Vacation as a public health resource

849684 research-article2019

JHTXXX10.1177/1096348019849684Journal of Hospitality & Tourism ResearchLehto, Lehto/ VACATION AS A PUBLIC HEALTH RESOURCE

Vacation as a Public Health Resource: Toward a WellnessCentered Tourism Design Approach Xinran Y. Lehto Mark R. Lehto Purdue University

In today’s technology-driven configuration of work and life systems, wellness imbalances underscore the need for time away from sources of stress in the workplace, school, and other living scenarios. Increasingly, consumers are turning to vacation travel for health and wellness enhancement. The tourism and hospitality industries can design experiences and services that support optimal health and wellness outcomes for consumers. Drawing from interdisciplinary perspectives, this study revisits tourism as a personal health and wellness resource and discusses opportunities for better leveraging design factors in delivering, communicating, and sustaining health and wellness benefits of tourism. This article proposes a traveler wellness–centered design framework and highlights the important role of tourism and hospitality providers in safeguarding human health and wellness.

Keywords:

vacation benefit; wellness; human-centered design; wellness-centered design; traveler-centered design; tourism experience

Introduction

Physical inactivity has become an epidemic. A recent publication by Bloomberg (Lee & McDonald, 2018) presents a ranking of nations based on a simple yet compelling lifestyle criterion—how much one exercises on a daily basis. It notes that globally one in four adults do not get enough exercise. Among other factors, a car-driving lifestyle, desk-bound jobs, and digitalization of life in general are accountable for such consumer tendencies. Although inactivity has been identified as a contemporary health issue for some time, this undesirable condition has seen no significant improvement between 2001 and 2016, according to the World Health Organization (WHO, 2017). WHO presents this as an urgent global wellness issue yet to be effectively addressed. Developed nations are particularly challenged in this regard. The United States, for example, has an alarming 40% of its population deemed as being insufficiently active Journal of Hospitality & Tourism Research, Vol. 43, No. 7, September 2019, 935­–960 DOI: 10.1177/1096348019849684 © The Author(s) 2019

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(Lee & McDonald, 2018). Exasperated by the dramatic increase of time spent online as a result of digitalization of all facets of life in today’s society, this trend is expected to hold true for the future, adversely affecting individuals’ wellbeing and productivity (Montag & Walla, 2016).

Life digitalization along with physical inactivity can compromise human mental wellness. While social media platforms such as Facebook have flourished because of their professed capacity to facilitate community building and foster human connectedness, they seem also to have created scenarios where the human connection can lose its ground. In today’s technology-driven configuration of work and life systems, the once thriving working and socialization practices seem to have been replaced by ones that invite “social atomization, alienation, compartmentalization, and disconnection” (Sundaram, 2016). In the United States for instance, a record number of college students are now seeking mental health counselling and treatment for depression and anxiety (Reilly, 2018). It seems increasingly difficult for consumers to switch off from digital platforms. Research has demonstrated that addiction to social media technology can lead to gradual forming of neurological connections in the brain in ways similar to how opioid addiction is experienced (Peper & Harvey, 2018).

Obsessive amounts of time spent on mobile platforms have been shown to have a negative effect on human connectedness and contribute to what Peper and Harvey (2018) termed as “semitasking,” a phenomenon in which people are constantly engaged in multitasking but with poorer performance outcomes due to the lack of ability to focus.

Against this larger societal backdrop, wellness, as a holistic measure of health, has forged itself into the forefront of consumer’s everyday life. Travel, food, fitness, spa, and other leisure-oriented products and experiences are in high demand (Barrie, 2019). This article discusses the role of vacation as a public health resource. Tourism is uniquely positioned to become an effective antidote to the current public health challenges for several reasons. Tourism is increasingly becoming an integral part of life for today’s consumers. Given its innate mobility-promoting characteristic”, travel promises activities and environments that often cannot be found in one’s everyday living environment. As such, a vacation can potentially be an effective mechanism for human wellness enhancement. Within this overarching proposition, our article sets out to discuss the theoretical underpinning for such a proposition, the mechanisms, parameters and tools that may assist in orienting the tourism and hospitality industries to strategically serve the wellness needs of the public.

Drawing from environmental psychology, industrial engineering and ergonomic perspectives, this article discusses theoretical aspects of the wellness benefits of a vacation product. It advocates a humanistic approach toward vacation experience design by elucidating relevant conceptual orientations and principles foregrounding such a product. This research aims at providing a synopsis of useful conceptual lenses and parameters that tourism and hospitality service providers may act upon in order to create, communicate, and

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deliver health and wellness-oriented values to travelers. Never more than now should the tourism and hospitality industry be positioned to serve the public’s health and wellness needs.

A Vacation is a Wellness Product

Researchers have attempted to develop various theoretical lenses to elucidate influential factors related to individual health and well-being. In the field of medical sociology, researchers describe two generic approaches toward health promotion: pathogenesis versus salutogenesis (Antonovsky, 1979). The pathogenesis model studies the origin and development of a disease, emphasizing the understanding of the biological mechanisms of diseases (Last, 2000).

Salutogenesis, on the other hand, represents an approach of focusing on factors that support human health and well-being (Antonovsky, 1979). The dialogue on tourism as health and wellness resources follows the salutogenesis tradition.

The idea of traveling for physical, mental, or spiritual rejuvenation is appealing to travelers, especially to the overworked who are saddled with family and work responsibilities. In fact, one may argue that tourism has a de facto wellness orientation as “rest and relaxation” is a baseline motivation for the contemporary traveler (e.g., Lehto, 2013; Pearce, 2011). An assortment of terms has been used to describe the phenomenon of catering to wellness seeking tourists. Spa tourism, hot spring tourism, medical tourism, yoga tourism, health and wellness tourism are all examples of subsets of the general area of “special interest” tourism. Sometimes, “health” tourism is differentiated from “wellness” tourism. The former emphasizes medical treatment-oriented activities such as heart surgery or cosmetic surgery. The latter represents a more holistic approach where a traveler seeks general well-being enhancement through participating in activities and programs of self-care nature such as yoga, Tai chi, hot spring/spa, massage, and physical activities. In this article, we choose to use “wellness” as an encompassing concept to characterize a vacation that can instigate the feeling of “being well and alive.” In essence, we argue that all forms of leisure travel are “wellness” tourism in the sense that common to all types of tourism products, a traveler seeks an experience that will make them feel good or better at the end of the trip. In such a vacation, travelers are seeking a wellness product delivered via a much broader scope of activities, services and programs than the classic special interest tourism products such as a “spa,” “yoga,” or “retreat.” A vacation product, in essence, should be conceptualized as a wellness product.

