Wellness Tourism in the Post COVID-19 Era in Blue Zones and Insular Areas. The Case of the Island of Ikaria

Abstract

This article presents a type of tourism, that of wellness tourism, which is developing rapidly in Greece and more specifically aims to examine how wellness tourism evolved during the COVID-19 pandemic, how it is located on the island of Ikaria, and also what is the perspective of potential and current consumers of tourist services on this island. The research indicated that although the pandemic damaged severely the tourism sector, tourists are willing to travel, showing also a preference in the country. The study also showed that the island of Ikaria is a well-known destination with a high percentage of the sample having visited it but without receiving any wellness services and a quite significant percentage not knowing about them. Moreover, the majority of the sample expressed their intention to visit the island and to promote the destination to others and also their strong belief that the staff in the tourism industry will meet the individuals’ needs regarding the measures taken due to the pandemic.

1 Introduction

Wellness tourism, the phenomenon of traveling to destinations offering a good natural environment in order to improve and/or preserve health, undergoes a rapid development during the last decades, and many researchers have focused on the demand for wellness tourism as well as on strategies for its development. The recent pandemic of COVID-19, however, has changed the way of traveling and traveling in general as it was known.

According to World Travel & Tourism Council (WTTC), tourism globally accounted for a total of 10,3% of GDP and in Greece specifically, tourism accounted for 20,8% of the country’s economy (World Travel & Tourism Council (WTTC), 2020). The implementation of lockdowns, in order to slow down the spread of the coronavirus, eroded the tourism sector, with many countries refusing to accept visitors and many companies going bankrupt. However, the tourism industry seems to recover, since international tourist arrivals during the first five months of 2022 tripled (+221%), although remained 54% below 2019 levels (UNWTO, 2022). Europe and the United States of America lead the recovery of tourism, even though the arrivals are still below those of 2019 (Table 1).

Table 1 International Tourist Arrivals by (sub) region

In Greece, in 2021, 96% of the hotels operated as opposed to 2020 when the 60% of them operated and during August the occupancy reached 67,9% as opposed to 27,7% in 2020 (RIT, 2021).

The tourism sector has been hit hard, and it is estimated that the tourists’ decisions on the way they travel will change, since from now on they will seek services in trustworthy environments. Instead of returning to previous operating model, the pandemic is forcing experts to rethink the unsustainability of the pre-crisis travel and tourism industry (Constantoglou & Klothaki, 2021). Health and safety will be of top priority in the new era and wellness services will grow rapidly in the post COVID-19 era. Health Tourism Worldwide (HTW) and Wellness Tourism Association (WTA) state that one of the most critical consequences of the pandemic is that personal well-being will be an important issue and travelers will look for suitable destinations and wellness services. Wellness remains an important incentive for travel, while tourism services that will adopt wellness service features will become more important than wellness travel (WTA & Health Tourism Worldwide, 2021).

2 Wellness Tourism

According to World Health Organization (WHO), health does not refer only to the absence of illness, but is a state of physical, mental, and social well-being and integrates the need for beauty, consciousness raising, longevity, and spiritual sensibility (Wang et al., 2020). Wellness is an antithesis of illness, and wellness tourism targets healthy people with an interest in maintaining and enhancing their health (Page et al., 2017). Wellness tourists are attracted by natural environments offering alternative wellness services and activities, such as SPAs, thermal spring resorts, fitness centers, and sacred sites providing spiritual restoration (Lowry, 2017).

The rapid development of wellness tourism has caught the attention of researchers in recent years, who have focused on the factors influencing the decision-making regarding a travel seeking wellness. These factors include socio-demographic and behavioral characteristics, previous experiences of wellness tourists along with other factors enhancing their well-being (Thal & Hudson, 2019). The term well-being is closely linked to life satisfaction and depends upon life choices, varying between individuals, which influence people’s perception of happiness and researchers argue that the concept of well-being is an aspect of a much wider concept, that of Quality of Life (Page et al., 2017).

In tourism terms, Quality of Life is linked to the sustainability, authenticity, attractiveness, and competitiveness of a destination and is evolved around three parts: the tourists themselves, the host community, and the tourism workers. The literature suggests that apart from the life-improving experiences offered to tourists, the carrying capacity of the destination and the enhancement of lives of those working in the tourism industry should be considered (Higgins-Desbioles, 2018). Wellness tourism seems to make a positive remark on the sustainability of the destinations, since it supports the values of the host community, promoting new forms of economic development and managing activities that lead to mental and physical harmony and prosperity (Quintela et al., 2017).

