CU-BSC.TTM-SEM-III-(Elective Group-B) Adventure & Wellness- Second Draft

d. Singapore 4. People travelling to others cities for seeking health care is called as a.Out bound tourists b.Inbound tourists c.Domestic tourists d.None of these 5. Traditional form of therapies is a. Ayurveda b. Allopathy c. Siddha d. None of these Answers 1-d, 2-a,3-d,4-c,5-c. 9.12 REFERENCES Reference books/material:  Atkinson, E.T. Himalayan Gazetter, Cosmo Publication, New Delhi, 1993.  Gupta. S.K. (2102) Tourism and Heritage Resources of Garhwal, Kaveri Books, New Delhi.  Bisht, D.S. Garhwal and Kamaon Hills, Trishul Publication, Dehradun,1982.  Bose,S.C.GeographyoftheHimalaya,NationalBookTrust,1976.Kaur, J, Himalayan Pilgrimages and the New Tourism, Himalayan Books,NewDelhi,1985  M. Smith and L. Puczko, Health and wellness tourism, B. Heinemann (2109)  Sonali Kulkarni, Spa and Health Tourism, Book Enclave, Jaipur (2108) 151 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 10: FORMS OF HEALTH TOURISM STRUCTURE 10.0 Learning objectives 10.1 Introduction 10.2 Forms of health Tourism 10.2.1 Medical Tourism 10.2.2. Spa 10.2.3 Ayurveda 10.2.4Yoga & meditation 10.2.5 Holistic 10.2.6 Spiritual 10.2.7 Ashram 10.3 Wellbeing and environment. 10.4 Summary 10.5 Keywords 10.6 Learning activity 10.7 Unit end Questions 10.8 References 10.0 LEARNING OBJECTIVES After learning this unit, the student will be able to  Explain the forms of health tourism  Identify various forms such as spa, Ayurveda.  Recognises the concept of holistic and spiritual  Defines health wellbeing  Analyse about the weather and climate. 152 CU IDOL SELF LEARNING MATERIAL (SLM)

10.1 INTRODUCTION The terms tourism and travel are sometimes used interchangeably. In this context, travel has a similar definition to tourism but implies a more purposeful journey. The terms tourism and tourist are sometimes used pejoratively, to imply a shallow interest in the cultures or locations visited. By contrast, traveller is often used as a sign of distinction. The sociology of tourism has studied the cultural values underpinning these distinctions and their implications for class relation Health & wealth is the renaissance and the great development in the medical field, Health and wellness Tourism pattern has become most viable tourist and development pattern in the Kingdom aided by both natural and those created by the State and the private sector. Under the guidance of his Royal Highness Prince Sultan bin Salman bin Abdelaziz, SCTH President, the Commission has paid particular attention to the development of health and wellness tourism through a number of steps by working with partners in the public and private sectors to provide the right environment and develop its products and services and programs. SCTH has developed specifications, standards and procedures for the health and wellness tourism programs in hospitals, medical centres and health resorts an accommodation, contributing to this valuable tourism program. 1. The packages need to be within a comprehensive tourism program, including the treatment and other services such as travel, accommodation, transportation, and tourism programs for the tourists and their companions. 2. Working with licensed tour operators by the SCTH which deals with the marketing and administration issues. 3. The allocation of a person or department in the medical institutions to be responsible for the administration of the tourism program, in cooperation with the tour operator and in coordination with the tour guide, the institution, the patient or tourist and the departments of the participating institutions. 4. Creation of a website for the institution explaining its potential and services. 5. Participation with the tour operator and other parties in the marketing of the tourism programs in specialized exhibitions and events. 6. Providing assessment and monitoring program to improve the tourism services and programs 7. Arranging agreements between the participating parties through obligatory contracts. 8. Health Tourism: travelling to receive medical treatment in specialized institutions jointly with tourism programs. 9. Wellness Tourism: healthy people travelling to other cities to maintain their physical and psychological health through receiving certain services in specialized institutions. 153 CU IDOL SELF LEARNING MATERIAL (SLM)

10.2 FORMS OF HEALTH TOURISM 10.2.1 Medical Tourism Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually referred to those who travelled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at home. Medical tourism (also called medical travel, health tourism or global healthcare) is a term used to describe the rapidly-growing practice of travelling across international borders to seek healthcare services. Services typically sought by travellers include elective procedures as well as complex surgeries, etc. The main categories in Medical Tourism are:  Outbound Medical Tourism – Travelling from home country to another country/ or crossing borders for seeking treatment is called as outbound medical tourism. E.g., Indians going to Singapore or Malaysia for treatment.  Inbound Medical Tourism – Foreigners from other countries travelling inside our country is called as inbound tourism. E.g., Medical tourists coming India for treatment.  Domestic Medical Tourism – People travelling to a different city for medical treatment within their own country is called as Domestic Medical Tourism E.g. People travelling from Chennai to Hyderabad for seeking medical help. Medical Tourism International Medical Tourism Domestic Medical Tourism Inbound Tourism Outbound Tourism 154 Importance and Benefits of Medical Tourism  Economic Development  Generates healthcare jobs CU IDOL SELF LEARNING MATERIAL (SLM)

 Creates more healthcare facilities in the country  Facilitates to latest technology in the medical sector.  Improves quality of life for people involved.  Knowledge exchange  Foreign revenue generation  Social Benefits  Economic benefits  Political benefits. Reasons for Medical Tourism Abroad  Not satisfied with medical treatment at home country  Long waiting time  Costly  Inadequate medical insurance in home country  Less cost compared to home country  No wait list  Access to latest technology  Greater mobility  Growing popularity of getting medical services abroad. India holds advantage as a medical tourism destination due to following factors:  Most of the doctors and surgeons at Indian hospitals are trained or have worked at some of the medical institutions in the US, Europe, or other developed nations.  Most doctors and nurses are fluent in English.  Top -of-the-line medical and diagnostic equipment from global international conglomerates is available at many Indian hospitals.  Indian nurses are among the best in the world. Nearly 1000 recognized nurses-training centres in India, mostly attached to teaching hospitals, graduate nearly 10,000 nurses annually.  Even the most budget-conscious traveller can afford first-rate service and luxury amenities Healthcare facilities tied up with medical tourism agencies offer aftercare services allowing patients to receive exclusive attention and care during recovering in a relaxed atmosphere. 155 CU IDOL SELF LEARNING MATERIAL (SLM)

Also, medical tourism gives patients a chance to explore new destinations and get wants and needs met. So that medical tourists can hold high-quality healthcare and enjoy travel overseas together for less price than for the only treatment in home countries. In fact, medical tourism facilitators and healthcare providers in some countries seeking to develop medical tourism are encouraged and supported by their host governments, e.g.  India has introduced a special M-Visa category for medical tourists;  Malaysia’s Ministry of Health has formed a special national committee for the promotion of health tourism;  Turkey’s Ministry of Health has recently announced special healthcare program for the promotion of health tourism. These patterns have even contributed to the reversal of the geographical trend of medical tourism: if, in the past, patients from the East were travelling to the West to get high-quality healthcare, nowadays, patients from developed Western countries, travel East, to developing countries for the best medical and technologically advanced health care. So, today such destinations like Mexico, Brazil, Argentina, Costa Rica, Israel, Turkey, India, Malaysia, Singapore, South Korea and Thailand are commonly recognized as a well- established and leading medical tourism hub in the world. The true benefits and advantages of medical tourism that international patients may experience are briefed in the following fact sheet:  Internationally accredited medical facilities using the advanced technologies  Highly qualified Physicians and medical support staff  Significant cost savings compared to domestic healthcare  Medical treatment costs are lower by at least 25-80% when compared to similar procedures in the UK or the USA  No waiting list – immediate access  Fluent native-speaking staff  Patient-focused concept: options for private room, interpreter, personal chef, dedicated staff during patient’s stay and many other tailor-made services  Round-trip travel support – from medical consulting before treatment up to a wide range of travel assistance throughout trip planning such as bookings, visa, transfer, accommodation, personal services and etc. 156 CU IDOL SELF LEARNING MATERIAL (SLM)

 Healthcare may easily be mixed with a holiday / business tri Medical Tourism Issues and Challenges  Follow-up problems  Language Barriers  Lack of Infrastructure  Lack of professionalism  No uniform pricing and standardization  Different law in different country  Organs trafficking Medical Tourism Service Providers Medical tourism facilitators play a major role in making medical travel easy and comfortable. A good medical tourism facilitator provides the following services:  Customized Treatment Packages  Guidance& Support 24*7  Assistance for Medical Visa Letter  Prompt Appointments with doctors  Hassel Free In-Patient Admissions  Money Exchange  Safe accommodation as per Patients Budget  Provision for Local SIM Cards  Eminent Interpreters  Guidance for End-to-End Transportation  Appeasing Tourist Packages  Post Treatment Follow-Ups 10.2.2 Spa Tourism SPA- A non- medical treatment to help body and mind relax and rejuvenate through massage. Spa’s use herbal oils, massage creams, rose water etc for this purpose. Different types of SPA’s  Ayurvedic Spa 157 CU IDOL SELF LEARNING MATERIAL (SLM)