Tourism signifies opportunities for a person–environment exchange beyond one’s daily routine. As such, the theoretical lens of environmental psychology has much to offer toward understanding tourism activities as a source of wellness because of its focus on human–environment interactional dynamics.

Environmental psychology studies have consistently linked characteristics of natural and built environments to an individual’s physical, cognitive, and emotional functions (e.g., Bratman, Hamilton, & Daily, 2012). Although effect sizes

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vary, they consistently support a superior influence on wellness of natural as opposed to urban environments. The evidence of these effects is mostly coming from self-reported data in controlled experimental settings, although physiological measures of outcomes are emerging (Bratman, Daily, Levy, & Gross, 2015).

Vacation, however, represents a more complex person–environment exchange process involving a full-bodied engagement with natural and built environments over a sustained period, when compared with other environmental exchange scenarios. Tourism researchers have noted a superior effect of vacationing in nature-oriented destinations as compared with urban destinations in some cases although the empirical evidence is not consistent in terms of the effect sizes of different environments (Lehto, 2013; Lehto, Kirillova, Li, & Wu, 2016).

Tourism as a Human Wellness Resource: A Conceptualization

To understand the wellness orientation of tourism, what constitutes human wellness comes to the forefront. American physician Halbert Dunn (1961) was the first to propose the concept of wellness, referring it to a special state of individual health that comprises “an overall sense of well-being which sees man as consisting of body, spirit and mind, and being dependent on his environment.”

The notion of human wellness has since been conceptualized from two differing perspectives (Keyes, 1998). The first tradition assesses well-being through clinical measures such as depression, distress, and anxiety. The second approach follows a more psychological tradition that operationalizes well-being through one’s subjective evaluation of well-being. The WHO (1964) defined health in terms of wellness as “physical, mental, and social well-being.” Saracci (1997) suggested that a state of wellness corresponds much more closely to happiness than to health. Hettler’s (1984) hexagon wellness model specifies six dimensions of healthy functioning including social, occupational, spiritual, physical, intellectual, and emotional dimensions. Ardell (2002, cited in Satya, Ganesan, & Ravichandran, 2008) considers wellness as a choice that people make to assume responsibility for improving their quality of life, suggesting a conscious decision to shape a healthy lifestyle. Myers, Sweeney, and Witmer (2005) defined wellness as being “a way of life oriented toward optimal health and well-being in which the body, mind, and spirit are integrated by the individual to live more fully within the human and natural community.” Essentially, for an individual to feel well, one has to be in optimal conditions for the mind, body, and spirit.

These various perspectives of wellness can provide a conceptual platform upon which optimal outcomes of a vacation can be built.

Hattie, Myers, and Sweeney (2004) proposed a structure of five dimensions of wellness: creative self, coping self, social self, essential self, and physical self. Wellness in all five selves are measures of individual wellness. This conceptualization of wellness effectively points to the importance of five types of personal resources essential for wellness. The first type is an individual’s creative resource capacity for problem solving and creativity needed in work and

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Figure 1 Vacation as a Health Resource

life scenarios. The second type refers to resources needed for coping with stress and maintaining the sense of worth and reality. The third type of personal resources attends to human’s need for social connections such as friendship and love. The fourth type corresponds to the resources needed for self-identity such as spirituality, gender identity, and cultural identity. The fifth type includes resources that maintain physical wellness such as physical exercise and nutritional needs. This wellness structure proposed by Hattie and colleagues allows researchers to tie wellness fulfilment to the various aspects of a functional individual. Tourism can play multiple roles in assisting an individual to protect, regain, or be in position to gain these various domains of personal resources.

The tourism and occupational health literature reflects an increasing effort to empirically assess how vacation travel may foster a better functioning individual from various angles. Examples include vacation effects on an individual’s cognitive restoration (e.g., De Bloom, Ritter, Kuhnel, Reinders, & Geurts, 2014; Lehto, 2013), vacation’s association with one’s creative capacity (De Bloom, Kinnunen, & Korpela, 2014), and vacation’s effect on subjective happiness (e.g., Chen, Lehto, & Cai, 2013). By uncovering the psychophysiological and psychosocial processes that engender beneficial outcomes for an individual, we may better understand the wellness properties of a vacation product and thus enable optimal vacation conditions for travelers. In this regard, we propose an overarching approach toward understanding a vacation as a wellness product, conceptualizing tourism’s wellness qualities from four domains: protective, restorative, instorative, and transformative (Figure 1). We posit that these four domains of vacation qualities and properties can optimally a foster a vacationer’s sense of wellness.

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That is, vacation can serve a role in 1.

2.

3.

4.

Preventing the loss of wellness resources by strengthening one’s wellness resources (e.g., consistency of healthy habits and physical activity regiment) Restoring cognitive resources (e.g., recovering from fatigue, stress or boredom; regaining mental focus) Installing or expanding creative and other productive resources (e.g., gaining new skills, perspectives, or novel ways of problem solving) Transforming life (e.g., engendering positive life changes)

Understandably, these wellness functions are not necessarily discrete occurrences nor do they operate in isolation, as human–environment transactions should be treated as embodied phenomena (Mini, Smith, & Franz, 2006; Parsons, 2011). The underlying assumption is that all psychological processes are related to physiological events. For example, the “entity of mind” cannot be independent of the central nervous system in that the mind has a substrate (Cacioppo, Tassinary, & Berntson, 2000). Consequently, when a vacation product delivers wellness values associated with these four wellness quality domains, it is important to understand that these four domains are certainly not mutually exclusive; in fact, they can be mutually dependent and have convivial properties. These wellness properties work together to protect, restore, or generate a vacationer’s creative resources, cognitive resources, social resources, physical resources, and spiritual resources.

The following sections intend to discuss how tourism and hospitality industries can design and deliver vacation products in accordance to these wellness functions and thereby assist consumers in feeling healthy, well, and alive via the means of a vacation. We posit that a vacation product can be so designed such that dimensions of traveler wellness are optimally catered to. Whether travelers are explicitly seeking wellness-oriented goals or not, a wellness orientation should be an all-encompassing strategy underlying vacation experience and service design, management, and marketing.