3 Wellness Tourism Economic Figures

Wellness tourism constitutes a rapid developing tourism sector, regarding the consumers’ intention to strengthen their mental and physical health, with the global wellness economy valued at $4,9 trillion in 2019 as opposed to $4,4 trillion in 2020 due to the pandemic of COVID-19, since well-being as an endeavor is integrated into all the activities of a person’s lifestyle (Global Wellness Institute, 2021).

Globally, wellness tourism shows a growth rate of 6,6% from 2017 to 2019, which is twice as much as the growth rate of general tourism, experiencing a fall by 11% in 2020. Asia–Pacific was the region with the largest wellness spending in 2020, followed by North America and Europe (Table 2).

Table 2 Wellness economy by region, 2017, 2019, and 2020

Due to the pandemic, mental wellness showed evident growth (+7,2%), since consumers requested for products and services that would help them cope with the stress-facing, and also healthy eating, nutrition, and weight loss (3,6%) grew since they sought ways to strengthen their immune system. On the contrary, due to the overall decline in consumption, personal care and beauty services showed a decline (−13%) and also spas (−38,6%) and thermal springs (−38,9%) were adversely affected by COVID-19 due to the restrictions imposed. However, despite the harsh effects of the pandemic, it is estimated that during the period of 2020–2025, the wellness economy will grow at a rate of 9,9% annually, reaching $7 trillion in 2025 (Global Wellness Institute, 2021).

Greece is known as a sea and sun destination. However, the need for the diversification of the product offered, as well as the market demand for the sustainability of the destinations, led to the development of special interest tourism products, where the primary goal was to provide experiences to travelers (Vasileiou et al., 2016). Wellness tourism in Greece is a steadily growing sector of the country’s tourism industry, since the resources, the climate, and the coastal and lakeside locations favor a growth focused on the body and mind well-being. It is worth mentioning that 1 out of 5 people working in the tourism sector is employed in wellness tourism and the country is seventh among the European countries regarding wellness travels (Global Wellness Institute, 2015).

4 Case Study Area: The Island of Ikaria

The island of Ikaria belongs to the North Aegean region, with an area of 254.41 sq.km. and a population of 8.555 inhabitants, regarding the 2021 census. Its capital is Agios Kirikos, named after the Greek myth of Daedalus and Icarus. It is one of the biggest islands in the North Aegean region with a remarkable historical and cultural civilization, including archeological findings, traditional architecture, and a local dialect. The island is mainly mountainous with many rare species of flora and fauna (Fig. 1).

Fig. 1

Source Google Earth (2022)

The island of Ikaria, Greece.

The inhabitants’ main occupations are tourism, agriculture, and fishing, and some of the products for which the island is known are red wine with the name “Pramneios Oinos”, olive oil, and honey. Ikaria is also known worldwide for the longevity of its inhabitants and for the “slow” rhythm of everyday life—a pole of attraction for the tourists who seek peace of mind.

According to Buhalis et al. (2022), destinations are the raison d’être for travel and tourism and by amalgamating cultures, nature, traditions, and humanity with private and public organizations, they offer transformative tourism experiences based on environmental, sociocultural, and economic resources. Ikaria is a wellness tourism destination due to the existence of thermal springs, with one of the natural resources recognized officially for its healing properties. Ikaria has a total rent capacity of 24 hotels, 1* to 3* hotels, and specifically 6 1-star hotels, 10 2-star hotels, and 8 3-star hotels and a total amount of 570 rooms and 1.096 beds. In Ikaria, there are also 89 units of rental rooms varying from 1st to 3rd category, and specifically 14 units of 1st category, 68 of 2nd and 7 of 3rd, and a total amount of 589 rooms and 1.235 beds and the average tourist expenditure per visit is 559€.

During 2021, the arrivals of inbound tourists were 2.896 people and those of domestic tourists were 5.539 people, with 11.309 overnight stays for the first group and 15.102 overnight stays for the second group, respectively, and an occupancy percentage of 18.4% (INSETE, 2022) (Fig. 2).

Fig. 2

Source INSETE (2022)

Ikaria island capacity.