 Boot camp Spa  Club Spa  Mobile Spa  Day Spa  Destination spa  Resort spa  Medical spa  Thermal Spa  Cruise ship spa  Airport Spa  Mineral spring spa Types of Spa treatments  Full-body mud mask: wrapping the whole body with a thick warm mud mask and should kept for 20- 30 min. This whole procedure treatment takes 60 min.  Herbal body wrap: Linen or muslin sheets are heated and soaked in a machine in which herbal pouches or oils have been placed. The body is then covered with towels or rubber sheets, followed by the linen or muslin sheet. Additional sheets and blankets are laid over and the body allowed to rest for 20 minutes. Wet cloths need to be constantly placed on the guests’ forehead. Due to the weight of the sheets, technicians can do no more than four to six wraps a day.  Paraffin body wrap: Paraffin wraps generate heat that helps the body perspire, thereby allowing moisture and previously applied nutrients to be absorbed from the skin surface into the body. The paraffin may be used alone or in conjunction with mud or seaweed.  Full Body Massage: These range from the basic Swedish massage to sports, deep tissue, Shiatsu, aromatherapy, and reflexology massages. They are booked for half an hour or a full hour.  Full-body facial: 158 CU IDOL SELF LEARNING MATERIAL (SLM)

Similar to a facial (hence, the seemingly self-contradictory name), this treatment involves cleaning, exfoliation, steam, massage, mask, and finishing lotion, and is booked for 60 to 90 minutes.  Body tanning /bronzing: Exfoliation is followed by the application of a tanning emulsion.  Water Therapy: Hydrotherapy has become the term for treatments using water for professional purposes. Water has been used as a treatment for various diseases since the times of the ancient Greeks.  Spot Treatment: Spot treatments work on a specific part of the body. They include spa manicures and pedicures; hand and foot treatments; scalp treatments; cellulite, anti-stress, and bust-firming treatments; back treatments and facials.  Exfoliation: Exfoliation involves rubbing, polishing, or scrubbing the skin, or using enzymes on it, to remove dead skin and dirt. Removing dead cells allows the skin to more easily accept moisturisers and other skin treatments.  Ayurvedic Message: Ayurvedic Massage is known as Abhyangam in Sanskrit. According to the Ayurvedic Classics Abhayngam is an important dincharya (Daily Regimen) that is needed for maintaining a healthy lifestyle. The massage technique used during Ayurvedic Massage aims to stimulate the lymphatic system.  Burmese massage: Traditional Burmese Foot Massage, Burmese massage has its ancient origins from Thai, Chinese and Indian medicine. Currently, Burmese massage also includes the use local natural ingredients such as Thanaka, which helps to promote smooth skin and prevents sunburn.  Thai massage: 159 CU IDOL SELF LEARNING MATERIAL (SLM)

Traditional Thai massage (NuadBoran) is generally based on a combination of Indian and Chinese traditions of medicine.  Turkish bath massage: In traditional Turkish baths, massage involves not just vigorous muscle kneading, but also joint cracking. Ashiatsu Japanese Message: In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure.[34] This technique typically uses the heel, sesamoid, arch and/or whole plantar surface of foot, and offers large compression, tension and shear forces with less pressure than an elbow, and is ideal for large muscles, such as in thigh, or for long-duration upper trapezius compressions.  Acupressure Acupressure is a technique similar in principle to acupuncture. It is based on the concept of life energy which flows through “meridians” in the body. In treatment, physical pressure is applied to acupuncture points with the aim of clearing blockages in those meridians. Spa resorts in India specializes in providing effective spa affair, accommodation, diet and other such things that work as a catalyst for sheer rejuvenation. These resort s are mostly nestled amid lush woods so that you can take a leap closer to purest form of nature. But the wellness of Ayurveda is not confined to just Keral a; as Ayurveda was born in India, you can get the best experience of the same in this very country o nly, rather than any other parts of the world. Best Luxury Spas in India Are Ananda in the Himalayas (Rishikesh) An expansive spa spread across 25000 sq. ft. with its 24 treatment rooms, state of the art gymnasium, outdoor temperature-controlled swimming pool and luxurious hydrotherapy facilities is the centre of attention at Ananda. The spa featuring more than 80 body and beauty experiences integrates traditional Indian wellness practices of Ayurveda and Yoga with the best of international wellness experiences at the best destination spa in India. The personalized therapy and activities program are designed to meet individual needs and health goals – de-stress, detoxification and cleansing, deep relaxation, anti-ageing, weight & inch loss, while also offering guidance in the areas of nutrition and active fitness. A team of 160 CU IDOL SELF LEARNING MATERIAL (SLM)

qualified nutritionists, Western & Ayurvedic physicians, spa therapists, Yoga and Fitness experts all gently guide towards a better lifestyle at this Himalayan spa and wellness retreat. Figure: 10.1 Ananda in the Himalayas (Rishikesh) Windflower Hall Spa (Shimla) Set amid cedar forests, with fresh air and a view of snow-capped mountains, the Spa Pavilion at the Oberoi’s Wildflower Hall Resort is a haven of tranquillity. Consistently ranked among the best spas in India and the world, it uses plant and flower essences in its aromatherapy and Ayurveda based treatments. It offers exclusive massage, yoga and Ayurvedic treatments at bespoke locations around the hotel and grounds. Its open-air whirlpool affords magnificent views across the Greater Himalayas, while our indoor pool – lit and adorned by overhead crystal chandeliers – is temperature controlled throughout the year Kaya Kelp- The Royal Spa (Agra) Located on the sweeping plains of Northern India, in Uttar Pradesh, Agra guards the mythic tributary of the Ganges, the Yamuna River. Kaya Kalp – The Royal Spa offers a majestic Mughal mix—a sensuous blend of Persian and Indian treatments. The Royal Spa opened in March 2008 at the ITC Mughal hotel. Measuring 99,000 opulent square feet, it’s one of the largest spas in Asia. Unsurprisingly, the spa quickly won a string of awards. True to its royal name, the design incorporates elements of Mughal landscaping and architecture. The lavish interiors are decorated with stone latticework, mother-of-pearl inlays, marble floors, and ornate mirror-work. The spa also has the first luxury hamam (Turkish sauna) in India. 161 CU IDOL SELF LEARNING MATERIAL (SLM)

Experience the chakra-balancing gemstone treatments, Shirodhara or an Ayurvedic ritual for improving intuition via a delicate rain of oil across the forehead. Essences of pomegranate, lime and ginger comprise The Royal Spa signature oil. ITC Mugal Spa ITC Mughal brings to the city of Agra, Kaya Kalp – the Royal Spa, recreating in today’s context, the opulence and luxurious lifestyle of the Mughal Dynasty. Spread over a vast expanse of more than ninety-nine thousand square feet, this is the largest spa in India and offers therapy based on ancient customs, to create meaningful experiences for the soul. This magnificent oasis of tranquillity, follows Mughal tradition in its extensive use of greenery and water, both important elements in gardens laid out by the Mughal Dynasty. Taj Lake Palace Jive Spa (Udaipur) The Leela Palace has India's only luxury tented spa. It sits amid gardens overlooking Lake Pichola and has elaborate treatment rooms with crystal chandeliers and a private swimming pool. Both Ayurvedic and modern western spa treatments are offered, along with customized well-being programs. The products used in the treatments are made with organic plant extracts and oils from around the world. Yoga and meditation sessions, traditional temple rituals, and healthy spa cuisine are also offered to guests. Taj Malabar Jive Spa (Cochin) The Taj hotel group is known for its Jiva spas, and the out-of-the-world Jiva Grande Spa at the Vivanta by Taj in Bekal is one of the largest. It's spread over a massive 165,000 square feet and is located on the opposite side of the river to the hotel, to provide total seclusion. It offers wellness programs of 3 or more days that include daily yoga sessions, plus massages and a facial. The serene spa offers Ayurveda programs, Indian aromatherapy, scrubs and wraps, and beauty rituals. You are not to get deprived of ultimate spa indulgence even if you are on a budget, as you would be able to find budget spas in India. 162 CU IDOL SELF LEARNING MATERIAL (SLM)