Vacation’s Protective Function

Travel represents physical mobility as vacationers move outside their daily living environment. As a result, tourism and everyday life have been described as belonging to divergent ontological worlds (Larsen, 2008). However, as Larson emphasizes, leisure, travel, and everyday life intersect in a complex fashion. In fact, a vacation represents a duality where a traveler assumes two roles simultaneously—those of an everyday self and a travel self. The traveler carries with himself or herself personal, social cultural dispositions and habituations, and yet at the same time is bestowed with a traveling mind-set, suggesting an openness to spend time and behave differently from his or her everyday life. As consumers increasingly resort to a healthy daily routine to enhance their

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well-being, destinations and hospitality businesses then play an important role in assisting travelers to stay on track with their dietary, sleep, and excise regimens. In this sense, tourism and hospitality businesses assume an important protective role in safeguarding healthy living on the road. This caretaker role is magnified in today’s environment when consumers converge on hospitality and travel services as preferred respite activities and consumptive choices. This suggests a need for the tourism and the hospitality industry to be keenly mindful of its assistive role in sustaining and strengthening consumers’ wellness resources.

It also signals an opportunity for tourism and hospitality businesses to create a strategic advantage built upon a wellness orientation.

There are emerging examples that tourism destinations and services are increasingly embracing the wellness protection role inherent in their very DNA. Cities are paying attention to such design factors as place walkability (Gorrini & Bertini, 2018; Hall & Ram, 2018), by creatively designing trails and walkways, or suggesting walkable routes around attractions and local sights and sounds—a trend that benefits both residents and visitors. One such recent example is a spiral treetop walkway placed in the middle of a forest reserve just south of Copenhagen. The walkway is connected to a 148-foottall observation tower, incentivizing visitors to be physically active. The hotel industry has also embarked on a wellness makeover by revamping their fitness programs and wellness amenities. MGM grand hotel’s StayWell room amenities, for example, include air purification, aromatherapy, circadian lighting to enhance sleep, energy, and productivity, longwave night lighting to minimize sleep disruption and reduce jet lag, and memory foam mattresses for better sleep quality. Hotels have also started to carefully align their food offerings with traveler wellness needs. A few such examples are healthy food and beverage options in market pantry and beverage outlets, and healthful menus options in hotel restaurants. Some additional examples include wellness-oriented services such as preloaded and programmed iPod exercise routines, information on neighborhood running routes, or providing reward program points redeemable for massage services. These amenities and services reflect a wellness orientation geared toward satisfying the health protection needs of vacationers.

Leading hotel groups have gone to the extent of acquiring brands that have wellness squarely built in their brand concept design (Barrie, 2019). For ­example, the Inter Continental Hotel Group has recently purchased Six Sense resorts, gaining a company with wellness as its brand focus. Hilton is launching a business travel hotel brand Signia—a brand with a strong wellness element in its design. The recent trend of realigning and placing hospitality and tourism programs in colleges of Health and Human Sciences is also clearly reflective of the increasingly prominent role of hospitality services in serving the public’s wellness needs. The caretaking role of the hospitality sector will continue to be highlighted. We anticipate seeing more creative approaches from the tourism and hospitality industries in fulfilling their wellness-keeping role.

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Restorative Function of Vacation

The restorative function of vacation may be the most explicitly sought-after short-term goal for today’s vacationers. Occupational health research has posited that workplace productivity and social capital need to be sustained by conserving and restoring mental processes via “recovery” (Sonnentag & Fritz, 2007). This recovery theoretical lens led to research examining how individuals can regain their optimal mental conditions via respites in nonwork periods, such as breaks during the day, in the evenings, and on weekends (Sonnentag & Bayer, 2005). However, the increasing non-separation of work and life in the context of digitalization increasingly render these short respites insufficient or ineffective to achieve recovery.

Consumers have resorted to taking a traveling vacation as a means to restore critical cognition resources such as attention and focus—capacities that tend to diminish as mental fatigue sets in due to the everyday grind of work and routine (Morrison, Lehto, & Day, 2018). Recent studies in tourism have zoomed in on the conceptual understanding of what constitutes a restorative vacation and what destination characteristics, activity traits, and service properties may be most conducive toward such goals (Lehto, 2013). The inherent characteristics of travel can potentially nudge a vacationer to have prolonged exposure and engagements with beneficial environmental qualities. Knowledge of these attributes and characteristics can guide destination and hospitality service providers in designing and delivering wellness values to the travelers.

Much of the understanding of the restorative properties of an environment come from environmental psychology, a domain area that is concerned with the human–environment exchange and how environmental qualities contribute to human wellness and health. Environmental psychologists, for instance, suggest sub-health conditions such as stress and mental fatigue can lead to the loss of an important cognitive resource—one’s voluntary or direct attention capacity (Kaplan, 1995). The wear and tear of this resource will inhibit the normal functioning of the prefrontal cortex—a part of the brain responsible for cognitive functions (Kaplan & Kaplan, 1989). Kaplan (1995) suggests that certain properties of natural environments can help restore one’s directed attention capacity—a mental capacity essential for fulfilling work and other daily demands. This restoration is achieved when an environment can help activate one’s involuntary attention—a form of attention that is unintentional or unconscious, and thereby effectively rest one’s directed attention. Based on Kaplan’s attention restoration theory, Lehto (2013) first proposed a perceived destination restorative qualities model, attempting to elucidate what may be important parameters for tourism professionals to be mindful of when designing and marketing vacation experiences to consumers. Lehto’s conceptualization comes in the form of a six-dimensional configuration. These six dimensions include the following:

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2.

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6.

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Compatibility—a traveler’s sense of congruence with a destination, that is, that of a person–environment fit Fascination—a traveler’s feeling of effortless immersion in and enchantment with tourism moments Scope—a traveler’s felt opportunities to engage in a rich collection of activities, experiences and interests.

Mental away-ness—a sense of psychological detachment from one’s daily routine Physical away-ness—a sense of physical departure from one’s daily living environment Orientation (originally termed as “discord”)—a sense of mental orientation and comfort towards the place being visited

These properties inherent to tourism can reduce thoughts of stressors associated with everyday life, which would otherwise preoccupy a consumer’s mind.

