Wellness, Well-Being... And What About Spa?

Going forward when you think about wellness, think prevention and health. When you think about well-being, think happiness.
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Recently I spoke at the Washington Spa Alliance Symposium in Washington, D.C. What drew me to participate was their theme: "The New Language of Spa". This is a topic about which I have thought a great deal over my many (don't ask how many!) decades in this industry. So I feel uniquely qualified to address what is now becoming an ongoing question: "What's the difference between wellness, and well-being...and where does that leave spa?"

If you go by the book, here is how Merriam-Webster makes the distinction:
"Well-being: the state of being happy, healthy, or successful"
"Wellness: the quality or state of being healthy"
"Spa: a place where people go to improve their health and appearance by exercising, relaxing, etc."

Language evolves to reflect our culture. Certain words begin in the jargon of an industry, then grow in colloquial usage, then become part of the vernacular. This is true in our industry, which began with "spa" as an all-encompassing term; then came "wellness", though it was not clearly defined; and then came "wellness tourism" which began to take hold as consumers were choosing travel with a healthy focus and we needed a way to talk about it...and measure it. And here is where it gets interesting: according to Global Wellness Institute research, the worldwide wellness industry is valued at over USD $3.4 trillion, with spa alone accounting for USD$60 billion. So you see, there is much to discuss.

Today we stand at the threshold of another term entering the conversation that could once again have a major impact on global thinking. That term is "well-being". And while some may think this is not new, it is actually having an impact on the industry now, creating, among other things, more confusion.

Admittedly, most people don't spend a great deal of time thinking about what the definition of well-being might be--or if there is a difference between wellness and well-being. It seems that most people use these terms interchangeably. However, I think it may become increasingly important to identify and trumpet a distinction...and the sooner the better.

Back to the numbers. A watershed moment came in 2007 when the researchers from SRI International were doing the first global study on the spa economy. They suggested that the squabbling that was going on at the time between people from organizations, countries and continents who were disagreeing on the definition of the word "spa" could be easily resolved if everyone recognized the wisdom of championing a very generic definition that would allow the various entities to be aggregated. They suggested that we all define "spa" broadly--places of renewal for body, mind, spirit--so that all categories could exist underneath it: water-based spas, resort spas, day spas, Ayurvedic spas, thermal springs, retreats, etc. Looking at it that way, all the revenue from these various entities could be counted together and a healthy and robust number would result--one that would make people take notice. And that is exactly what happened. Their landmark report came out in 2008, in which they estimated the Global Spa Economy for the first time ever--and it was a whopping USD $60 billion! That got attention around the world and for the first time the Global Spa Economy was viewed as a major contributor to a country's GDP. Something those of us in the industry always knew, but now we had the statistics to prove it.

This language decision was monumental...it calmed down the disagreements and allowed each establishment that had something to do with renewing body, mind, spirit to still maintain its unique identity. The term "spa" is now used around the world and it continues to resonate with people--especially consumers when they think about a place they would like to go for a pleasurable experience, and one that's good for them, too. Even though defined somewhat differently in various cultures, the word "spa" has enjoyed a universally positive reception; as a famous doctor once told me when comparing it to health, wellness, and medical, "the word 'spa' makes me smile." And now a little more about the other terms.

Wellness. Emerging on the radar in a big way less than a decade ago, the term "wellness" seemed to be a good alternative to the word spa in some settings. While born in the U.S. in the 60's, and introduced in a 60 Minutes segment in 1979, the term "wellness" most notably joined the spa-related conversation in Germany when Brenners Park Hotel added the words "and Spa" to their name while at the same time legally preventing any other businesses in that country from using the word "spa". As a result, the word "wellness" emerged as a close match. In the U.S., and later in other parts of the world, wellness had the advantage of not being immediately tied to pampering and indulgence the way the word "spa" often was. In addition, it shined a light on the value of spa experiences in terms of health and prevention. It was a term that governments and corporations began to use. Even the medical establishment eventually came around to acknowledging that wellness had a place--once they got over the fact that it didn't just refer to complementary and alternative medicine for which they didn't always exhibit all that much respect. It gained additional traction in the medical establishment once they noticed that consumers were enthusiastically embracing it and paying out-of-pocket for "wellness."

Wellness Tourism. The 2010 Global Wellness Institute research study on wellness tourism resulted in an important insight that I would argue has done more to establish our industry than perhaps anything else. Recognizing the need to distinguish wellness tourism from medical tourism, this extensive research project helped identify and define the difference; this was good for medical, spa, consumers, governments, etc. Basically it allowed wellness to flourish separately from medical, where regulations and restraints were the norm.

Over time, this differentiation became clear:
•medical is most often about cure, wellness is about prevention
•the medical profession has patients, wellness has guests
•medical is strictly evidence-based, wellness can be a bit more experimental
•medical costs have skyrocketed, wellness is more democratized
•medical has an authoritarian culture, wellness is more collaborative

Well-Being. So here comes "well-being"! While used interchangeably with wellness at the moment, I feel that well-being is beginning to set itself apart from wellness. I would argue that the reason for this is the increasing momentum in measuring "happiness" around the world and the importance happiness is being given in many of the well-being indexes and scores that are being referenced.

This measuring of happiness is a relatively new development, most notably begun when Bhutan replaced Gross National Product scores with a Gross National Happiness score. Currently there are two important indexes increasingly being quoted around the world. The first is the "Gallup Healthways Well-Being Index" which has been around since 2008. The other is the "United Nations World Happiness Index" which was started in 2012 and whose 2015 numbers were released earlier in March 2016.

Examining these scores more carefully, one notices that when happiness is added to the mix, as it is in most well-being scores, it becomes more and more obvious that well-being is not wellness. Just as happiness is not the same as wellness.

Here is an example that shows clearly why the indexes of happiness or well-being are not necessarily good measures of a country's health or wellness. Take Mexico for example. In 2015 they scored very high on the Gallup Healthways Well-being Report; in fact, out of 200+ countries, Mexico was rated #10 in well-being! At the same time, the BBC reports that Mexico has the highest obesity and childhood diabetes rates in the world; each of its citizens, on average, consume 163 litres (36 imperial gallons) of soft drinks per year--40% more than in the United States. They could hardly be considered a model for a well population. They may have a high well-being score, however they would not score very high in wellness. (Does this mean that soda makes you happy?)

The UN World Happiness Report that was recently released is another monitor to watch. It showed Denmark at the top of the list and for the first time found a very clear association between happiness levels and a country's level of income equality. If you live in a country where people are generally more equal in income (such as Denmark and many of the Scandinavian countries) one finds higher happiness scores. Where there is more income disparity, the happiness scores are lower. Once again, this is something different than measuring how healthy one might rate a population.

When I finished my presentation at the Washington Spa Alliance Symposium, I left everyone with a summary statement that I later learned resonated with many. I end here sharing it with you.

Going forward when you think about wellness, think prevention and health. When you think about well-being, think happiness. This will assure that our industry does not get swept into the happiness world where many other factors will increasingly be debated. And it will give us a chance to claim the prevention mantel that is so important for the future of our world.

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