Historical development of Health Tourism
Prehistoric Period
People do things based on their intuitions by nature. For example, they used instinctive practices to stop bleeding by pressing their fingers or tying them from above, squeezing the nose in case of nosebleeds, putting a feverish child or adult in cold water, which can be seen as a treatment method. Later on, people who began to learn by “trial and error” discovered the beneficial and harmful medicinal effects of many plants. Medicine is one of the oldest professions in the world. Since this first person who practiced medicine, knowledge and experience have been accumulated and developed and transferred for centuries with the master-apprentice relationship.
In prehistoric times, physicians were also the witches of the tribes, as it was considered necessary for those dealing with treatment to be able to interact with the spirit world and to rule the hidden forces of nature due to the belief that spirits were the cause of illness. The data of the witch doctor are learned from the cave paintings found in different geographies and from the field studies carried out in the last centuries about the indigenous peoples such as Africans, Australians and South Americans who continued their primitive lifestyles.
Circumcision, which is one of the oldest surgical practices, can be dated to fifteen thousand years ago with the same studies. This is a period when people from neighboring tribes visit other tribes for treatment and seek help from the witch doctor there. Again, it is certain that the tribes believed to be successful in circumcision had an orientation to their physicians. These visits for the purpose of receiving health care can be shown as the most primitive examples of health tourism, since communication facilities are not developed, but there is the possibility of going and coming back from very close tribes.
Antiquities and Early Ages
Studies of ancient civilizations show a close connection between health care and religion going back a few thousand years. In the light of the findings of archaeological evidence, it is seen that many ancient civilizations benefited from the healing effects of hot springs and sacred baths.
Archaeological assessments have found that the Sumerians (4000 BC) built the earliest known health facilities around hot springs. In the Bronze Age (2000 BC), St. There is evidence that people bathed in the rich mineral springs and drank mineral waters around the city known as Moritz. With the invention of writing, advances in medicine were made in ancient civilizations (such as Sumer, Akkad, Babylon, Egypt, China, Hittite, Indian, Greek, Roman). M.O. VII. In the 16th century, the Assyrian king Ashurbanipal had established a large library with old and new cuneiform tablets and copies that he had collected from all over his kingdom. Researchers state that a significant part of them are related to medicine and that people who wanted to practice medicine at that time flocked to the library city and realized a kind of health science tourism.
The ancient Egyptians recorded their medical experience and knowledge on papers obtained from the papyrus plant and used in the form of rolls, as in all other subjects. Of these; Edwin Smith, where drug prescriptions and health advice are given, Ebers, where surgical treatment and procedures are described, and Hearts papyrus, where fracture-dislocation treatments are discussed, are the most important in terms of the medical information they carry. The Egyptian civilization influenced the development of Greek civilization almost as much as the Sumerians. These documents show that in the Ancient Egyptian civilizations established on the banks and delta of the Nile, people were traveling to the centers where medical knowledge was concentrated in order to get rid of their diseases. The earliest written sources on medicine in ancient Chinese civilization are attributed to three Chinese emperors. Fu-Xi (Fu-Hsi; Pao-Xi, Pao-Hsi) (around 3000 BC), one of the emperors who were accepted as physicians due to the medical knowledge they wrote, put forward the yin-yang view; Shennong (Chen-Nungh) (around 2800 BC) introduced medicinal plants in his work called Pen-tsao, gave hundreds of medicine recipes and emphasized the importance of counting the pulse.
Nei Ching, which means the law of medicine, which determines the principles of Chinese medicine and is believed to have a history of about 4000 years, attracts the attention of researchers even today. This book describes methods of diagnosing diseases and treatment with acupuncture. The oldest written sources of Indian medicine are the Vedas, which means “knowledge of life”. B.C. The four scriptures (Rigveda, Sama-veda, Ayur-veda, and Atharva-veda), influential up to 800 BC, contain religious and medical information. These books describe diseases, drug prescriptions and surgical interventions. B.C. Since 900 BC, the Greek civilization has developed on the knowledge of Sumer and Egypt. The Eastern world, which was dominated by Alexander the Great, met the Greek civilization, and in this way, an important stage of development for the Greek civilization started again. B.C. Founded by Alexander the Great in 331, the city of Alexandria has been one of the most important centers of medical thought and practice.
