Perception of impact of tourism on health in costa rica. August 2010. Executive summary.


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Perception of impact of tourism on health in costa rica. August 2010. Executive summary.

  1. 1. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica. August 2010. 1 EXECUTIVE SUMMARYRUPRECHT-KARLS UNIVERSITÄT HEIDELBERG - GermanyDepartment of Tropical Hygiene and Public HealthIm Neuenheimer Feld 324D-69120 Heidelberg, GermanyTeléfono: +49 (0) 6221 56-4905Email msc_ih@uni-heidelberg.deStakeholder perception of impact of tourism on health and biodiversity in Costa Rica.August 2010.Researcher: Felipe Mejia Medina, Chemical Engineer, M.Sc. in International Health.Supervision: Valérie R. Louis Valerie.Louis@uni-heidelberg.deEmail:Personal:,Work: mejiafa@paho.orgUniversities: felipe.mejia@uni-heidelberg.deWeb Site: Summary Tourism is one of the most important world‟s economic activities and it has showedcontinuous growth up to 2009 when different political situations as well as natural disasters indifferent parts of the world, the financial crisis and the A(H1N1) influenza pandemic, caused adecline in tourists arrivals by 4% in 2009 with an upswing of 2% in the last quarter of the yearafter the tendency had gone down by 10%, 7% and 2% in the first three quarters respectively.However, unemployment is expected to go up while oil prices may remain volatile. Since the increase of tourist arrivals makes the places overcrowded, it has beensuspected to generate an overexploitation of resources. Indeed, human mobility has beenconsidered an important reason for massive exchange of species putting at risk the biologicaldiversity and the correct function of the ecosystem. Furthermore, an increase in A(H1N1)cases are expected “Transmission of tuberculosis (TB) on board of commercial aircrafts duringlong distance flights was reported during the 1980s” (WHO International Travel and Health2010). However, it was showed that the probability of transmission of severe acute respiratorysyndrome (SARS) in 2003 in the same condition was very low. The tourism impact under study, from a global point of view, is related basically to: 1. On Biodiversity: -Land cover/use. 1. Accommodation. 2. Traffic infrastructure. 3. Leisure activities 4. Indirect impacts - Wild species related. 1.Coming species to tourist destination 2.Disturbance, collection, trampling of local species populations.By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health
  2. 2. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica. August 2010. 2 2. On population - Health related. 1. Direct Health impacts 1. Malaria, leishmaniasis, dengue fever, others. 2. VIH and other sexual transmitted diseases. 3. Accidents and injuries. 4. Behavioral changes related 5. Tourism workers‟ health. 2. Indirect Health impacts 1.Economic health impact 2.Environmental health impact 3.Socio-cultural health impact 4.Political health impact - Energy Use - Perception and understanding. - Water Use. Since the 1990s, tourism in Costa Rica has been promoted as an important industrydue to its natural beauty and environmental commitment and it has become one an importantdestination for eco-tourism in the world. It is one of the most important and dynamic areas ofthe Costa Rica‟s economy and has recovered considerably after the global tourism depressionin the beginning of the past decade. However, after a 7% growth in 2008, foreign directinvestment in Costa Rica fell by 50% in the middle of 2009. This is partly explained somecontraction in sectors such as tourism due to the financial crisis and the A(H1N1) pandemicwhich caused a downturn in tourists arrivals. Costa Rica is positioned as one of the leading eco-touristic destinations offering a widerange of options from nature treks, fishing, rafting, beach resort tourism, etc and it has beenboosted by fiscal incentives such as tax credits of 25-50% regarding the amount invested. Thenumber of tourist has been raised thanks to a set of strategic alliances and package sales ofdifferent and specialized international operators Indeed, since 1999 the number has increasedby 92% in 2008. By middle of the last decade, tourism industry has become an important source ofemployment: approximately 22% of the working population belong to the tourism industry. In regard to transportation, governmental efforts and policies have given stronglyinvests in improving the current road infrastructure at the point that y 2008, 49% of the roads inCosta Rica are paved. Partly because of tourism demands as well as urban populations andexport sector requirements. A new passenger terminal is under construction in one of the twomain airports of Costa Rica: Daniel Oduber due to the increase of international flights. It wasplanned to be finished by the third quarter of 2009, however, it is has been delayed to date. The study of tourism is a recent academic field and despite already the analysis aboutthe environmental impact of tourism especially on the economy, biodiversity, and use of land,among others, there is no further analysis about the impact in a sector highly sensitive to thepopulation such as health or about the perception of this impact on health and its relations tobiodiversity and water, energy, waste and infrastructure utilization among differentstakeholders. Travel is a Public Health issue but it has not been adequately linked with thetouristic activities. Furthermore, certifications on sustainable tourism have been raised todevelop sustainable processes and there have not been studies about the perception of thistool as a mitigation-adaptation measure.By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health
