coefficients
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Jőreskog, K.G.; Sőrbom, D. 2004.
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OUTDOOR RECREATION II
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Th e primary objective of the propo
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Question 10. Do you believe that SU
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Rodney B. Warnick Tom Stevens Unive
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Table 1.—Estimated visitation to
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Table 2.—Estimated national park
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For this section of the trend analy
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5.0 DISCUSSION, CONCLUSIONS, AND IM
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RECREATION TRAILS IN MAINE AND NEW
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Table 2.—Average cross-sectional
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Table 5.—The percentage of stream
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Demrow, C.C. 2002. Maine trails man
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Turner, J.M. 2002. From woodcraft t
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Chad P. Dawson, Professor State Uni
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80 70 60 50 40 30 20 10 0 Very diss
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Table 4.—The number of campers in
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Fuller, C.; Dawson, C. 1999. A comp
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Table 1.—Modal response rates Ini
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Smee, A.; Brennan, M. 2000. Electro
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Table 1.—Characteristics of parti
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Table 3.—Results of discriminant
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5.0 CITATIONS Babbie, E. 2001. Th e
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Bernardita Silva Graduate Assistant
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Table 1.—Expenditures by 2008 Ame
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6.0 CITATIONS Della Bitta, A.; Lond
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the economic impact of travel, and
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the air show. Th e second most popu
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not displace other local spending.
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6.0 CITATIONS Adams, P.D.; Parmente
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MANAGEMENT AND USE OF PARK, RECREAT
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which suggests that diff erent type
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Table 2.—Between-groups ANOVA to
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forest settings (means = 4.4 and 4.
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LEISURE RESEARCH
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communities together, and a decline
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Table 2.—Life satisfaction scale
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onds within a social group is a mec
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“I JUST WANTED TO GET AWAY”: AN
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Th e importance of “getting away
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Gerlach, J. 1989. Spring Break at P
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www.nrs.fs.fed.us The U.S. Departme
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