10. 2.3 Ayurveda Tourism Figure: 10.2 Ayurvedic treatment Ayurveda is a trustworthy medicinal system as it has no record of causing any side - effects, in the cases treated by professionals. There have also been cases where even the mainstream medical science gave up, but Ayurveda treated. The Chinese and Tibetan systems of medicines are derived from the teachings of Ayurveda. Indian spas not merely provide a healthy treatment and massage but also masters in diet, lifestyle routine and other such aspects. Ayurveda was evolved from India around 5000 BC. It is closely associated with the wellness of body, mind and soul. India has become the most preferred wellness destination of the world due to the presence of rich natural resources, ashrams, meditation centres and world- famous spas. According to the Global Spa Summit Report 2011, spas are the backbone of the wellness tourism sector and the concept of wellness is incomplete without the involvement of spa. This study would examine the role played by spa resorts in promoting India as a wellness tourist destination. Ayurveda is an Indian practice of medicine that dates back to more than 4000 years. It’s an age-old medical practice which is still widely popular and practiced in India. The word Ayurveda is composed of two Sanskrit words- Ayu meaning ‘life’ and Veda meaning ‘knowledge’. Therefore, meaning of Ayurveda translates into ‘knowledge of life’. Ayurveda as a medical practice augments or uses natural processes of the body to treat or prevent diseases and to rejuvenate the physical, biological and mental state of the person. It makes use of natural products from plants, animals, and metals like gold, silver iron etc for treatment of ailments. As the word about Ayurveda has reached the West, more and more tourists are flying to India to benefit from the goodies of Ayurveda. It has now given birth to Ayurveda tourism to India. Being birthplace of Ayurveda, India stands as a trusted place to get Ayurveda treatment. Apart from getting treated, foreigners take back home a number Ayurvedic products and 163 CU IDOL SELF LEARNING MATERIAL (SLM)

medicines. The simplicity and pureness of Ayurveda is luring foreigners from all over the world to India. Ayurveda Valley is the most trusted name by foreigners for getting Ayurveda treatment in India. Figure: 10.3 Ayurvedic Massage Benefits of Ayurveda The benefits of Ayurveda are numerous and far ranging. It not only involves medicines but yoga and meditation too. The distinctive feature of this treatment discipline is that no harmful chemicals are used. Whatever is used for treatment comes from a natural source; plant or animal and the medicines rely on the natural capacity of body to heal and rejuvenate it. It relies on the Chakras and internal energies of the body. Thus, it eliminates any possibility of side-effects which are very common in traditional medicine. Ayurveda in itself is a complete treatment regime for diseases as well as a rejuvenation therapy. Many physicians recommend use of Ayurveda alongside with the traditional treatments for faster recovery. This practice is very common when it comes to treating skin ailments, gastrointestinal diseases and breathing problems. Ayurveda is not only being used for treating diseases but also as an add-on therapy to accelerate recovery, healing body functions and detoxification. It is also being used to relax the body and mind of the stress by simple oil massages or Ayurvedic spas. Ayurveda has proved to be exceptionally good foreskin care, acne and skin diseases. It’s a holistic treatment approach assuring you peace of body and the soul. Ayurveda valley And Ayurveda Today Ayurveda has become one of the most sought-after attractions in India by visitors and 164 CU IDOL SELF LEARNING MATERIAL (SLM)

so it becomes important for the visitors to choose an authentic Ayurveda treatment provider. Ayurveda Valley and Ayurveda have become almost synonymous in India. The southern state of Kerala is considered as hub of Ayurveda in India, but it cannot be in the itinerary for every traveller coming to India. So, Ayurveda Valley provides for certified and authentic Ayurveda treatment centers in all major cities of India. Operating from Bangalore, Ayurveda Valley has its Ayurveda treatment centers in Bangalore, Hyderabad, Kerala, Delhi, Jaipur, Goa, Chennai, Hyderabad and many more. With us you don’t have to exclusively travel to Kerala to get Ayurveda treatment. You just need to step into any of our Ayurveda treatment centers in India or give us a call; we will pick you up. You can avail from a number of treatment packages suiting to your needs and stay in India. Figure: 10.4 Ayurveda treatment at Hyderabad Ayurveda is one of the world’s oldest medical systems that originated in India. The practice has two-fold aims:  To maintain the health of a healthy person, rejuvenate, purify and prevent diseases  Heal the ailment of the patient Ayurveda in Sanskrit means \"Knowledge of Life\" (Ayur - lifespan, and Veda-knowledge). The basis of this medical form is solid Indian writings of old, compiled over a 2 century period between 1500 BC and 400 AD, when many experts put down their observations and experiences. India being the home to this form of treatment offers many exciting therapeutic and rejuvenation packages. Experience healing and rejuvenation through this ancient form run by 165 CU IDOL SELF LEARNING MATERIAL (SLM)

India’s accredited centres with all modern amenities in natural settings to make your stay a memorable one. Ayurveda Treatment Overview Figure: 10.5 Ayurvedic Treatment in Kerala Ayurvedic Offerings Therapeutic Rejuvenation Dhara Kayakalpa Chikitsa Sirovasti Sweda Karma Pizhichil Body Slimming Udvarthanam Beauty Care Marma Chikitsa Meditation and Yoga Nasyam Panchakarma Treatment Karnapooranam Tharpanam 166 CU IDOL SELF LEARNING MATERIAL (SLM)

Njavarakizhi Therapeutic Dhara Treatment for chronic headaches, insomnia, mental tension and cases of hysteria, hallucination and insanity Snehapanam Treatment to alleviate osteoarthritis, leukaemia etc Sirovasti Treatment for dryness of nostrils, mouth and throat, severe headaches, facial paralysis and burning sensation in the head Pizhichil Treatment for spondylosis, rheumatic diseases like arthritis, paralysis, hemiplegia, nervous weaknesses and nervous disorders Udvarthanam Treatment for diseases like hemiplegia, paralysis, obesity and certain rheumatic ailments MarmaChikitsa Treatment for musculoskeletal ailments due to trauma or accidents Nasyam Treatment for nasal ailments Karnapooranam Treatment for ear ailments Tharpanam Preventing cataract and strengthening vision Njavarakizhi Treatment for wasting of muscles, rheumatism, sports injuries, pain in the joints, emaciation of the body or parts of the body and certain kinds of skin diseases Kashayadhara Treatment for skin Rejuvenation Kayakalpa Chikitsa Body immunisation and longevity treatment Sweda Karma Body Sudation 167 CU IDOL SELF LEARNING MATERIAL (SLM)

Thaulyakna Chikilsa Body Slimming Beauty care Herbal face pack, herbal oil massage, intake of herbal tea etc. improves complexion and beautifies the body Meditation and Yoga Mental and physical well being Panchakarma A five-fold treatment for mental and physical well-being - tunes the Treatment body, organs, mind, breath, nerves and purifies the blood Figure: 10.6 Ayurvedic treatment for bones. Principles of Ayurveda Health care is a highly individualized practice under Ayurvedic principles, which state that everyone has a specific constitution, or prakriti, that determines his or her physical, physiologic and mental character and disease vulnerability, according to Dr. Bala Manyam, a neurologist and professor emeritus at Southern Illinois University School of Medicine. Prakriti is determined by three \"bodily energies\" called doshas, Manyam told Live Science. There are three basic doshas, and though everyone has some features of each, most people have one or two that predominate, according to the University of Maryland Medical Center: Pitta energy is linked to fire, and is thought to control the digestive and endocrine systems. People with pitta energy are considered fiery in temperament, intelligent and fast-paced. When pitta energy is out of balance, ulcers, inflammation, digestive problems, anger, heartburn and arthritis can result. Vata energy is associated with air and space, and is linked to bodily movement, including breathing and blood circulation. Vata energy is said to predominate in people who are lively, creative, original thinkers. When out-of-balance, vata types can endure joint pain, constipation, dry skin, anxiety and other ailments. 168 CU IDOL SELF LEARNING MATERIAL (SLM)