5 Blue Zones and the Ikarian Longevity

There are few regions in the world, regarded as places with a high percentage of centenarians, compared with other surrounding regions. These regions are labeled Blue Zones, and they are isolated or nearly isolated places where the inhabitants share homogeneous genetic background, traditional lifestyle, and dietary habits (Poulain, Buettner & Pes, 2020). Up until now, five regions are considered as Blue Zones and are accepted by scientists as an effective model of healthy aging transferable to more societies: the island of Okinawa in Japan, the island of Ikaria in Greece, a mountainous area on the island of Sardinia in Italy, the peninsula of Nicoya in Costa Rica, and the city of Loma Linda in California (Marston et al., 2021; Poulain, Buettner & Pes, 2020). The high percentage of people that live healthy and lead active lives beyond 100 years of age without serious disease and with a close relationship to friends and families led researchers trying to identify the factors associated with the longevity of the population in these specific areas (Poulain, Buettner & Pes, 2020), and they came up with 9 principles contributing to these areas unique characteristics, forming a triangle with natural movement at the top and dietary habits and the sense of belonging at the bottom (Marston et al., 2021).

Natural movement is considered as extremely important since immobility fosters decline whereas 20 min of exercise benefits a person a lot. Good physical health is equally important as emotional well-being and eliminating stress in life are found to be vital for centenarians, who keep a balance between having a purpose in life and not letting life become so serious. The eating habits of the population in these regions were investigated thoroughly, and it was found that the dietary habits contribute positively to their overall well-being. People in these areas seem to follow the Mediterranean diet: they use olive oil which is found that benefits the heart, they have a moderate intake of alcohol, and they seem to consume food only until they are 80% full. The sense of belonging is crucial and the centenarians have an active social life, perform their religious duties, and enjoy spending time with friends and family, whereas not a small percentage of them live under the same roof with their grandchildren (Beer, 2022).

In the island of Ikaria in Greece, people live more than the age of 90 years and more than 30% of the deaths are above that age and the death from natural causes is ten years greater than other parts of Greece and the world (Stefanadis, 2011). Researches have shown that the traditional way of living of its inhabitants, as well as the healthy Mediterranean diet, the physical activity status, the active social life, and an optimistic attitude of life, contributes to the longevity of the people there.

According to studies, the longevity of people in Ikaria relies also on the commonest occupation there, farming, which made it possible for oldest aged people to continue to work. Apart from that, researchers also found a relationship between the marital status and family solidarity with the low rates of depression among people there. The high level of social interaction is considered also important, since it appears to have beneficial effects on health, reducing mortality risk and improving mental health. The island of Ikaria is also known for the “Panigiria”, festive gatherings related to religious events, organized throughout the year in the different villages of the island, where the participants celebrate and dance all together, the participation which could have a positive influence on health (Legrand et al., 2021).

Ikaria is characterized by the presence of radioactive hot springs, an environmental factor influencing human health (Chrysohoou et al., 2013). The natural radioactivity in the surface of the island was measured, and it was found that the levels of radioactivity together with the consumption of potable water, the spring called “immortal water”, contribute to the radiation overdose for the population, an overdose though, which is not linked to mortality but to the longevity of the population living in the area.

As mentioned above, locals follow the Mediterranean diet, which is associated with protection from coronary heart disease and is characterized by a high intake of vegetables and olive oil, together with fish and dairy products intake and a moderate consumption of res wine. What is more, the inhabitants also show a moderate or high level of physical activity with the benefits of the regular physical activity in older adults being extensive (Legrand et al., 2021).

6 Methodology

The rationale of this research was to process data regarding the sector of wellness tourism on the island of Ikaria and attempt a prediction for the future, after the pandemic of COVID-19. The purpose of the sample examination was to clarify whether the field of wellness tourism is known to those tourists who have visited the island and to its residents, and the use of its properties before and after the appearance of the pandemic.

Regarding the local wellness tourism, the thermal springs, the existing facilities, and the possible use by visitors, as well as any facility and/or accommodation that falls under the category of wellness, were taken into account.

Not only that, but also the sample’s view was asked, as to whether and how the pandemic would affect the tourism product and to what extent its choices will be affected in future in relation to the new situation.