These six dimensional traits are noted to promote restoration on the part of the traveler, and therefore can serve as design parameters for tourism and hospitality professionals to optimally foster efficient renewal of travelers diminished functional resources. In fact, researchers have noted that these six areas of qualities are primal for inducing travelers overall sense of satisfaction with a vacation (Lehto, 2013; Lehto et al., 2016). The importance of the restorative functions of a vacation product calls for a more careful scrutiny of the mechanisms in a vacation that can lead to such positive outcomes for the travelers. It is in this context, we argue that considerations of specific wellness values that a vacation can deliver and how these values can be tangiblized through the design specificities of a vacation product is pertinent to the industry practitioners as well as consumers themselves when choosing a vacation product.

Instorative and Transformative Functions of Vacation

Travel promises opportunities for vacationers to gain new personal resources.

A traveler’s interactions with novel natural, social, and cultural environments can potentially benefit one’s intellectual and creative resource development.

Tourism’s potential linkages with one’s creative resources have garnered recent research attention (e.g., De Bloom et al., 2014). Travel is seen to possess potential for generating individual creativity resources (McCoy & Evans, 2002) although these functions may not be explicitly sought by the vacationers.

Creativity is typically understood as the ability of bringing into being something that is both unconventional and useful (Amabile, 1996; Sawyer, 2006).

Extensive research has been conducted on what may instigate creativity as it is a welcomed resource for success at the individual as well as the collective level. Although the “aha” moment of a creative idea is thought to be elusive, researchers have examined the potential processes, mechanisms, environmental and other contextual stimuli, and personal characteristics in relation to

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creativity (e.g., Leung, Maddux, Galinsky, & Chiu, 2008; Schooler & Melcher, 1994). Regarding individual creativity, researchers have noted the facilitating role of various contextual factors such as cognitive state, affect, and motivation (Amabile, Barsade, Mueller, & Staw, 2005; Fong, 2006; Fredrickson, 2001).

One approach that perhaps can enable the understanding of the potential linkage between travel and its potential for personal creative resource generation is the creative cognition approach (Leung et al., 2018). The central tenet of this approach is the belief that every individual can produce creative ideas. It is in this context that researchers have recognized the value of the copresence of different cultures and the role of multicultural experiences in generating possible creative resources. Leung et al. (2018) suggested that several traits for such cultural copresence experiences can potentially foster creativity. These include direct access to new concepts, multiple underlying functions beneath the same representation/form, destabilized routine structure, a psychological readiness (open mind-set), and opportunities to foster synergistic scenarios for seemingly different ideas. In this regard, we can see that travel can be closely aligned with these traits.

Travel by default entails a person to situate him-or-herself away from home and into novel environmental and/or cultural settings. The potential for tourism in facilitating creativity seems to have been long speculated on. However, this topic has only recently drawn attention from researchers and empirical evidence of a direct link between travel and measurable creative resource gain has yet to be clearly established. Theories of restorative qualities of nature have also alluded to creativity being enhanced or instored via contact and interactions with nature (Kaplan & Kaplan, 1989). Other researchers have suggested that certain physical and social conditions are most conducive to creativity (McCoy & Evans, 2002). For example, Ulrich (1993) noted that nature, challenge, freedom, support, multiple sensory stimuli available in a natural environment may be conducive to creative behavior. Travel is known to offer potentially intriguing experiences, a promise of free exploration, away-ness from status quo, and novel social interactions. In this regard, travel may naturally stimulate inclinations for rebelliousness, criticalness, skepticalness, and flexibility—psychological conditions inimical to creativity (MacKinnon, 1962). An interesting question regarding practice is “Can tourism experience and service design elements foster creativity?” Conceptually, it would seem so when destination environments, activities, and services available accord with creativity-inducing characteristics.

Vacations’ transformative function may be the least explicitly sought-after function. However, travel has been known to sometimes produce a transformative effect on individuals where travelers make major life changing decisions in life or acquire perspectives or skills that enable them to feel “new” and different although specific triggers of such transformations have not been clearly understood (Kirillova, Lehto, & Cai, 2017a, 2017b).

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A General Framework for Traveler Wellness–Centered Design

This article advocates for traveler wellness–centered design of the vacation product. From this perspective, it is important to understand that a vacation product entails multiple destination entities and industry components along with the travelers themselves to coproduce such an experience. The notion of wellness-centered design begins with the assumption that steps can be taken to enhance the wellness related outcomes for vacationers. The travel process itself can be divided into stages of activities such as pretrip planning and preparation, travel to and from a destination, destination activities, and posttrip activities.

The activities themselves involve interactions with other people, use of travel products and systems, the built and natural environments within which the travel activities take place, and the multiple organizations providing travel-related services. Each of these elements are part of a larger travel system within which a particular travel process takes place and can be focused on during the wellness centered design of a vacation experience.

Figure 2 presents a general framework for traveler wellness–centered design that reflects this perspective. Designing wellness features, delivering wellness values, communicating wellness benefits, and sustaining destination wellness resources are important action-oriented functions for such a traveler wellness ecosystem. There are a larger set of questions to consider in this system. Who is the designer of the travel experience? What do they design? What are the goals and objectives of each of the participants in the design process? How will these goals be achieved? What is the larger impact of the design solutions of one part of the system on other elements of the system? Clearly, the traveler themselves play an important role in this system by choosing particular travel products and their participation in travel activities. These choices determine the organizations providing travel products and facilities (such as hotels, restaurants, and transportation facilities), the destination environment, other travelers, and so on, meaning that travelers are indirectly shaping or influencing the design of the travel system. Travel support organizations, such as online distribution services, travel agencies, destination marketing organizations, or welcome centers play an important role at this level in the travel process, by helping travelers make better choices that can enhance their wellness outcomes.

Other organizations participate in the design process in ways that vary greatly in scope and focus. At one extreme, corresponding to centralized top down design of the travel experience, an organization might offer a door-to-door wellness centered travel package. For example, think of a luxury cruise vacation package which offers a limo ride to and from the airport, first-class flights to and from a seaport, comfortable lodging on a luxury liner, a menu of healthy food offerings, recreation facilities, and stops at attractive destinations, and so on.

Here, each element of the travel experience can be designed by the provider to enhance traveler wellness. More typically, however, each of the participating

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Figure 2 A General Framework for Traveler Wellness–Centered Design

organizations can design only part of the larger travel system that delivers the travel experience. At one extreme, each of the subsystems of the larger travel system operates independently. This situation corresponds to a decentralized bottom-up system in which the transportation system, lodging and hospitality system, and attractions are at best loosely coupled.