Although he gave important medical works, the opinion is that the Romans did not bring new knowledge and theories to medicine. However, especially wealthy Roman citizens traveled to the places where famous physicians lived in order to find a cure for their diseases and took part in the historical process of health tourism. It is not clear when the first health institution was established, whose purpose was only the treatment of the sick, except that people were often cared for and treated in temples/temples or palaces, homes, and the market.
However, according to archaeologists, in Egypt BC. It is recorded that there were maternity homes in the 2000s. In ancient Indian civilization, BC. In 226 there were seventeen hospitals; where patients are kept clean; medicine, fresh fruit and vegetables and care are given; Massage is explained. It is stated that people travel to these hospitals without the criteria of wealth, especially in Indian society. It is understood from the archaeological excavations that in some of the temples called Asklepion built in the name of Asklepios according to their polytheistic religions in the ancient Greek civilization, the sick were treated. The most famous ones are recorded in Peloponnese (Epidauros), Datça (Knidos), Kos (Khos) and Bergama (Pergamon). In the Asklepions, priest-physicians called Asklepiads were giving treatment through baths, theaters, libraries and some medicines they developed.
The ancient Greeks are widely accepted as the first civilization to lay the foundations of the health tourism network. The Asclepius Temples, the first examples of which were built around İzmir in Anatolia, are considered to be the first health centers of the world. People from all over the world were going to these temples to find a cure for their diseases. B.C. Other temples were built for treatment in the Greek region around 300 BC. Of these, the one known as Epidaurus was the most famous and offered services such as a gym, snake farm, temple of dreams, and thermal baths. In addition, Hippocrates, known as the father of medicine and named after the medical oath, also lived in Anatolia, around İzmir, and was the reason for the formation of patient mobility towards the region where he lived in his own time. In similar periods, with the spread of yoga and ayurvedic medicine in India, 5000 years ago, those who wanted to see the benefits of the real medical practices of those days, which are accepted as alternative treatment methods today, went to India for treatment purposes.
The Romans, on the other hand, prioritized the need of the army, which they needed so much in the wave of conquest that lasted for years, and gave importance to army medicine. The most important contribution of the Romans to medicine was health institutions. For the wounded and sick soldiers of the Roman army, large hospitals with wide courtyards were opened in army ranges at road junctions. Wounded and sick soldiers from the military units in different regions were sent to these hospitals and they carried out the health tourism activity of that period. Over time, the surrounding people began to be treated in military hospitals, and in this way, the mobility of health tourism changed from soldiers to people.
In the Roman period, hot water baths and springs called hot springs were used for active health purposes and were turned into privileged centers primarily for the nobility and for the wounded soldiers in times of war. These spa centers have not only been health facilities, but also commercial and social meeting centers for the wealthy and the upper class, with both hot springs and hot water baths. Before Islam, health and medicine issues had a unique place in the way of life of Turks in Central Asia, in line with religious beliefs.
Those dealing with treatment in pre-medieval Turks are evaluated in two groups. The first of these was the shamans who performed religious-magical treatments and called “Kam” or “Baksı”, and the second was the physicians who treated them with drugs called “herbal”, “emci” or “ata sagun” and other substances. With the acceptance of Islam, the effect of “Arab Medicine” began to be seen in Turkish societies.