  3. 3. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica. August 2010. 3 The following research question was addressed in the study: which are the perceptionsamong different stakeholders about the impact that the tourism industry has on populationhealth in parallel to biodiversity and water, energy, waste and infrastructure utilization as aconsequence of the travel, the stay and the contact to a new environment for leisure purposesand about the importance of the tourism certification schemes to reduce this impact? The field research was a qualitative and quantitative exploratory study which usesdescriptive statistics. In order to achieve the objectives of this study and in order to establishcommon and/or specific tendencies about tourism: impact interviews with closed questionswere made to tourists, local population and representatives of hotels and tour operators andin-depth interviews were carried out in hotels and tour operators. Informal conversations wereengaged and recorded with few local people as well. The field study took place between 17 th ofJune and 29th of July in 2010 The data collection was developed considering the type of stakeholder under study.:Tourists, Residents in Costa Rica (working in tourism), Resident in Costa Rica (NOT working intourism). Because of tourism is very close to the population nearby Poas Volcano as well asaccommodation establishments, restaurants, shops, etc; in occasions were not easy to clearlydifferentiate which a primary or secondary service provider is. It was designed a questionnaire with 44 close questions and items inquiring aboutattitudes and perceptions of tourism. Each statement was situated on a five-point scale asrecommended by Maddox, with 1 representing a response of „„strongly disagree‟‟ and 5representing „„strongly agree‟‟ and 1 representing “strongly decrease” and 5 representing“strongly increase”. For just one yes/no question 1 representing “yes” and 0 representing “no”.The questionnaire was tested previously in a pilot for each stakeholder in order to develop aunique tool which applied for all. Since 32% of the costa-rican people for 2008 have access to internet concentratedmostly in the urban areas, all hotels, tour operators and the expected local population in thecities of Costa Rica are highly probable users of internet. Due to that fact, it was designed alsoan online survey using the service of Survey Monkey to test some of the possible answers.The link to the site was sent to the pilot participants by e-mail, explaining what the purpose ofthe survey was and how to fill it out with the contact information and finally asking to send itback. Likewise, the same questionnaire was designed in an Excel sheet which allowed to onlyfill out the blanks due to the other cells were blocked. At the end, there was a suggestion box.This Excel file was sent also to the pilot participants by e-mail. In-depth interviews were conducted using an interview guide, after obtaining a writtenor verbal consent from the interviewee. The privacy of the interviewees was respected and allwas done in private rooms. Answers were categorized according to the same items used forthe questionnaire. All interviews were taped. The in-depth interview was tested with theworkers at the places close to the student„s hotel. Informal conversations were planned to be held, specifically with the local populationwho had indirect contact to tourists. The purpose of this idea was to have an extra point ofview of the tourist‟s behavior at the place of study and general remarks about the localbackground and social issues. Almost all conversations took an average time of 20 minutes. Both methods inquired about attitudes and perceptions about seven topics: 1) increase ofnumber of tourists; 2) impact on use of land; 3) impact on biodiversity; 4) impact on healthincluding diseases dispersion, fast food, alcohol, tobacco and illegal drugs consumption andstress impact; 5) impact on energy; 6) impact on water and waste use; and 7) usefulness ofcertifications of sustainable tourism. Analysis of coefficient of variations and an analysis of variance (ANOVA) were carried outBy Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health
  4. 4. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica. August 2010. 4for each question of the questionnaire, followed by a Scheffé test to establish whichstakeholders had different perceptions. In-depth interviews were analyzed by content analysisin order to establish common characteristics. Costa Rica is a country which receives and holds an increasing number of tourists whocome to experience the tropical adventure and the possibility to have contact with differentexpressions of biodiversity and culture. However, the excess of tourists‟ arrival is a globalconcern because of the negative impact that this industry may have in the long term ondifferent settings such as ecosystems, cultures, money sources and health. In spite of diverse studies made on the perception of biodiversity or economic impact oftourism in similar countries or carried out in Costa Rica, none has been made approaching thehealth impact considering different stakeholders. Although previous researches have studiedthe impact on health related to traveling, there is no connection between this concept andtourism per se. Tourism is for Costa Rica one of the biggest source of income and a national pridemaking it a very sensitive issues for the general population. This involves or touches directly orindirectly almost all governmental and non governmental institutions as well as all locals. In order to develop adequately policies for such an industry, there must be a balancebetween how far people are willing to be controlled by those policies if afterwards they may re-elect the politicians and the facts about its positive and negative impacts in the short and longterm on different settings. The objectives of this study have been achieved by studying some of the common andspecific tendencies about the perception of the tourism impact on different aspects. However,there is a need to make wider and specific studies focus on each of these aspects but withoutlosing their interrelation. Tourists do not always see tourism as a positive activity, neither for tourists nor forlocals. A negative perception about their possible influence was found. On the other hand,locals in general perceive tourism as a convenient activity with not truly important negativeimpacts. This may be because tourism is also their source of income and a good nationalimage for the world. The tourism impact and influence on local‟s behavior seems to be neglected ormisunderstood. The process of transculturation1 has been part of different societies which dealwith the presence of a new approach to life. This may lead under certain conditions to theconsequent creation of new cultural patterns. There is a need to better understand, in the caseof health to name one, how the