One of the serious consequences of this lack of coordination is that this can lead to serious overuse and depletion of wellness resources at a destination. For example, attractive destinations such as Venice and Amsterdam are struggling to cope with the effects of overcrowding due to mass tourism. Conflicts may also occur when providers use a common resource, such as a beach or other natural/ urban environments. To address such issues, governing organizations at the destination (such as tourism boards, community planning and zoning commissions, etc.) can play an important role in managing the use of destination resources in a sustainable way that avoids damaging the potential wellness values offered by the attractions and services at the destination.

The design elements contributing directly to travelers’ destination experience can be understood as composing of four broad, often overlapping, areas: 1.

People: refers to wellness considerations in design that facilitate positive social interactions (e.g., designing humanness in services, designing communal spaces for social interactional needs, online social support forums such as a female traveler network on Facebook)

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Activity: refers to wellness quality considerations in designing experiences, activities and programs-the very core aspect of what vacationers travel to places for (e.g., walkability design, sensory design, programming design, queuing design) Environment: refers to wellness considerations related to the macro (destination), meso (business), and micro (consumption/product) levels of environmental setting and feature design (e.g., air quality, safety, landscape, architecture, soundscape, servicescape) Product: refers to tangible products’ wellness considerations (healthful foods, excise amenities, souvenirs that reflect uniqueness)

As discussed in the previous sections of this article, each of these design elements can contribute to traveler wellness outcomes in a variety of ways. From this perspective, the travel experience can be viewed as a form of therapy that can potentially provide a wide variety of wellness benefits. Once a provider knows which design elements contribute to traveler wellness, they can then focus on enhancing these elements by offering products, services, activities and experiences designed to be wellness enriching. However, this is at best only a partial solution, as travel may also include time spent on unnecessary activities that do not provide wellness benefits, as well as travel conditions that cause stress, anxiety, boredom, fatigue, illness, or injuries. Travelers may also fail to choose and consume healthy travel products even if they are available. Each of these issues are important considerations in the design of a traveler wellness ecosystem, as expanded on below.

Industrial Engineering Tools for Optimizing Vacation Wellness Effect

Wellness-centered design implies that the travel experience should be designed to maximize wellness-related objectives. Two complementary strategies that provide a good starting point for attaining this goal are 1.

2.

Eliminating or reducing time and effort spent on nonwellness value added travel activities Enriching activities to add wellness-related value to the travel experience

The first of these approaches largely corresponds to the traditional focus in the field of Industrial and Systems Engineering of reducing waste and thereby increasing the productivity of human systems that produce products or services.

This approach is illustrated by the Toyota Production System (Liker, 2003; Ohno, 1988) and more generally the concept of Lean Manufacturing which focuses on eliminating forms of waste, such as idle time, unnecessary operations, transportation time, accidents, or defective products, through a process of continuous improvement. Value Stream Mapping is a commonly used tool to identify which of the activities performed at each stage of the production process

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add value. Eliminating activities that do not add value along with identifying other sources of waste using methods such as Root Cause Analysis often leads to large improvements in production efficiency, reliability, safety, and quality of the delivered products.

From the perspective of wellness-centered design, it is easy to see that Value Stream Mapping and related approaches could be applied to reduce or eliminate non-value-added traveler activities or other forms of waste during the different stages of the traveler experience, such as pretrip activities, transportation activities, destination activities, lodging activities, and so on. The latter approaches are especially useful for identifying how to improve elements of the larger system involving vendors, transportation systems, and travel providers. Activities not providing wellness added value become a natural target for wellness-oriented improvement. For example, consider the case of the Singapore Changi Airport, which is adding a mix used development (Jewel) that include a recreation area (gardens and attractions) in which travelers waiting for flights can spend time immersed in a natural setting. Doing so transforms the nonwellness value added activity of sitting in a crowded terminal into one that provides potential wellness benefits.

The field of industrial engineering also places heavy emphasis on modeling and data analytics to optimize processes and services. Such approaches include the use of forecasting models to predict customer demands, scheduling, and simulation models to create smoother work flows, and real-time monitoring of system status. In the travel industry, Walt Disney World has followed this approach to maximize guest experience for many years. For example, Disney uses traveler attendance forecasts updated in real time to assign labor resources at locations such as park entry turnstiles, restaurants, and merchandise locations to ensure adequate staff is available at the right time to minimize customer waiting and otherwise ensure guest service standards are met. Forecasting models updated in real time are also used to predict wait times for attractions which guests can use to decide on which activities to participate in. Rather than physically waiting in line, customers can enter virtual queue using phone apps for particular attractions and go elsewhere to enjoy other activities, before returning at the scheduled time. Another innovation is the use of interactive queues, which provide various forms of entertainment to guests waiting for an attraction. To test and refine potential solutions, Disney makes extensive use of computer simulation and analytical tools such as queuing theory prior to making physical changes. Such models include realistic visual animations of customer arrivals, servers, and related activity to measure and identify issues such as wait times, queue lengths, travel distances, bottlenecks, and congestion. It is easy to see that these industrial engineering approaches used by Disney to reduce the time spent by customers on nonwellness value added activity such as waiting in line could be used by a wide variety of other travel providers such as airports, resorts, museums, and so on.

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Reducing the Adverse Effect of Travel From a Design Perspective

To a large segment of vacation travelers, the attractions and activities at the destination are the primary reason for traveling. Identifying and enhancing the specific elements of a destination that provide wellness benefits is a first step for tourism and hospitality experience and service providers to act on in their executive role of consumer wellness caretaker. One aspect of this wellness strategy that needs to be systematically considered is the adverse effects of travel. Travel can come with negative effects on health and wellness of the travelers. The discussion of how a vacation may promote health and wellness cannot be complete without careful consideration of eliminating or mitigating the adverse effects that can commonly be associated with travel.

Some of the common adverse impacts include stress and fatigue, sleep interruption, unhealthy eating and drinking, lack of exercise, and personal safety.

Industrial and systems engineering has much to offer in identifying and mitigating these adverse effects. This includes the use of industrial engineering analytical tools such as those mentioned above as well as methods of ergonomic design (Lehto & Buck, 2007). Both approaches can be used to understand how different design elements may create stress and adversely affect travelers’ wellness needs.