Middle Ages
This period medicine is also called Arabic Medicine or Islamic Medicine. Arab Medicine does not mean Arab medicine, but medicine in which Arabic is used as the language of science. With the emergence of the religion of Islam, one of the brightest periods of history began. Especially in the four centuries between the eighth and twelfth centuries, the light of science and philosophy has illuminated the Islamic world stretching from the shores of the Atlantic Ocean to North India and Central Asia and all the geographies that can be reached from there. Early Islamic scholars, who initially focused on translations from Indian, Egyptian, Iranian and Greek sources, later made significant contributions to all disciplines. In the Umayyad, Abbasid, Seljuk and Ottoman periods, cleanliness was given importance, especially since the religion of Islam created a common ground.
Preventive health services were expanded and focused on health practices were prioritized. The hadith “Travel and find health” reveals the understanding that emphasizes health tourism in particular. Due to the lack of advanced transportation facilities as today, the movements to be considered as health tourism took place between close geographical locations. In written records, due to the turmoil and confusion experienced after the collapse of Roman civilization, Asia has been the region where health tourism activity has been experienced more. In the regions that provide health services in Asia, the treatment environments built around the temples have started to be replaced by centers that can be called hospitals or darüşşifas that perform clinical treatments. During this period, the use of mineral springs called “onsen” in Japan became widespread in the whole country due to their therapeutic properties. During the long war periods that affected the whole of the Middle Ages, soldiers started to go to places with hot water sources to be treated after the wars. In this period, the Umayyad State of Andalusia (765-1031) established the Universities of Morocco, Cordoba and Gırnata, and provided the spread of science and medicine to the west. The first modern university in the world was the University of Kairouan in Fez, Morocco, and was founded in 859. In the following period, a large and excellent medical faculty was established in Cordoba, as the first Faculty of Medicine in Europe.
The kings and statesmen of the countries established in Europe, coming to Cordoba for treatment is a complete health tourism activity in the current sense. The first real hospital, fully organized with the facilities of that day, was established in Baghdad in the 8th century by Caliph Harun Reşid. This hospital, which was the first center of the rise of Islamic medicine, served as a model for later Islamic hospitals. It is the Mansuri Kalavun Hospital, which was built by the Mamluk Sultan Kipchak Turk Mansur Kalavun in the 13th century in Egypt as a remodel from an old Fatimid palace. The hospital is structured with different wards divided for various diseases and hundreds of beds in separate sections for men and women. In this state, the first foundation of the hospital architecture divided into clinics was laid. In addition, the hospital, which has lecture halls, library, mosque and administrative offices, continues its activities today. This hospital served for years as the most important center for health tourists in the nearby geography who could reach Cairo under the conditions of that period.
It is the period when Muslim scientists and civilizations established health centers serving foreigners in medieval health services. Thanks to the Andalusians, darüşşifas, maristans, bimarhanes and hospitals were established in every region from today’s Spain to today’s India of the Mughal Empire. Ibn-i Sina, Er-Razi, Al-Cezeri are the greatest known medical scholars of this period. Demands for health services all over the world have been towards the facilities that will be called health centers in Muslim countries. Gevher Nesibe Hospital and Medicine Madrasa, which was accepted as the first medical faculty of Anatolia, was built in 1206 and became the health attraction center of the nearby geography. There are hospitals built under various names in Damascus, Mosul and Aleppo among the health organizations in the lives of the Turks before they settled in Anatolia. These facilities were providing health tourism services by hosting patients from Samarkand and Yemen. The Anatolian Principalities, which were founded after the collapse of the Anatolian Seljuk State, adopted and kept these Seljuk facilities alive, and added health facilities such as leprosy and blindhouses and spas.
Renaissance Period
The Islamic world became the most powerful and respected community in the world in the Middle Ages, thanks to the civilization and scientific advances it established. The Christian world, with a correct orientation on the origin and reasons of this superiority, engaged in an intensive translation activity from Arabic to Latin, especially in the second half of the twelfth century, and they brought many Arabic scientific, philosophical and medical works into Latin. This separated Europe from the Middle Ages, ending the dark age. Europe reached the Renaissance with the speed it took from this awakening, and western civilization was based on it. The Renaissance period from the 14th century to the 17th century was not only a period that saw the rebirth of art and culture in Europe and England, but also a period in which health tourism flourished. A village known today as the Town of Waters in France became the most famous health center in all of Europe after the discovery of iron-rich hot springs in the region in 1326.