Kapha energy, linked to earth and water, is believed to control growth and strength, and is associated with the chest, torso and back. Kapha types are considered strong and solid in constitution, and generally calm in nature. But obesity, diabetes, sinus problems, insecurity and gallbladder issues can result when kapha energy is out of balance, according to Ayurvedic practitioners. 10.2.4 Yoga & Meditational Tourism Yoga tourism is a journey of self with trans- formative capacities on physical, psychological, spiritual, and social awareness. Together they integrate mind, body, and spar. Yoga tourism is travel with the specific purpose of experiencing some form of yoga, whether spiritual or postural. The former is a type of spiritual tourism; the latter is related both to spiritual and to wellness tourism. Figure: 10.7 Ayurveda Massage Ayurveda, which literally means the science of life (Ayur = Life, Veda = Science), Ayurveda is an ancient medical science which was developed in India thousands of years ago. Believed to have been passed on to humans from the Gods themselves, Ayurveda developed and evolved into what it is today from several ancient treatises, most notably Adharva Veda which dates back to five thousand years. The ancient Vedic literature by sages has clearly laid out instructions to maintain health as well as fighting illness through therapies, massages, herbal medicines, diet control and exercise. Kerala, The Land of Ayurveda. 169 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure: 10.8 Kerala traditional Massage Kerala owns a non detachable tradition of Ayurveda that has surpassed the many attacks and intrusions both in land and foreign. For about many centuries the Ayurveda Vaidya’s (traditional practitioners of Ayurveda) were almost the only opening for people needs curing from every kind of ailments in Kerala. The mastery over the legacy of eight families of Vaidya’s (Ashtavaidyas) and their followers treated the whole state for hundreds of years. Likes the other Indian states, the position of Ayurveda in Kerala is not substitution but mainstream. As a matter of fact, today Kerala is the only State in India which practices this rishi medicinal science with utmost commitment. Being the only sector of treatment or the people, the Vaidya’s of Kerala were in task to describe the theories of Ayurveda and adjoin them actively in to fruitful healing systems in everyday life. Thus the majority of the contemporary proceedings and protocols of Ayurveda have enlarged in and around Kerala. The Advantages of Ayurveda In Kerala Figure: 10.9 Treatment in Kerala. Ashtangahridayam, the authorized user friendly voracious text of Ayurveda, compiled by the Vagbhatananta is seldom used anywhere in the world as it is vastly done in Kerala. The Vaidya’s of Kerala are extra talented in this most ancient treatise of Ayurveda which many 170 CU IDOL SELF LEARNING MATERIAL (SLM)

scholars prefer an innovation over the prior Samhitas of Charka and Sushruta, the originators of Ayurveda. It is in Kerala that Kashaya Chikitsa (treatment with concoction) has come to be as a ranked protocol including hundreds of Kashayams that were scientifically categorized and organized in accordance with several treatment needs. Keralite Vaidya’s were the first to concentrate on the anti-oxidant properties of Abhyangam leading to the profusion of Kizhis. The vast volume of Ayurveda colleges and the largest number of practitioners in comparison to any region in the world has led to a tradition of Ayurveda research in a scientific and ideal manner in Kerala. Ayurveda at Somatheeram Ayurveda is the soul and essence of Somatheeram, which has been providing Ayurvedic treatment the traditional way for more than 20 years and has rightfully earned the name ‘The Ayurveda People’. Treatments at Somatheeram take place under the supervision of qualified doctors and well-trained therapists in hygienically maintained environs. The herbal garden with more than 600 varieties of herbs provides the ingredients for various Ayurvedic medicines made with due care and diligence at Somatheeram’s own medicine manufacturing unit. At Somatheeram, a range of treatments and therapies are offered including basic massages, Pizhichil, Njavarakizhi, Sirodhara, Vasthi, Sirovasthi, Udvarthanam, Abhyangam, Nasyam, Thalam etc. Yoga enhances wellbeing of the body and mind. In addition to having an Ayurvedic experience, enjoying a great holiday in the sunny beach is a special advantage at Somatheeram. In simple words, a complete makeover for the body and soul is what this Ayurvedic Hospital with a Resort ambiance is all about. And for the keen student of Ayurveda various courses are taught at Somatheeram by experts. 10.2.5 Holistic Tourism Holistic tourism has become a new and alternative form of tourism and an important trend among tourists who seek programs and experiences that would allow them to achieve balance between mind, body and soul. Choosing holistic tourism means that a tourist can enjoy a different and full experience which goes beyond the simple contact with cultures, people, places or landscapes. It focuses on self-transformation and on an attempt of people understanding more about themselves. It is crucial we understand each person´s view about this new type of tourism since this perspective will surely bring potential new investors to this product. Knowing what every tourist value, feels and needs- in terms of personal fulfilment- can turn this new type of tourism into a competitive one. The results allowed a better understanding of the holistic tourists’ characteristics, their main motivations, self- image perception and satisfaction levels while taking part in holistic tourism. Tourism is an industry that truly contributes to the economic growth of a country. But it is also a socio-cultural phenomenon with great importance in the study of modern 171 CU IDOL SELF LEARNING MATERIAL (SLM)

Nowadays, tourists seek new living experiences and not merely a simple contact with cultures, people, landscapes and/or places any more. They are also focused on their self- transformation and on being part of a spiritual experience Holladay & Ponder. Tourism is a spiritual journey Wilson and journeys can be ways of spiritual tourism. So, the spiritual dimension is part of new forms of tourism: wellness or holistic tourism are some of these new forms. In the last decades, holistic tourism has gained strength in the modern world with tourists pursuing programs and experiences that they believe will bring balance to their lives. This growth is mainly due to the current human desire to focus on the “I” and on wellbeing Wang. The desire to escape their routine, to disappear for a while to find one’s inner self. Holistic tourists represent a new segment for touristic spiritual experiences. Tourists seek a holistic harmony between body, spirit and mind. Some researchers define this new tourism as a high-level wellbeing product. In fact, holistic tourism is considered one of the most prospective tourism markets in the wellness industry representing about 6% (524.4 million) of all domestic and international trips and 14% ($438.6 billion) of the money spent in that market. According to projections, this market is expected to grow by more than 9% per year throughout 2017, nearly 50% faster than what can be expected in the other tourism contexts. Holistic tourists’ main goals are to preserve or promote their body, mind and spirit health. They usually stay in specialized hotels or resorts that provide professional care, counselling and expertise similar to those wellbeing tourists are known to expect. Some resorts and spas are exploring this high-profile market offering expensive and luxurious packages to improve health (body), provide relief from pain and stress (spirit), and educate towards a wellbeing concept in life (mind). In addition, some destinations are revitalizing themselves, searching for uniqueness and distinction, establishing their image and offer in this “growing global leisure‐based and self‐conscious fitness lifestyle”. Besides its growing importance, holistic tourism has been poorly studied, studies have focused on the wellness market and specifically on the holistic tourism. The studies that focused on how the spiritual movement influences tourists’ motivations and experiences are scarce. So, the aim of the present study is to fill this literature gap and to deepen the knowledge about this new form of tourism. This study also brings insights for holistic destination managers that will help them to explore this new luxury market as they will understand holistic tourists’ motivations, self- image and satisfaction levels. 10.2.6 Spiritual Tourism Spiritual tourism is to travel to find purpose and meaning to your life. It elevates your physical, mental, and emotional energies. It develops, maintains, and improves your body, mind, and spirit. In a nutshell, it connects your body, mind, and soul. Hence, spiritual tourism can be defined as traveling on pilgrimage to acquire enlightenment, entertainment, and 172 CU IDOL SELF LEARNING MATERIAL (SLM)

education to leave your footprints and take your memories back to your home by expressing your gratitude to God. Figure: 10.10 Spiritual Tourism India. Spiritual tourism is not connected with any specific religion. It is different from religious tourism. Spiritual tourism is to connect your body, mind, and soul while religious tourism is to seek blessings from God based on your religious faiths and beliefs and attain salvation. Spiritual tourism is a broader perspective than religious tourism. Religious tourism is a subset of spiritual tourism. The Significance of Spiritual Tourism Spiritual tourism falls in the services sector. It increases employment opportunities and contributes to a nation’s GDP growth. There are innumerable advantages of spiritual tourism. It brings inner peace and happiness. It provides purpose and meaning to your life. It encourages local cultures and their traditions. It protects their natural gifts, talents, and arts. With the rapid growth in technology, there is more disturbance to locals and natives. But with increased spiritual tourism, there are opportunities to protect the nature and the natural talents of local communities. The local communities are fortunate to see various people and observe their cultures, and customs by staying in their native places. They feel empowered because they take pride in their cultures and customs. They become more interested to protect their history, traditions, and environment. They become more engaged and integrated with mainstream society. Spiritual tourism encourages foreign investment indirectly as tourists bring foreign exchange. However, there are several demerits with spiritual tourism. It increases sexual exploitation and crimes. It destructs nature and disturbs the ecology. Overall, the merits outnumber the demerits. Hence, spiritual tourism must be encouraged to enhance empathy, compassion, peace, and prosperity. 173 CU IDOL SELF LEARNING MATERIAL (SLM)