Some examples of travel quality–related wellness stressors include 1.

2.

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Poorly designed, stressful, processes and service interruptions that cause travelers to waste time performing unnecessary tasks, or waiting for service (such as waiting for a lost baggage or for a room to be ready) Failure to provide necessary information in an appropriate form to travelers at the time it is needed to guide their decision making (such as inadequate signage in airports or rail stations, failure to provide updated information regarding activity schedules) Stressful interactions with poorly trained, uncooperative, or unmotivated service staff Poorly designed layouts of service facilities that result in congestion, crowding, and excessive travel distances from point to point Unhealthy, uncomfortable, unsafe, or stress-producing environmental conditions Poorly designed, uncomfortable, or difficult to use travel related products (such as cramped seating in airplanes, uncomfortable beds in hotels) Poorly designed online distribution and purchase systems that are cognitively straining for users

Some of the underlying issues contributing to such problems and potential solution strategies are expanded on below.

Poor Ergonomics The emerging role of ergonomics in product and service design (Lehto & Buck, 2007) should be recognized in combating the potentially adverse effects

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of travel. From the perspective of wellness-centered design, better ergonomics provides a user or human-centered approach for systematically identifying and addressing unhealthy elements of the travel experience. That is, unhealthy travel-related activities or conditions that cause stress, anxiety, boredom, fatigue, errors and mistakes, illness, or injuries. Ergonomic solutions and areas of focus especially applicable to travel-related applications can be broadly divided into three areas. Environmental ergonomics focuses on the influence of the thermal environment, noise levels, lighting, and other environmental factors on health, aesthetics, comfort, and performance of people. Physical ergonomics focuses on how to better fit user activities and products to human anthropometric, physiological, and biomechanical characteristics. Cognitive ergonomics focuses on mental activity such as perception, memory, information processing, reasoning, and decision making needed to perform a task (such as booking an air ticket on a vendor website), and on the many factors that influence performance on tasks that require mental activity from consumers (Lehto & Buck, 2007).

The three traditional areas of focus, that is, environmental, physical, and cognitive ergonomics map directly to ergonomic issues that arise in travel settings.

Examples of such ergonomic disregard are (1) noisy, uncomfortable hotel rooms or travel facilities and (2) prolonged sitting in cramped poorly designed seats, movement restrictions, and excessive lifting by passengers in airplanes or airports (think of a small female lifting a heavy bag above her head into an overhead bin on an airplane). Other examples include confusing or poorly designed transportation facilities (e.g., the chaos of a large crowded train or subway station—with long-winding lines of people waiting, and all signs in a foreign language), error provocative computer interfaces (such as an automated ticket dispenser with multiple fares for different transportation zones), or inadequate signage systems.

To apply these ergonomic principles, various forms of task and activity analysis have been developed in the field of human factors engineering and ergonomics to evaluate human performance using products and services in a wide variety of settings (Lehto & Buck, 2007). At the most basic level the focus of these methods is to first identify what tasks are being performed to attain particular user goals. In many applications, this process is guided by the analysis of similar systems to suggest potential problems and improvement strategies. The focus here is often on identifying critical incidents or problems occurring in the past as targets for improvements. Observation (or contextual task analysis) of people using the analyzed system or a similar system often is essential to identify activities and activity sequences, errors, and the information actually used by people in the actual use setting.

During a task analysis, the relationship of the tasks performed to particular goals is often described as a hierarchy in which tasks contain subtasks. For example, in a travel setting, travel to the airport might involve subtasks such as deciding how to get there, when to leave, which route, and so on. Attention is

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also often placed during task analysis on addressing issues such as how much time is spent is spent on particular tasks and on how well they are performed. To address the latter issue, focus is often placed on determining task requirements, in terms of time, and other variables such as physical and mental demands, and then comparing these requirements with the abilities of targeted user populations. For example, the focus might be on accommodating first time users, or users with certain disabilities. Along these lines, a travel site catering to first time or inexperienced travelers might provide a package of preselected options reducing the need to consider all the details.

Cost Cutting and Overreliance on Digitalization and Automation A most critical strategy for enhancing traveler wellness is for travel providers to shift away from a short-sighted focus on cutting costs and increasing efficiency to a focus on delivering high-quality products that satisfy the wellness needs of travelers. Cutting costs is of course desirable in that it makes travel more affordable to travelers. However, an excessive focus on cost cutting can lead to overproduction of low-quality travel products such as cramped, crowded, unhealthy aircraft cabins or unattractive cookie-cutter vacation products, offering minimal human services that add to the stress of travel rather than delivering the wellness related benefits. A closely related trend is overreliance on automation, forcing travelers to serve themselves with often confusing or unfamiliar systems (such as an automated flight or hotel checking-in system).

As also discussed at the onset of this article, it is noted that consumers are increasingly finding it hard to switch off from digital platforms. Even in the travel scenarios, they are again digitally connected, either by choices (e.g., socialization activities) or coerced by tourism and hospitality businesses (e.g., use of an assortment of digital travel and services applications). From the perspective of wellness value delivery, some of the pervasive practices of digital services as default options or only options in the travel and hospitality settings are debatable. It should be noted that although travel experiences can be enriched by digital technologies (e.g., immersive experiences enabled by digital technologies such as digital museums), digital technologies can also potentially take away travelers’ opportunities and incentives to be physically active and mentally get away (switch off).

More and more digitalized services, in pursuit of efficiency, have reduced humanness in the delivery of services and experiences. In some cases, they provide no options for traveler to stay off digital platforms. Examples are ample, from self-check in-and-out kiosks, to tablet-based self-ordering and payment systems in a restaurant. There is something undesirable about forcing travelers to “work” with the goal of efficiency. We may ask “What is the very essence of hospitality?” In the context of wellness value creation for travelers, humanness in services and social interactions may be core elements of design that should be considered to enable travelers’ sense of human connections.

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Overproduction, Crowding, and Overstandardization From the perspective of many destinations, attracting travelers is only one of many potentially important objectives. A significant concern, from the wellness perspective, is that once a destination that provides an attractive mix of wellness-promoting elements is “discovered,” more travelers will want to go there. In response to this demand, travel providers will provide more hotels, restaurants, and convenient forms of transformation. This in turn will bring in more travelers. The unfortunate consequence is that this spiraling trend of overproduction can lead to mass tourism, resulting in serious overuse and depletion of wellness resources at the destination. For example, think of the flocks of tourists arriving at attractive destinations such as Venice, Amsterdam, and Machu Picchu forcing these destinations to cope with the effects of overcrowding. This problem is compounded by travel operators such as cruise or tour operators who drop off sometimes hundreds of tourists at the same time to briefly walk around attractions.