In order to undertake this research, the quantitative approach was chosen. This type of survey is based on the collection of information resulting from data measurements, which can be either quantitative or qualitative (Constantoglou & Klothaki, 2021). The main survey instrument in a quantitative survey is the structured questionnaire (Creswell, 2011), which was used in this survey and will be presented in the results section. The majority of the questions were closed-ended, and especially belonging to the Likert scale. The reasons that led to the choice of this type of questions were the possibility they provide to the researchers for easy comparison of the answers and their ease of coding. The fact that they do not provide the freedom of answers to the user is mentioned as an important disadvantage of this type of questions (Creswell, 2011) and this is one of the limitations of this study. Prior to the drafting of the final questionnaire, a pilot questionnaire was distributed to 5 visitors of the island, who did not participate in the final survey, in order to identify possible ambiguities and duplications in the questions. Finally, the statistical analysis of the data was implemented with the statistical program SPSS v22., using appropriate Descriptive Statistics instruments.

The questionnaire was created in google forms and sent to the study’s participants by email. Respondents were asked to respond exactly to the same questions, as part of a research strategy, in order to collect descriptive and explanatory data regarding views, attitudes, characteristics, etc. The sample consisted of all age groups, since wellness tourism concerns an extremely large age range, in order to be achieved a broader picture in the examination of results. The limitations encountered relate to the approach of the sample due to the limitations in interpersonal relationships. In the approach of the sample, the contribution of the local tourism market players was considered significant, since they acted as a communication channel on the one hand, and as facilitators of the research on the other, during a time of restrictions, such as the quarantine imposed for health reasons. Considering the aforementioned factor, a sample of 70 people was formed through random sampling using questionnaires, out of a total of 150 questionnaires sent via email.

7 Results

The survey examined a mixed sample of men (37,1%) and women (62,9%), of all age groups (Fig. 3) with a higher percentage (37,1%) of those between 31 and 40 years old. The 45,7% of the sample are married with children (Fig. 4) and the 37,1% of the respondents are single, whereas the majority of the sample (44,3%) have received higher education, while the minority (1,4%) received compulsory education (Fig. 5).

Fig. 3

Age group

Fig. 4

Marital status

Fig. 5

Education

Forty people among the respondents believe that tourism has been severely affected by the pandemic (Fig. 6), while none of them thinks that the industry has not been affected at all.

Fig. 6

The tourism industry has been affected negatively by the pandemic of COVID-19

In the question regarding whether the respondents are aware of wellness tourism, a quite significant percentage of them (34,3%) are not aware of what wellness tourism includes—a fact demonstrating the need for communication and advertising to the general public. Of the 65,7%, who are aware of wellness tourism, the 26,8% of them have opted for such services in the past and those who have no experience of wellness tourism services so far intend to choose a destination providing services such as thermal springs, spas, fitness centers, and resorts promoting both mental and physical health in future (89,2%).

An interesting fact is that tourists intend to travel to Greece by 84,3%, compared to 15,7% that would prefer a destination abroad (Fig. 7)—a fact that highlights the country’s dynamic in the tourism sector, as well as in future tourism development.

Fig. 7

Greece as a wellness destination

The public is ready and willing to receive wellness services, without specific requirements in mind from the destination (41,4%), while 24 people stated that they prefer a remote destination for this purpose (34,3%) (Fig. 8).

Fig. 8

Choosing a destination

Regarding the intention of travel during the season of 2021 (2nd year of the pandemic), 77,1% of the sample intend to travel (Fig. 9).

Fig. 9

Intention of traveling in 2021

As far as the island of Ikaria is concerned, 80% of the sample (Fig. 10) have already visited sites providing wellness tourism services; however, 42,9% are not aware of the facilities existing on the island and only 7,1% knowing them very well (Fig. 11). The need of promoting the island and its services is evident here, in order to strengthen its brand awareness.

Fig. 10

Previous visit in wellness-related sites on the island of Ikaria?

Fig. 11

Awareness of the tourist facilities on the island of Ikaria

About 76,8% agree that Ikaria is a well-known destination, and 44,9% confirm that the island has a good reputation, while 37,7% admit knowing the special features and activities someone can deal with there. However, only 8,7% agree that the level of services provided there is high (Fig. 12).

Fig. 12

Beliefs about the island of Ikaria

When it comes to whether the respondents would suggest others to visit the island (Fig. 13), 58,3% intend to do so, and the 38,3% would visit the island again, while 43,3% express their intention to visit Ikaria even if prices increase. The latter case shows a competitive advantage of this place, as it gathers unique features of interest to a part of the public willing to pay more if they have to in order to visit the island again.