There is a growing number of employees globally going for spiritual vacations. It helps them reflect and acquire peace, solitude, and relaxation. It improves their decision-making and leadership abilities and skills. Journeys can be regarded as “spiritual” When contemplating spiritual tourism, there is an inclination to just include those journeys that correspond to one’s personal understanding of spirituality. The following can be subsumed under the heading: Figure: 10.11 Spiritual tourism in India 10.2.7 Ashram Tourism An Ashram is a place for practicing Yoga, Meditation and other spiritual practices to evolve and grow spiritually. Ashrams are typically set outside a village or town in a quiet and peaceful area. They consist of only basic facilities with living quarters, dining hall, Yoga hall, library and gardens. An Ashram is an oasis of serenity and calmness. There is no place or need for luxury in an Ashram. The purpose is to go back to the basics and become independent from regular habits, patterns and indulgences. Traditionally an Ashram is the home of a spiritual master or teacher who lives there with his family. People visit the Ashram to seek guidance and spiritual wisdom. Visitors that stay at an Ashram become a part of the teacher’s family. They follow the daily routine of the Ashram and help with chores while pursuing their spiritual goals. Ashrams were originally founded as Indian hermitages or places of seclusion, and remain so today. Ashrams still play a very important role in the traditional Indian culture. Up until about 100 years ago, Ashrams also served as the place to provide basic education for children. In recent years, and especially over the past few decades, the concept of an Ashram 174 CU IDOL SELF LEARNING MATERIAL (SLM)

has spread across the world, and Ashrams have become more accessible to tourists and visitors from abroad. Spirituality is an integrated part of the Indian culture, and so too are regular visits to temples and Ashrams. In India it is an inherent belief and a deeply internalized concept that, Spirituality is an essential part of the daily life in India. People in India grow up with the ideas of self-awareness and self-development. The concepts of spiritual evolvement and enlightenment are taught from an early age. The concept of an Ashram is in fact quite special. It can be compared to a monastery, but the comparison falls short as Ashrams are not only the residing place of monks, saints and spiritual teachers, but are also open and accessible to anyone and everyone. People from all backgrounds, ages and beliefs can visit and stay at an Ashram for any period of time. The teacher helps and welcomes them regardless of their beliefs and faith. Many people want to grow and live spiritually, but they do not want to become a monk and leave everything and everyone in their lives. Ashrams provide a middle ground, giving people the opportunity to escape their daily routines and temporarily relinquish regular dependencies and addictions. During this pause, balance can be brought back to one’s life and one can learn and strive to maintain that balance upon return to daily ‘normal’ life. The lifestyle at an Ashram is for the most part very different from the one you are used to back home. You wake up early with the rising sun, practice breathing exercises, meditate, sing chants to release emotions, eat simple food, practice Yoga Asanas to improve the condition of the body, and discuss philosophies to open the mind. Throughout the day, you follow a strict routine in a basic setting without any distractions. This simplicity helps us understand the importance of the things in life we generally take for granted. It also helps us reflect on our mental conditioning, our habits and our addictions, which we sometimes confuse for necessities. Most suffering in the present Western and Westernized civilizations are connected to stress, an imbalance between emotion and logic, and an overall lack of discipline. Yoga Ashrams provide a safe space, free from distractions and routines of daily life, and the chance to get rid of excess emotional and material baggage. Visitors come back to themselves and reflect on the true purpose and meaning of their life. 175 CU IDOL SELF LEARNING MATERIAL (SLM)

One must be careful when choosing an Ashram. An authentic Ashram is non-sectarian in nature. An Ashram does not teach or preach any particular religion, faith or guru. A true Ashram only promotes a healthy lifestyle and self-awareness through self-discipline and reflection. The Ashram experience can be intimidating, but ultimately, it will give you a clear sense of priority and importance of things in your life. For those seeking peace, personal insight, and a break from routine, finding an Ashram may be precisely what the doctor ordered. Staying at yoga ashrams in India: What is ashram life? There are many types of ashrams in India, with spiritual gurus who are well-known or said to be mystical healers. The Sivananda Trivandrum ashram was a gem of a yoga retreat in Kerala, secluded in the 12-acre fold of a tropical wildlife preserve. At night, I was lulled to sleep by the sounds of crickets, weird night animals and the husky deep heaves of tigers in mating-heat (not kidding). This yoga ashram in India offered an all-inclusive stay with two daily yoga sessions, clean dorm accommodations, exquisite meditation halls dressed in Hindu mythology, two vegetarian meals a day and unlimited filtered drinking water. It also has a Ayurvedic doctor and massage room, where a lady rubs warm oil over your body as Ayurvedic treatment. (You have to wash it off with chickpea mix. It’s a little grease but an interesting new experience). Most people know Sivananda as a yoga teacher training center (Read How to Choose a School in India for your YTTC) . But if you’d just like to further your yoga practice, learn about Ayurvedic practices or experience a deeper spiritual cleansing, then Sivananda yoga ashrams offer a lot. The campus bore amazing facilities that were geared towards western travellers. My every western need was conveniently provided for. This makes a monumental difference when you’re in India. The rigors of travel are often rife with the obstacles of food/water safety and sanitation. Ease is a luxury that’s hard to come by here. India has always been a popular destination with spiritual seekers who flock to the country's many ashrams. Every ashram is different though, so which one to choose? This guide to popular ashrams in India will give you some ideas as to what's on offer. 176 CU IDOL SELF LEARNING MATERIAL (SLM)

Art of Living Ashram Founded in 1982 by Sri Sri Ravi Shankar, the Art of Living is renowned world-wide for its stress-elimination and self-development programs based mainly on breathing techniques, meditation and yoga. The Art of Living as a voluntary organization also undertakes various initiatives aimed at uplifting humanity and enhancing the quality of life. The foundation course at the ashram is the three day Art of Living Part I residential workshop. You'll learn revitalizing breathing techniques to restore the natural rhythms of body and mind.  Where: In the Panchagiri hills, 36 kilometres southwest of Bangalore, near Udipalya village.  Courses: Art of Living I & II, yoga, meditation, Vaastu Shastra, Vedic math, and youth training courses. Osho International Meditation Resort Osho was perhaps India's most controversial spiritual leaders due to his views about sex. The Osho ashram no longer holds workshops calling for undressing, and free love isn't encouraged. Yet, unlike many ashrams, there's no gender segregation anywhere at the Osho ashram. The ashram, which is more like a resort, aims to provide a luxurious environment where people can be at ease with themselves. Despite the compulsory wearing of maroon robes, it's commercial and far removed from Indian culture. Courses are mostly directed at healing from traumatic experiences, rather than personal development.  Where: Pune, Maharashtra (4 hours from Mumbai).  Courses: Active meditations (including jumping and screaming), Tantra workshops, plus a huge range of multi-diversity courses. Isha Foundation Ashram The Isha Foundation is a non-profit organization, founded by Sadhguru Jaggi Vasudev in 1992. Its purpose is to foster people's spiritual and physical wellbeing through yoga and outreach programs, such as environmental rejuvenation. The core of the Foundation's activities is a customized system of yoga called Isha Yoga. The 3-7 day introductory program, known as Inner Engineering, introduces guided meditations and a powerful inner energy process for deep inner transformation.  Where: Isha Yoga Center, at the base of the Velliangiri Mountains in Tamil Nadu. 177 CU IDOL SELF LEARNING MATERIAL (SLM)

 Courses: Inner Engineering, Hatha yoga, yoga for children, advanced meditation programs, sacred treks, mind and body rejuvenation retreats based on Ayurvedic principles. Mata Amritanandamayi Ashram Fondly known as the \"Hugging Mother\" or \"Amma, the Mother of All\", Sri Mata Amritanandamayi Devi envelopes devotees with her love. She focuses her attention on trying to overcome the lack of love and compassion in the world, and devotees are particularly attracted to her for her comforting embraces. Free public darshans (audiences) are held with Amma at around 10 a.m. on Wednesdays, Thursdays, Saturdays and Sundays.  Where: The Amritapuri Ashram is in Kollam, Kerala. 110 kilometres north of Trivandrum.  Courses: Integrated Amrita Meditation Technique (a 20 minute combination of yoga, pranayama, and meditation). Morning and evening mediation, prayers, and service are all part of the ashram life. Sri Ramana Maharshi Ashram The teachings of modern sage Ramana Maharshi are based on a process of self-inquiry, which he initiated at the age of 16 in 1886. After realizing that his real nature was \"formless, immanent consciousness\", he left his family home and traveled to holy Mount Arunachala, where he remained for the rest of his life. The core of his teachings can be found in a booklet called, \"Who Am I?\" It contains instructions that come from his direct experience of self- realization. Free accommodations and food are provided to devotees who wish to practice his teachings at the ashram.  Where: Tiruvannamalai, 200 kilometres southwest of Chennai, in Tamil Nadu.  Courses: The ashram has a daily schedule of activities including puja (worship), Vedic chanting, and group readings. Sri Aurobindo Ashram Founded in 1926 by Sri Aurobindo and a French woman known as The Mother, the Sri Aurobindo Ashram has grown into a diversified community with thousands of members. The ashram sees itself as working towards the creation of a new world, a new humanity. If you're looking for a quiet haven of retreat, this isn't the right ashram for you. It's \"a vibrant center of life in a modern urban setting\". There's no renunciation of the world there. Everyone spends time each day in one or another of the Ashram's 80 departments. 178 CU IDOL SELF LEARNING MATERIAL (SLM)