A related trend is the mass production of standardized travel products.

Imagine travelers going places to see something different, only to discover things are quite similar. This would reduce both the restorative and instorative effects of a vacation. The introduction of these low-cost standardized products can seriously damage the original character of the destination (such as uniqueness and the sense of away-ness sought by travelers). For example, think of replacing the original cafes in Paris, with McDonalds and Starbucks or replacing the quaint waterfront fishing docks in a small village with a large-scale tourism development project such as a chain five-star hotel with no regard for the locale characteristics. These sound like extreme examples, but such standardization is actually happening in many parts of the world where the economic efficiency is a dominant model. Other conflicts may occur when service providers use a common resource, such as a beach or other natural environment. For example, a resort focusing on providing a restful restorative beach vacation may have to share this resource with a provider of noisy jet skis. Complicating such issues is the fact that for many destinations, travelers share living and activity spaces with residents. Many of the spaces and activities may not have been designed with accommodation of travelers in mind, resulting in serious crowding and sometimes hostility instead of hospitality from the locals.

In a nutshell, the very wellness resources that a destination offers may not be sustainable in such scenarios. To address such issues, governing organizations at the destination can play an important role. One approach is to restrict the production of travel facilities by placing limits on where they must be located (e.g., no hotels might be allowed within parks or environmentally sensitive areas). A second is to limit the capacity or size of service facilities.

A third is to require the design to aesthetically match the original character of the destination. For example, no McDonalds restaurants are allowed on the quaint attractive side streets lined with outdoor cafes in Paris. A fourth is to

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limit the number of tourists arriving to locations or the time they are allowed to stay. For example, Machu Picchu strictly limits the number of tourists allowed to enter each day and Venice now charges tourists on cruise lines entering the city. A fifth is to encourage means of transportation other than cars. For example, cities such as Amsterdam place restrictions on where cars are allowed. Other examples include Brisbane, Australia, which provides a wellness enhancing waterfront transportation system that includes catamaran ferries, along with separated bike lanes, walking lanes, and jogging lanes that are parallel to a street for cars. Creative solutions toward issues related to overstandardization, over use, and overcrowding are called for.

Supporting Wellness-Centered Traveler Decision Making

Expanding on the notion of cocreation, the inherent role of the travelers themselves in a tourism experience along with roles of experience and service providers emphasize the importance of the traveler-centered design orientation, in order to optimally deliver wellness values to the travelers. User-centered design traditionally starts with various forms of customer requirements to assess their needs. The field of human factors engineering and ergonomics provides a large set of complementary methods many of which are also traditionally used in industrial engineering and user centered design. These are used to define customer requirements that can be organized using frameworks such as quality function deployment (QFD) to identify and organize desired product features and their importance to customers.

Houses of Wellness Quality QFD is a systematic procedure for determining what the customer wants, how well these needs are satisfied by existing products, and how to best modify the product to satisfy the customer. The results are organized in a so-called house of quality that shows how strongly the engineered (or designed) elements of a product are related to the characteristics desired by the customer. It also shows how well the characteristics desired by the customer are satisfied by existing or proposed products and the relationships between engineered elements. QFD begins by assessing the so-called Voice of the Customer—characteristics of the product in the customers own words and their importance. Their relation to engineered design elements is then determined by expert analysis, along with target values for each customer attribute and engineered element, trade-offs between engineered elements, and the technical feasibility and cost of reaching the targeted values.

Along these lines, a wellness-oriented House of Quality for a particular destination might relate features of the destination to customer wellness related attributes. For example, a house of hotel wellness quality might map the relationship between characteristics (such as wellness amenities, distance to attractions, walking paths) of a hotel to customer wellness attributes (such as

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restfulness, walkability, etc.). These relationships might be developed by experts alone, or by using analytical methods for assessing and modeling customer preferences as a function of product attributes (Lehto, Nah, & Yi, 2012). Examples of these analytical methods include AHP (the analytical hierarchy process), SMART (subjective multiattribute rating technique), conjoint analysis, and policy capturing models. Each of these approaches relates attributes to choices and provides an estimate of how important each attribute is, but differ in how they are implemented.

In practice, it is easy to see that following such an approach to develop Houses of Wellness Quality for travel products, destinations, and services could be used by designers to guide the development of customized products that better fit the wellness needs of particular travelers. Such information could also be used to help engage or support travelers in designing their own travel experience, as expanded on below.

Traveler Decision support How to help consumers enjoy a travel experience that would be healthful and enriching? So much of what is done in marketing is selling oriented not necessarily driven toward what is best for the consumers—what can transform consumers into better beings, hence the caretaking principle should replace the efficiency principles. Caretaking role is a role that tourism and hospitality should consciously embrace.

Classic economics would suggest that travelers will seek out products and services that satisfy their wellness needs. The basic assumption is that travelers will make choices based on the value they expect to receive from each alternative by considering wellness-related attributes of each alternative and their importance. The demand for these products will in turn encourage providers to design travel products that better satisfy traveler wellness needs by enhancing these elements to make their products more attractive to the traveler.

As mentioned earlier, there are many emerging examples showing both an increased demand for wellness products and a corresponding focus on satisfying traveler wellness needs by tourism destinations and providers (such as wellness catering hotels and resorts). On the other hand, there are discouraging examples, such as the trend in the U.S. airline industry toward providing increasingly cramped unhealthy seating and unhealthy food choices on time-consuming flights with multiple connections. The key question that arises is “What can be done to encourage travelers to make choices that lead to better wellness outcomes and encourage destinations and service providers to provide better wellness products?” This leads us to several related topics as expanded on below.

Information needs and information quality. Travelers need certain types of information to make informed choices that satisfy their wellness needs. At the most basic level, this would include characteristics or attributes of the considered alternatives travelers can use to decide which alternative to choose. The qual-

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ity of the information used depends on what is available at the time the choice is being made, its completeness, accuracy, and relevance among other factors.