constant presence of tourist may influence the health of thepopulation regarding different issues: sexual behavior, practice of sports, food, alcohol,tobacco consumption, transmission of infectious diseases and finally if so, the health systemitself and its policies. The perception of the usefulness of the certifications in sustainable tourism is a veryimportant topic since Costa Rica is the only country that can certify its touristic services. This isrelevant especially considering that sustainability must cover ecological, economically,culturally and health-related sustainability. Ecological sustainability is the only one consideredby the population and by the tourists. However, the impact on health in this study has beenonly addressed in a general manner. And considering that Certifications on Sustainable Tourism have good reputation amongthe stakeholders, it should also include other aspects such as cultural interaction and healthimpact in its activities and procedures. Bias about sexual tourism in relation to sexual behavior1 Understood as the process of creating one new cultural phenomena.By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health
  5. 5. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica. August 2010. 5was found out. In general, people relate immediately topics such as “sexual transmitteddiseases”, “unwanted pregnancies” or “use of condom” with sex tourism. Other sexualintercourses as consequence of the interaction among the group of tourists or between touristsand locals are not normally considered, thus neglected as a possibility. This may lead to riskysexual behaviors. Costa Rica is a small but highly touristic country. Throughout, there are different typesof population and different types of touristic services. Studies about perceptions and relatedpolicies must consider these differences and should be carried out for each of these areas. In regard to the common and specific tendencies, the process of classification ofstakeholders was difficult. Almost all residents have contact with the touristic activities, thus toclearly differentiate, who are the residents who work for this industry and who are not, was nota precise task. The history of civilizations is the history of migrations and huge health impacts haveoccurred because of the introduction of new people to new environments as it happened from1492 when Christopher Columbus arrived in the Americas initiating the conquest from Spain toestablish the Empire in the so-called New World. The death of the native population throughthe first century was caused by sustained hard work but was especially due to the presence ofnew pathogens which were unknown and for which the natives did not have any immunedefense. There was a change in their behavior and in how they used to approach life. And thishistoric example is also a situation that may happen with the presence and uncontrolledincrease of tourism. To name a present example, the virus H1N1 was easily spread to theworld because of the mobility of the people. That is why the measures of previous vaccinationare so important not only for tourism but for all travels. Not all impacts are negative. And not all changes have bad consequences. Healthy orecologically conscious behaviors are also considered as an influence to the locals. In thatsense, policies should boost these pros and control the negative ones. The perception of the negative impact is not always the same for all stakeholders,especially when it comes to a new topic such as health impact. There is confusion among allgroups about what may happen through the continuous presence of people with their ownpatterns of behavior and who come from different settings and have different cultures. There is finally a misunderstanding about what a health impact is. In general, the worldhealth is only related to health system and hospitals. Consequently in the case of Costa Rica,this ends up in the concept of medical tourism. This study has underlined that dealing with different perception of not-easily-classifiedstakeholders is a very complex issue and therefore the policies should also deal, consider andinclude all. In this study differences were found especially on tourists‟ perceptions abouttourism impacts compared to the other groups. But in general, health impact did not seem tobe an issue for the stakeholders maybe precisely because of the lack of proper information. Every person has a different perception of the same situation and it depends upon itsown background and context. The perception of groups, representing a determined number ofindividuals and understanding group as a unity, is hence the result of the integration of theseperceptions in a common perception which relies in the center of the social network. Policies are usually made, considering either all affected groups in their totality or theirdivision in subgroups, divided by factors such as gender or education to name a couple. Thesubgroups may be built in order to take into account the expected variety in perceptionamongst them. Making policies for tourism, being based on social, economic, cultural and health issuesmeans considering these different perceptions and balancing them. The measures derivedBy Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health
  6. 6. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica. August 2010. 6from policies should neither be too invasive, nor too loose. This implies that the awareness through communication and education must cover thewhole community and the coming tourists by informing not only the possible touristic offers orpossibilities but also its probable impacts. This may help the stakeholders to take informeddecisions but also to increase the satisfactory experience of all. This study has been useful to establish that the perceptions of the tourism impact ondifferent issues vary along the actors involved. Besides, it shows that there are no majorconcerns about negative health impacts or impacts not related to ecological consciousness. Itmeans there may be an increase in the risk of any touristic activity or action within the regionboosted by tourism, if there is the perception that negative impacts are unlikely. This studyopens the next questions for possible researches.By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health