 Where: Pondicherry, 160 kilometres south of Chennai.  Courses: Collective meditations are held, but there are no prescribed practices, rituals, compulsory meditations, or systematic instructions. ISKCON The International Society for Krishna Consciousness (ISKCON) is commonly known as the Hare Krishna movement. It's based on the teachings of Lord Krishna and is a branch of Hinduism known as Gaudiya Vaishnavism, which was started in the 16th century by spiritual leader Chaitanya Mahaprabhu. ISKCON was not founded until much later, by Bhaktivedanta Swami Prabhupada, in 1966. The Bhagavad Gita is one of the main texts used. Devotees practice bhakti yoga, which involves dedicating all thoughts and actions towards pleasing God (Lord Krishna).  Where: There are centers all over India. The world headquarters are in Mayapur, West Bengal. Other popular centers are in Delhi, Mumbai (Maharashtra), Vrindavan (Uttar Pradesh), Bangalore (Karnataka). Do note that although both sexes are welcome, ashram facilities are mostly provided for men, as women are not encouraged to live an ascetic lifestyle in the temples. Guesthouses are available though, for short-term stays.  Courses: Daily activities include worship, classes on the Bhagavat Gita, celebration of religious festivals, and lectures on spiritual topics. Ramakrishna Mission Ramakrishna Mission is a religious movement that's based on the teachings of Sri Ramakrishna. It was founded by his chief apostle, Swami Vivekananda, in 1897. The teachings follow the system of Vedanta, which combines both Hindu religion and philosophy. The belief is that every soul is potentially divine, and this divinity can be manifested through work, meditation, knowledge and devotion to God (the four Yoga’s). All religions are recognized and honored, as they are considered to be different paths to the same reality.  Founded in 1982 by Sri Sri Ravi Shankar, the Art of Living is renowned world-wide for its stress-elimination and self-development programs based mainly on breathing techniques, meditation and yoga. The Art of Living as a voluntary organization also undertakes various initiatives aimed at uplifting humanity and enhancing the quality of life. The foundation course at the ashram is the three day Art of Living Part I residential workshop. You'll learn revitalizing breathing techniques to restore the natural rhythms of body and mind. 179 CU IDOL SELF LEARNING MATERIAL (SLM)

 Where: In the Panchagiri hills, 36 kilometres southwest of Bangalore, near Udipalya village.  Courses: Art of Living I & II, yoga, meditation, Vaastu Shastra, Vedic math, and youth training courses.  Osho was perhaps India's most controversial spiritual leaders due to his views about sex. The Osho ashram no longer holds workshops calling for undressing, and free love isn't encouraged. Yet, unlike many ashrams, there's no gender segregation anywhere at the Osho ashram. The ashram, which is more like a resort, aims to provide a luxurious environment where people can be at ease with themselves. Despite the compulsory wearing of maroon robes, it's commercial and far removed from Indian culture. Courses are mostly directed at healing from traumatic experiences, rather than personal development.  Where: Pune, Maharashtra (4 hours from Mumbai).  Courses: Active meditations (including jumping and screaming), Tantra workshops, plus a huge range of multi-diversity courses.  The Isha Foundation is a non-profit organization, founded by Sadhguru Jaggi Vasudev in 1992. Its purpose is to foster people's spiritual and physical wellbeing through yoga and outreach programs, such as environmental rejuvenation. The core of the Foundation's activities is a customized system of yoga called Isha Yoga. The 3-7 day introductory program, known as Inner Engineering, introduces guided meditations and a powerful inner energy process for deep inner transformation.  Where: Isha Yoga Center, at the base of the Velliangiri Mountains in Tamil Nadu.  Courses: Inner Engineering, Hatha yoga, yoga for children, advanced meditation programs, sacred treks, mind and body rejuvenation retreats based on Ayurvedic principles.  Fondly known as the \"Hugging Mother\" or \"Amma, the Mother of All\", Sri MataAmritanandamayi Devi envelopes devotees with her love. She focuses her attention on trying to overcome the lack of love and compassion in the world, and devotees are particularly attracted to her for her comforting embraces. Free public darshans (audiences) are held with Amma at around 10 a.m. on Wednesdays, Thursdays, Saturdays and Sundays.  Where: The Amritapuri Ashram is in Kollam, Kerala. 110 kilometres north of Trivandrum.  Courses: Integrated Amrita Meditation Technique (a 20 minute combination of yoga, pranayama, and meditation). Morning and evening mediation, prayers, and service are all part of the ashram life. Health and Environment 180 CU IDOL SELF LEARNING MATERIAL (SLM)

The environment can directly and indirectly impact on our health and wellbeing. Environmental health examines the interaction between the environment and our health. We use the following definitions:  Environmental health refers to aspects of human health (including quality of life) that are determined by physical, chemical, biological, social and psychosocial factors in the environment.  Environment broadly includes everything external to ourselves, including the physical, natural, social and behavioural environments.  Health is a state of complete physical, mental and social wellbeing, and is not merely the absence of disease or illness. Why is the environment important for health? We need safe, healthy and supportive environments for good health. The environment in which we live is a major determinant of our health and wellbeing. We depend on the environment for energy and the materials needed to sustain life, such as:  clean air  safe drinking water  nutritious food  Safe places to live. Many aspects of our environment – both built and natural environment – can impact on our health. It’s important that we interpret health issues in the wider context of our environment and where we live 181 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure: 10.12 Health and well-being in neighbourhoods. Health effects related to the environment Many aspects of the environment can affect our health. Environmental hazards can increase the risk of disease, including cancer, heart disease and asthma [2]. Table 10.1 gives examples of how different aspects of the environment can affect our health. Table 10.1: Environmental exposures and related human health effects Environmental exposure Examples of health effects Outdoor air pollution Respiratory conditions, cardiovascular disease, lung cancer Unsafe drinking water Diarrhoeal (gastrointestinal) illnesses Contaminated recreational Diarrhoeal (gastrointestinal) illnesses; eye, ear, nose and throat water infections Mosquitoes, ticks and Malaria, dengue fever, Rickettsial disease other vectors 182 CU IDOL SELF LEARNING MATERIAL (SLM)

Environmental exposure Examples of health effects UV (ultraviolet light) Too much: melanoma, non-melanoma skin cancer, eye cataracts exposure Too little: vitamin D deficiency, leading to rickets, osteoporosis and osteomalacia Second-hand smoke In infants: low birthweight, sudden unexpected death in infancy exposure (SUDI) In children: asthma, lower respiratory infections, middle ear infections In adults: ischaemic heart disease, stroke, lung cancer Household crowding Infectious diseases, including lower respiratory infections Cold and damp housing Excess mortality Climate change Infectious diseases, including giardiasis, cryptosporidiosis and salmonellosis; heat stroke Hazardous substances Poisoning, burns, dermatitis Lead In children: developmental delays, behavioural problems In adults: increased blood pressure Asbestos Breathing difficulties, lung cancer, mesothelioma Noise Hearing loss, cardiovascular problems, insomnia, psychophysiological problems Indian Cities Having Pleasant Weather India is generally associated with extremely hot and humid temperatures but the sheer vastness of this land gives way for a lot of serene places. A pleasant climate would mean not too hot and not too cold, the perfect balance between the two. India is diverse in terms of weather with hot humid tropical temperatures to cold sub-zero temperatures. However, there are a handful of cities with best weather in India, and we are here to highlight them for a pleasant holiday. So, if you have never visited India before check out tips for first 183 CU IDOL SELF LEARNING MATERIAL (SLM)

time travellers. Most of them are South Indian states as the lower half of the country experiences less extreme weather conditions compared to the North. Belgaum: The Sleepless City Located in the Northwest part of Karnataka is this quaint little city of Belgaum. The city stands at an elevation of over 2500 feet giving it an average annual temperature of not more than 75 degree Fahrenheit. The monsoons are filled with rain and the summer temperature peaks at 96 degree Fahrenheit. This is one of the cities with best weather in India and experiences a serene climate throughout the year. Nashik: The Wine Capital of India An ancient holy city in Maharashtra, Nashik is situated at the foothills of the Western Ghats. This city experiences temperatures ranging from 77 to 95-degree Fahrenheit. At an elevation of 9,300 feet above sea level, Nashik is one of the highest elevated cities in the country. The monsoon rains are relatively moderate and the summer sees a maximum of 95 degree Fahrenheit. Hyderabad: The City of Pearls The capital city of the brand-new state Telangana, Hyderabad is associated with scorching hot summers. It is true that Hyderabad faces hot summers but compared to other cities in India it is truly a relief. Even if it does there are plenty of weekend getaways from Hyderabad to beat the heat. It is also one of the safest cities from natural disasters, keeping its climate under control as well. This city rarely sees extreme climate changes and maintains a consistent mellow weather throughout the year. Hyderabad is without a doubt one of the cities with best weather in India. Pune: Oxford of the East The Oxford of the East, Pune is a small city in the state of Maharashtra with consistently pleasant weather throughout the year. The average temperature ranges from 70 to 86 degree Fahrenheit. With an elevation of 1,800 feet above sea level, Pune retains a likeable climate. The monsoon is not too harsh but the summers can get quite hot but once the sun sets the temperature drops. If you are still a bit doubtful about traveling to a new city give the Pune Travel Guide a read Nainital: The Lake City 184 CU IDOL SELF LEARNING MATERIAL (SLM)