One pressing concern is that travelers may be provided inadequate, incomplete, or misleading information that makes it difficult to make good choices. For example, a travel website might not mention a low-cost hotel is located in a high-crime area, negative comments may be scrubbed from a provider’s website, or no information might be provided about sugar levels and calorie counts on a menu. It is easy to see for each of the above examples how the missing information might result in traveler choices with less than desired wellness outcomes. For example, based on price alone, a traveler who values both safety and walkability might book the hotel located in a high-crime area. This, of course, might lead to negative wellness outcomes, such as increased stress and reduced physical benefits of walking.

On the other hand, another issue is that travelers might be provided excessive amounts of mostly irrelevant, poorly organized, or overly detailed information, leading to information overload and decision fatigue. For example, hundreds of user comments might be listed on a hotel website, without any guidance on how relevant they are to the wellness needs of a particular type of traveler such as an older female culture tourist versus young male adventure traveler, or on how to compare the hotel against other options using this information. Further complicating the issue, the traveler may have little insight into how the listed characteristics or attributes of the considered alternatives lead to wellness outcomes or most important, the traveler may lack awareness of how they contribute to the earlier discussed protective, instorative, restorative, or transformative wellness functions of a vacation.

To summarize the current situation, it is at best difficult for travelers to compare the wellness-related costs and benefits of travel destinations, products, and services. Compounding the problem, booking sites encourage travelers to focus on price when making their travel-related choices, by not including easily understood measures of how the alternatives influence wellness. A good first step in addressing the above issues would be to include measures of wellness quality along with price and other characteristics of the compared alternatives, as expanded on below.

Wellness quality rating/index. In an ideal world, travelers would know for sure how each of the choices they make will affect their wellness. This, of course, will never be possible, but certainly many forms of information could help travelers judge the wellness-related attributes of travel destinations, products, and services. For example, a destination might have a safety and health rating, walkability rating, environmental quality rating, cultural attraction rating, and so on.

A hotel might have a room comfort rating, safety rating, restfulness rating, food quality rating, exercise facility rating, and so on. A restaurant might have a nutrition rating, noise rating, cleanliness rating, and so on. Food items might have calorie rating, sugar rating, fat rating, and so on. An airline might have a seat comfort rating, seat space rating, food quality rating, and so on. Providing such

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information along with price and other attributes of travel destinations, products, and services could act as a nudge which encourages travelers to consider wellness quality when making their decisions.

The wellness quality ratings themselves might be generated by crowd-sourcing methods in which travelers rate travel destinations, products, and services on wellness criteria, conducting surveys, or various forms of expert assessment. Knowledge of which attributes contribute value to the traveler can also lead to methods of decision support oriented toward helping particular travelers make better choices.

A wellness quality index can be developed based on the house of wellness qualities. This can be applicable to the product and business level (such as restaurants, hotels, cruises, airlines, etc.) but can also be developed at a destination level. These indexes can be utilized by businesses and destinations as a strategic advantage in marketing their experiences and services. More important, they can be developed and provided to consumers in supporting their purchase decision making. In a Recommender System (such as tripadvisor.com or expedia.com), when a wellness score is provided alongside price information, consumers will be framed into a wellness lens of decision making, instead of simply considering pricing. In this way, consumers will be nudged into considering wellness factors in their decision making.

Concluding Remarks: Toward a Health and Wellness Ecology

A vacation signals a clear geographic departure from a consumer’s everyday environment and at the same time is a continuation of everydayness on the part of the vacationer, as a traveler remains himself or herself and carries with themselves their preexisting dispositions of everyday-ness. The mobility nature inherent to tourism signals fresh resources and opportunities for enhancing wellness through mental and bodily engagement instigated by tourism’s spatial–temporal structure, sites, locales, spaces, architecture, landscape, and social historical contexts.

Although travel for health and wellness has had a long historical context and has been examined as a domain of special interest tourism for some time, tourism and hospitality have taken on a broader and more foundational role in safeguarding human wellness as we embark on a societal and technological transformation. The tourism and hospitality sectors are currently presented with opportunities and challenges of a magnitude unprecedented. Environmental stress, political divide, coupled with technological advancement in artificial intelligence, and other factors have interestingly brought on stressful living conditions, which have led to an increase of undesirable “modern” psychological and physical conditions. In response, tourists are increasingly driven by motives related to enhancement of overall well-being. This need is manifested in the growing interest on the part of the consumers in this line of travel products and by the rising number of destinations throughout the world that are positioning or repositioning themselves around the theme of “wellness.”

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This societal context casts a bright light on the well-being orientation of tourism and hospitality. But what can be done to achieve this goal? We assert that the tourism and hospitality industries can design experiences and services that better support optimal health and wellness outcomes for consumers. At a system level, wellness needs should become an overarching orientation governing product experience design and marketing messages. We advocate a dramatic increase in academic research and industry practice directed toward developing and applying parameters and measures of wellness along with the use of modeling methods, due in part to their promise for guiding system wide holistic approaches toward improving wellness centered decision making by both consumers and businesses. Toward this objective, we propose wellness-oriented design parameters such as wellness indexes based on design factors and also provide examples of how industrial/ systems engineering principles and tools can be used to identify design solutions that protect and promote the health and wellness of the general public.

We also propose that tourism and hospitality wellness orientation needs to be understood from an ecological view. A core concept of an ecological model is that wellness enrichment behavior has multiple levels of influences, often including intrapersonal (biological, psychological), interpersonal (social, cultural), business organizational, community, physical environmental, and policy. It is hoped that this article stimulates further conceptual conversations and empirical research toward building a comprehensive framework for guiding our understanding of the multiple and interacting determinants that tourism practices can take into consideration when designing experiences and products. Healthy behaviors can be maximized when the destination and hospitality service systems support healthful choices, and travelers are motivated, educated, and nudged to make those choices. Achieving this goal requires a commitment to enhancing wellness at the level of the individual traveler as well as interventions by destinations and businesses to achieve optimal health and wellness outcomes.

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Submitted April 8, 2019 Accepted April 13, 2019 Refereed Anonymously Xinran Y. Lehto, PhD (e-mail: xinran@purdue.edu), is a professor in the Department of Hospitality and Tourism Management, Purdue University, West Lafayette, IN. Mark R. Lehto, PhD (e-mail: lehto@purdue.edu), is a professor in the School of Industrial Engineering, Purdue University, West Lafayette, IN.