Fig. 13

Intention to repeat the visit in Ikaria in future

Regarding the sample’s thoughts about how the next tourism season will end up on the island, 77,1% of them are optimistic that during the next season, tourism on the island will recover.

About 40% of the respondents express a moderate view on whether the health protocols set by the State affect negatively their accommodation, whereas 5,7% believe that it will not be affected and 14,3% that it will be affected a lot (Fig. 14).

Fig. 14

Beliefs whether the health protocols set by the State affect the accommodation

The majority of the respondents believe that hotel owners will comply to the measures set by the State, in order to prevent the spread of COVID-19, with an only small percentage of them (5,7%) expressing the opposite view (Fig. 15).

Fig. 15

Compliance of the hoteliers to the health protocols set in order to prevent the spread of COVID-19

Considering the staff’s response to the special health and safety conditions, the respondents believe that the staff will respond to the fullest extent (Fig. 16).

Fig. 16

Compliance of the staff to the health protocols set in order to prevent the spread of COVID-19

Not only that, but also the vast majority of the sample believes that the staff will meet quickly the customers’ needs, so that they do not waste extra time due to the procedures imposed by the pandemic (Fig. 17).

Fig. 17

The staff will meet the customers’ needs so as not to waste extra time

The respondents think highly of the staff since they also think in a great percentage that the staff will be able to respond to individuals’ needs while at the same time will meet the requirements of the pandemic (Fig. 18).

Fig. 18

Response of the staff to individuals’ needs

Finally, a mediocre view is expressed regarding whether the facilities of Ikaria have an up-to-date character and whether they meet the expectations of wellness tourists, with only the 7,3% agreeing that facilities on the island of Ikaria are up to date (Fig. 19).

Fig. 19

The facilities on the island of Ikaria are up to date

The island of Ikaria has several thermal springs. One of them, “Apollo”, in the area of Therma, was recognized by the Greek Government as medicinal in 2019, and although the Government voted for a law that promotes the modernization of the hot springs with a simultaneous attraction of private investments, the respondents who are familiar with the tourist facilities of Ikaria do not completely agree or disagree that the infrastructure of the thermal springs has been entirely renovated (Fig. 20).

Fig. 20

The infrastructure of the thermal springs is completely renovated

8 Conclusion

The research carried out on the island of Ikaria demonstrated the need for modernization, communication, and promotion of the island to the general, potential tourist public, and also the need to upgrade the services, so that the tourists enjoy a complete travel experience, which will motivate them to travel again and increase the tourist expenditure, contributing to the overall prosperity and development.

The sample thinks that the pandemic of COVID-19 affects tourism, but believes firmly that the people working in the tourism industry will try to meet the unprecedented needs and requirements.

The island of Ikaria has several natural thermal springs, and one of them, “Apollo”, is recognized by law by the Green government as medicinal, a recognition that adds value to the island. However, the infrastructure of the thermal springs, apart from being functional, could have been more attractive for the general public and compete other destinations that invested in their tourism product. Their landscaping would add value, as the tourist perceives wellness as an overall experience—physical, mental, and visual—concepts completely intertwined.

Recently, the Greek government, taking into consideration that tourism yields a lot of income to the country and that the natural springs are a valuable asset to it, has voted for the establishment of a limited liability company under the name “Thermal Springs of Greece” with the main purpose being the exploitation of the natural resources and springs of the country, as part of the property of the Green State. This company will be responsible for the administration, management, and exploitation of the natural thermal resources and springs, as well as their facilities and the environment around, in a radius of five hundred (500) meters, and the government with this law seeks to promote wellness tourism, a rapidly growing sector with multiple benefits for the tourism economy.

An organized tourism campaign supported by the power of social media, as well as with the help of the state’s promotion of local destinations, will strengthen the tourism economy, which strives to offer quality services again.

The island of Ikaria is able to compete other well-known and well-publicized tourist destinations, and with its unique characteristics, it constitutes an excellent place with unique elements, fully exploitable for tourist purposes.

Finally, it would be of interest for further investigation regarding Ikarian hoteliers and their intention to promote tourism on their island and how familiar they are with the use of the new marketing tools, as well as what the intention of local actors is, in order to modernize and upgrade the tourist infrastructure.