A resort town in the Kumaon region of India’s Uttarakhand state, Naintal is a haven for perfect temperatures. Almost 7,000 feet above sea level, this formerly British hill station is gifted with the perfect weather. The only time Nainital’s weather gets a bit unbearable is during the monsoon months as the rains get pretty heavy. However, this remains insignificant as the rest of the year is filled with mellow temperatures. Bengaluru: The Green Lungs of India The Garden City of India, Bengaluru is at an elevation of more than 3,000 feet above sea level. As the nickname suggests, Bengaluru’s green spaces control the otherwise extreme hot temperatures faced in the South. The city is privy to temperatures ranging from 70 to 84 degree Fahrenheit. Many Indians from the South relocate for the serene climate and shopping scene in Bengaluru. Thekkady: Kerala’s Most Prized Possession This little quaint town in Kerala has won the Best Holiday Award in 2017 which means the weather definitely had something to do with it. The temperature here stays consistent at around 73 degree Fahrenheit. Unlike most places in India, Thekkady has a very predictable climate. The rains in monsoon are moderate and the summers stay warm but cozy. Mysore: The Sandalwood City The City of Palaces, Mysore is located in the southwestern Karnataka state enjoying calm weather throughout the year. Average temperature lies at 77 degree Fahrenheit as it benefits from the tropical savanna climate. It has cool winters followed by moderately warm summers. The driest and hottest season is restricted to just May and June while the rest of the months are pleasant. Not only is the weather a real hoot but also you can choose to live in any one of the royal hotels in Mysore. These are eight of the cities with best weather in India but a few special mentions include Srinagar and Shimla. These two North Indian places also experience peaceful climate but can get gruesomely cold in the winters. However, if the rains get a bit too much for you, you can always wander away to any offbeat monsoon travel destinations in India. Health Resort An establishment that provides various facilities and treatments intended to improve. The health resort on New Zealand's north coast offers luxury villa accommodation. 185 CU IDOL SELF LEARNING MATERIAL (SLM)

A place where there are natural amenities such as thermal springs that are said to be conducive to health .Davos was thought to have the purest and driest air of any health resort in the world. The planners envisage the island as a health resort for people seeking new or natural cures. Yab Yum Resort, Goa Situated at a two-acre palm grove in Ashwem beach, Yab Yum Resort is a family friendly wellness resort complete with a paddling pool and babysitting facilities. The yoga classes here are suitable for beginners and experts alike. Private classes are available as well. Rejuvenating massages like the Ayur-Balance Massage and Ayur-Yogic Massage are great for relaxing and removing emotional blockages. There are two types of accommodation available in this fuss-free retreat. There are cottages which are built in the traditional Goan style and then there are the wonderfully eccentric domes built out of lava rock, palm leaves, grass and mango wood and local clay and sand. Karuna Farm, Tamil Nadu Figure: 10.13 Karuna farms Karuna Farm is anything but luxurious. A place that advocates an alternative lifestyle, it’s all about austerity, self-sufficiency and getting back to nature here. The houses at the farm are built with recycled waste such as tyres, bottles, tins and mud and all power is sourced from solar energy and hydroelectric power. They are also involved in organic farming that includes a vegetable garden and fruit and coffee plantation. Kamdhenu, Tara and Gopi are the three 186 CU IDOL SELF LEARNING MATERIAL (SLM)

resident cows at Karuna who provided 45 litres of fresh milk every day. All these offbeat activities take place amid the serene backdrop of the breath-taking landscape of Kodaikanal. Figure: 10.14 Organic farming at Karuna Palani Hills. The term health resort is loosely applied to several kinds of institutions quite unlike in their facilities and methods of promoting health as well as their importance in medical preparedness. This term includes hospitals or spas possessed of certain natural therapeutic facilities for the treatment of chronic diseases and, in a sense, other institutions offering convenient, attractive and healthful accommodations in an environment calculated to attract those needing rest and rehabilitation as well as those seeking athletics, sports or even social advantages. For military use we must include in this consideration hospitals and hotels some of which offer little more than sunshine, mountain air and sea breezes. These institutions have a potential military value for housing purposes during mobilization or for conversion into convalescent hospitals and camps as military operations progress. Many of the larger hotels, as for instance those at Atlantic City, are being acquired by the military services. Choosing a health resort | The diet should meet your needs. Most health resorts specialize in providing a nutrition regiment that is designed to achieve specific goals. If you are committing to a health resort experience, the diet needs to present an opportunity to help you lose weight or improve whatever ailment you are striving to remedy. The diet’s foundation, recommends virtually every major public health organization, should be fresh foods that are not processed, with plenty of fruits, vegetables, and whole grains, and lean, healthy sources of protein like fish, white poultry, and legumes (beans). Health resort chefs should be prepared to accommodate any special needs, such as vegetarian preferences, food allergies, sensitivities, or gluten-free requirements. 187 CU IDOL SELF LEARNING MATERIAL (SLM)

Resort cooking schools, are an excellent opportunity to discover healthy new foods. You also need to like the menu. There’s no point in going to a health resort to lose weight or learn healthy habits if you don’t like the food. Even if you can stick it out during the time you are at the resort, you’re not going to maintain the same diet when you get home. Choosing a health resort | Look for personalized experiences. While health resorts have a general approach to how they help clients lose weight or follow healthy lifestyles, they should also customize all clients’ programs depending on their goals and needs. Let the resort know what your goals are, and find out how the staff will work with you to help you achieve your goals. When you arrive on site, a staff member should sit down with you to make sure the health resort understands your goals and is ready to accommodate you. Consider, too, who you’ll be talking to. What are his or her qualifications? Will you be consulting with a physician? Registered dietician? Psychologist? Exercise physiologist? Optimally, you want your initial consultations to be with health professionals like these. To avoid losing time, the first day is a good opportunity to go over and modify, if necessary, your daily schedule for the remainder of your stay. You should also have input over which activities to participate in to ensure that you are able to include all your favourites. Choosing a health resort | Pick one with qualified professionals who are involved throughout your stay. Health resorts are safer and more effective when qualified professionals not only design but also implement their guests’ plans. Weight loss and healthy lifestyle programs should be physician-approved. Physicians should be on hand for physicals, overall supervision of exercise programs, and ideally, periodic consults throughout your stay to chart your progress and manage your cardiovascular or metabolic function. Other professionals to ask about when comparing health resorts are those in charge of the nutrition and exercise programs. Will certified trainers design your exercise program and work with you one-on-one? Optimally, you want exercise trainers with undergraduate and/or post-graduate degrees in fields such as exercise kinesiology. Does a registered dietician oversee meal planning and preparation? Look for professionals with an “RD” credential, which means they have received a bachelor’s degree from a U.S. regionally accredited university or college and course work approved by the Commission on Accreditation for Dietetics Education of the American Dietetic Association (ADA). Ayurveda health resorts. 188 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure: 10.15 Ayurveda Health Resort Choosing a health resort | You like the atmosphere. Your time at a health resort is probably doubling as vacation time, so it’s important to make sure the experience will be pleasurable. All staff should be welcoming and friendly, from the time you first make contact with the facility to inquire about staying there, to the time you leave to return home. These other options can also turn your healthy trip into a dream vacation. Figure 10.16- Health resort Choosing a health resort | The facilities are top-notch. Your experience at a health resort will be more pleasant if the facilities are relatively new. Be sure to carefully evaluate photos or videos of the bedrooms, dining hall, and other 189 CU IDOL SELF LEARNING MATERIAL (SLM)

accommodations to make sure the environment is comfortable, upscale, and most importantly convenient. Check out travel sites like TripAdvisor to see how previous guests evaluated their stay. Current trends in health resorts suggest growth in facilities that are multi-purpose. Before you commit, ask whether your destination resort has all of the equipment and other resort amenities you expect. Having a wide variety of recreational opportunities at your disposal can help maintain motivation and give you a better chance of discovering healthy, fitness-related activities you’ll enjoy continuing after you return home. Ask whether you will have access to the following amenities when considering a health resort:  Pool, lake, or ocean access  Gym and fitness studios with new equipment and enough of it – you don’t want to get stuck waiting for an elliptical or treadmill.  Tennis courts  Yoga studios  Golf courses either on site or near by  A classroom for group fitness classes, such as spinning, Zumba, yoga, or weight training. Figure: 10.17 Fitness Studio 190 Choosing a health resort | Look for an experience that is lasting. CU IDOL SELF LEARNING MATERIAL (SLM)