Important figures such as the Russian Tsar Peter I and the writer Victor Hugo visited these facilities and made the region a center of attraction. The word “SPA”, which takes its roots from the Roman saying “Salude Par Aqua” or “Salus Per Aquam”, that is, “health from water”, was first used for this village. In the 16th century, the upper rich layer of Europe revived the old Roman baths, and St. Touristic towns such as Mortiz, Ville d’Eaux, Baden Baden, Aachen and Bath in England have been included in the health tourism mobility of people in today’s sense as health centers. In this period, the regions where the health facilities were established under the conditions of that day became the cities where Muslim scientists lived. While seeking healing in thermal springs in the West, a significant number of hospitals were serving in the Ottoman Empire, which followed this period.
Post-Renaissance Period
Towards the end of the Renaissance period, noblemen from all over Europe continued to go to Bath to be cleansed and treated. In the 1700s, Bath was the first and only city in England to have a sewer system. In order to keep the interest of European aristocrats coming for health tourism, sidewalks were built for pedestrians, streets were illuminated to maintain trade for longer hours, and some standards were set for hotels and restaurants. A period of health tourism was experienced in Europe, in which almost everyone with income above a certain level and means of transportation visited the city of Bath in order to find health.History of
The discovery of the New World has led to the development of new destinations for health travelers in Europe. In this period, the Far East and India were almost rediscovered and people took trips to find health in those regions. In the 1600s, British and Dutch colonies began to build wooden cabins near mineral springs and used them for health purposes. In this period, as the centers of medicine in the Islamic world, Istanbul, Bursa, Budin-Pest (Budapest), Baghdad continued to be the health tourism centers of nearby and far geographies with its darüşşifas and spas. In the 18th and 19th centuries, Europeans and Americans continued to travel to the far corners of the world in search of cures for diseases such as tuberculosis.
Health Tourism from 1900s to the Present
During this time, the U.S. and Europe are now the health care centers of the World, as well as commercial and industrial centers. However, health care journeys continued as a concept that the wealthy could benefit from. The American Board of Medical Professionals (ABMS) was established in 1933 and became the umbrella organization for medical professional associations in the United States. The educational and professional policies developed by ABMS formed the basis of standards, many of which are still used around the world. These standards are the reason for the health tourism mobility towards the USA, which started then and continues today. After the 1960s, India has become an important stop.
The hippie (hippie, flower child, flower child) movement, which attracted the high society of America and England, has progressed into a health tourism industry where yoga and ayurvedic treatment are rediscovered. Developing technology and medical scientific advances caused the cost of health services to increase greatly, and in the 1980s and 1990s, US patients began to prefer cross-border options such as dental treatment in Central America. Due to the level of the health system, the USA lived in a period when the number of incoming patients was higher, while its own citizens were looking for solutions outside the country, and this outward flow continues to the present day by increasing.
In 1994, the JCI Accreditation Agency was established to check and ensure that the healthcare facilities where patients of US origin go for treatment comply with the international standards determined by them. As a result of the Asian economic crisis in 1997 and the devaluation of Asian currencies, the state authorities of these countries started serious advertising campaigns to develop health tourism, which they saw a significant income potential with tourism. These efforts started to pay off with Thailand becoming a preferred center for plastic surgery in a short time. With the guidance of governments, health tourism facilities such as Thailand, Singapore and India have become legitimate and attractive centers for developed countries with JCI accreditation. Thus, an irreversible process against the west has begun in health tourism activity.
This process reached its final point in 2008, when some US-based insurance companies started to consider outsourcing in health and offered their members the opportunity to have non-emergency procedures and surgeries done in other countries. The next step will be the period in which cross-border health care costs are accepted by all countries and health insurances “provided that it is an accredited health facility”.