You may only stay at a health resort for a few days or weeks, but the effects can last a lifetime. You can jumpstart your weight loss and live a healthy lifestyle while staying at the resort, but a truly exceptional health resort experience gives you the tools to continually meet your goals when you’re back at home. See whether the resort offers the following to help you make long-term progress.  Educational opportunities, such as healthy cooking demonstrations and nutrition classes.  Individual consults with professionals like psychologists and registered dietitians to help you zero in on your specific needs and goals  Help making a plan for when you go home so you can continue your healthy habits.  An option for ongoing support, such as phone calls or emails with a dietitian after you go home. A health resort can be the catalyst to help launch a healthy lifestyle, improve your physique, maintain a healthier lifestyle, or lose a few pounds. While there are dozens of health resorts to choose from in the United States, be sure to consider multiple options before making a commitment. Take the time to evaluate what each health resort has to offer, what makes each resort unique, and what matters most to you. Figure: 10.18 Zumba 10.3 HEALTH WELLBEING & ENVIRONMENT Health and medical tourism are considered one of the fastest growing segments of the tourism industry. Recently, research on health resorts has been gaining academic attention in tandem with the positive contribution of the health and medical segments to the tourism industry. The purpose of this study is to better conceptualize how the behavioural intentions of health 191 CU IDOL SELF LEARNING MATERIAL (SLM)

tourists are shaped in the emerging context of the health resort. This study illuminates the likely perceptions of prospective tourists about the attractions of health resorts, and endeavours to examine the response of health tourists using data from 359 international health tourists/travellers, comprising of Thai, Indian, and Chinese nationalities. The study also uses the partial least square structural equation modelling (PLS-SEM) technique in order to analyse the responses of international tourists gathered at two international airports in China. The present study shows that tourists' expectations and their behavioural intentions are generally associated indicators of perceived health resort attractions. Expectations play a significant mediating role, while culture impacts the overall phenomenon of proposed associations in a moderating way. Moreover, sustainable tourism attractions also play a significant role in shaping Thai travellers ’behavioural responses, while medical facilities and risk levels are considered significant in determining Indian and Chinese travellers ‘behaviours. By developing theoretical and empirical grounds, this study offers implications for further research and development in health resorts and other niches of health tourism. Figure: 10.19 Swimming This story illustrates the importance of considering the environment, health and wellbeing together rather than separately because these issues interact in complex ways with a range of costs and benefits for society. The example comes from a recent report on the 'environment, health and wellbeing (EHWB) nexus' published by European Environment Agency's (EEA) Scientific Committee. The document follows a seminar held at the EEA on February 12 this year, which brought together experts and policy makers from many different fields. Many of the participants argued for a new type of inter-disciplinary science which takes a systemic view, looking at the many positive and negative links and trade-offs between these usually separate areas. In health tourism air pollution, for instance, has often been considered in terms of its health implications. But the report argues that research should further incorporate these areas, allowing us to gain a system-wide understanding of multiple causes and effects. 192 CU IDOL SELF LEARNING MATERIAL (SLM)

Such a change in thinking is more necessary than ever, according to many of the participants in the February workshop. In the past, environmental issues have often been treated as isolated problems with a clear cause and effect. If a lake was polluted, for example, conventional wisdom dictated that the problem was caused by a single point source of pollution. We are increasingly looking at things differently. Risks interact in complex ways, with multiple causes and effects. We may come to realise that the pollution problem in the lake was the result of complex chemical reactions in the atmosphere between different pollutants and substances. Part of the reason things seem more complex is that we have a better understanding of the world's complex systems. But it is also true that the world is more complex and interconnected. Globalisation has accelerated global environmental problems - climate change is a striking example of an issue which is truly global in its causes and effects. Other examples include the global movement of pollutants and the way economic trends can deplete resources on the other side of the planet. Figure: 10.20 Yoga Such complexity means it may be impossible to determine a single cause for an environmental or health problem. In the case of illness caused by ragweed, there may be other factors at play alongside pollen – some studies have shown that allergies are worsened 193 CU IDOL SELF LEARNING MATERIAL (SLM)

by air pollution. Indeed, this is just one of a cocktail of many hundreds of chemicals, substances in air and water, pathogens radiation and other stresses in everyday life. Add differing levels of vulnerability to this mix, and we may start to understand the complexity. Health science can also benefit from taking a broader EHWB view. Consider the increasing incidence of some types of cancers – by taking an EHWB view, health systems could focus on the multiple aspects of our lifestyles which can increase the risk of cancer, rather than just treatment. Such a preventative approach could mean reducing exposure to chemicals and pollution for multiple benefits. Another preventative health policy could be to create nature reserves. While the benefits for biodiversity are well known, there is growing recognition that enjoyment of the natural world can improve both physical and psychological health. Access to green space in cities has been linked to longer and healthier lives in elderly people, and improvements in early years development. These benefits could even spur a positive cycle – other research suggests that those in good health have a greater possibility of looking after the environment. 10.4 SUMMARY  Health Tourism: travelling to receive medical treatment in specialized institutions jointly with tourism programs  Medical tourism attracts more tourist.  Many foreigners come to India for learning yoga.  Ayurveda ‘s panchakarma is the main attraction for tourist.  Tourist are affecting the weather and climate.  Health and medical tourism are considered one of the fastest growing segments of the tourism industry 10.5 KEYWORDS  Ayurveda- In Sanskrit, Ayurveda means “The Science of Life.” Ayurvedic knowledge originated in India more than 5,000 years ago and is often called the “Mother of All  Unani- Unani medicine is a system of alternative medicine that originated in ancient Greece but is now practiced primarily in India. Involving the use of herbal remedies, dietary practices, and alternative therapies,  Siddha - The Siddha System of Medicine (Traditional Tamil System of medicine), which has been prevalent in the ancient Tamil land, is the foremost of all other medical 194 CU IDOL SELF LEARNING MATERIAL (SLM)

 Zumba - Zumba is an exercise fitness program created by Colombian dancer and choreographer Alberto \"Beto\" Pérez during the 1990s.  Thai massage - Thai massage or Thai yoga massage is a traditional therapy combining acupressure, Indian Ayurvedic principles, and assisted yoga postures. 10.6 LEARNING ACTIVITY 1. Collect information about various Ayurvedic and wellness packages given by the state of Kerala. 10.7 UNIT END QUESTIONS 195 A. Descriptive Questions Short Questions 1. Explain medical tourism? 2. Explain spa in health tourism? 3. Define- Zumba. 4. Define- fitness centres 5. Define- spas Long Questions 1. Explain in detail forms of health tourism? 2. Describe the health wellbeing and environment? 3. Explain the importance of Ayurveda. 4. Why siddha treatment is called as the traditional treatment. 5. What is Allopathy treatment. Explain B. Multiple choice questions 1. India has introduced a special -------- category for medical tourist. a. H-visa b. R-visa c. M-visa d. None of these 2. ------- Pollution is considered as health implication in health tourism. a. Water CU IDOL SELF LEARNING MATERIAL (SLM)

b. Air c. Land d. None of these 3. The traditional method of treatment is a. Siddha b. Unani c. Ayurveda d. None of these 4. The best place for Ayurvedic treatment in south India is a. Keraka b. Karnataka c. Andhra d. Tamilnadu 5. ____ is the medical Hub of India. a. Chennai b. Delhi c. Bangalore d. Mumbai Answer 1-c, 2-b, 3-a, 4-a, 5-a 10.8 REFERENCES Reference books/material:  Atkinson, E.T. Himalayan Gazetter, Cosmo Publication, New Delhi, 1993.  Gupta. S.K. (2102) Tourism and Heritage Resources of Garhwal, Kaveri Books, New Delhi.  Bisht, D.S. Garhwal and Kamaon Hills, Trishul Publication, Dehradun,1982.  Bose,S.C.GeographyoftheHimalaya,NationalBookTrust,1976.Kaur, J, Himalayan Pilgrimages and the New Tourism, Himalayan Books,NewDelhi,1985  M. Smith and L. Puczko, Health and wellness tourism, B. Heinemann (2109)  Sonali Kulkarni, Spa and Health Tourism, Book Enclave, Jaipur (2108) 196 CU IDOL SELF LEARNING MATERIAL (SLM)

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