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View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Cape Peninsula University of Technology REVITALISING THE HEALING TRADITION - HEALTH TOURISM POTENTIAL OF THERMAL SPRINGS IN THE WESTERN CAPE MARK SIMON BOEKSTEIN Thesis submitted in fulfilment of the requirements for the degree Doctor of Technology: Tourism Management Faculty of Business at the Cape Peninsula University of Technology Supervisor: Professor J. P. Spencer Co-supervisor: Professor J. N. Steyn Cape Town Date submitted: November 2012 CPUT Copyright Information The dissertation/thesis may not be published either in part (in scholarly, scientific or technical journals), or as a whole (as a monograph), unless permission has been obtained from the university i DECLARATION I, Mark Simon Boekstein, declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the Cape Peninsula University of Technology. Signed Date ii ACKNOWLEDGEMENTS There are a number of people without whose help and support this research would not have been possible, and I would like to extend my thanks to: Professor John Spencer, my supervisor Professor Kobus Steyn, my co-supervisor The management and staff of all the thermal spring resorts, not only for their assistance, but for always making me feel welcome. iii ABSTRACT Revitalising the healing tradition – health tourism potential of thermal springs in the Western Cape There are 11 thermal springs in the Western Cape, seven of which have been developed into eight resorts. Only one of these resorts has a focus on health and wellness, with appropriate facilities, with the others functioning primarily as family leisure resorts. Internationally there has been a move by traditional thermal spring resorts to begin offering a combination of health (medical and wellness) services in combination with leisure activities. In light of current international trends, as well as perceived domestic needs, it appears that the Western Cape‟s thermal spring resources are not being optimally utilized as tourist attractions, neither for domestic nor for international tourist markets. This research sets out to evaluate the potential for health tourism development of thermal springs in the Western Cape. It analyses relevant aspects of both the supply and demand sides of thermal spring tourism in the Western Cape. A database is compiled of thermal spring resorts and undeveloped thermal springs in the Western Cape, which includes facilities and services, and relative locations with respect to tourist attractions and tourism routes. The mineral and radon gas contents of the respective thermal waters are measured and discussed in relation to known medicinal properties. A questionnaire-based survey was undertaken, involving 383 respondents at six resorts, and activity-based market segmentation was carried out using k-means cluster analysis. A four- segment user profile (typology) of current visitors, based on activity preferences, was compiled. It was found that there is considerable potential for the development of thermal spring health (medical and wellness) tourism products in the Western Cape, based on available resources. A framework for thermal spring health tourism product development in the Western Cape is proposed, and recommendations are made for future development and marketing. Key recommendations include the development of balneological treatments, and radon therapies, at certain resorts, and investigating of the availability of local resources that could be incorporated into medical or wellness tourism products. iv CONTENTS PAGE NO. DECLARATION (ii) ACKNOWLEDGEMENTS (iii) ABSTRACT (iv) CONTENTS (v) LIST OF TABLES (ix) LIST OF FIGURES (x) GLOSSARY (xi) CHAPTER 1: INTRODUCTION AND CONTEXT OF THE STUDY 1 1.1 Introduction 1 1.2 Thermal springs in the Western Cape 2 1.3 Thermal spring water 3 1.4 Balneotherapy 4 1.5 Thermal spring tourism and links to leisure and recreation 5 1.6 Health tourism 7 1.7 Health spa tourism in South Africa 9 1.8 Research 10 1.9 Problem statement 13 1.10 Aims of the research 13 1.11 Significance of the research 14 1.12 Overview of the research design and methodology 15 1.13 Organisation of the thesis 17 CHAPTER 2: HISTORICAL DEVELOPMENT AND SPATIAL DISTRIBUTION OF THERMAL SPRING TOURISM 19 2.1 Introduction 19 2.2 Early history - ancient Greeks and Romans to the 20th century 19 2.3 Europe 22 2.4 North Africa and the Middle East 24 2.5 Asia 26 2.6 Australasia 27 2.7 North America 28 2.8 South America 29 2.9 Antarctica 30 2.10 Sub-Sahara Africa 30 2.11 South Africa 31 2.12 Thermal spring resorts and the product life-cycle concept 35 2.13 Moving towards the future 37 CHAPTER 3: USING THERMAL WATER FOR HEALTH PURPOSES 38 3.1 Introduction 38 3.2 Balneotherapy 39 v 3.2.1 Chemical effects 40 3.2.2 Thermal effects 41 3.2.3 Mechanical effects 41 3.3 Balneological (medicinal/healing) classification of thermal waters 42 3.4 Balneological classification of South African thermal waters 44 3.4.1 Indifferent waters 45 3.4.2 Chalybeatic waters 45 3.4.3 Alkaline waters 46 3.4.4 Sulphate waters 47 3.4.5 Salt (sodium chloride) waters 48 3.4.6 Triple waters 48 3.4.7 Siliceous waters 48 3.4.8 Lithium waters 49 3.4.9 Sulphur waters 50 3.5 Medicinal properties of minerals found in thermal waters 50 3.6 Medicinal properties of gases found in thermal waters 51 3.6.1 Hydrogen sulphide 51 3.6.2 Carbon dioxide 51 3.6.3 Radon 51 3.7 Medicinal properties of peloids (muds) found in thermal waters 56 3.8 Positioning balneotherapy in modern medicine 56 CHAPTER 4: CONCEPTUALISING THE LINKS BETWEEN HEALTH AND THERMAL SPRING TOURISM 58 4.1 Introduction 58 4.2 The links between health and tourism 58 4.3 Medical tourism 61 4.4 Wellness tourism 62 4.5 Spa tourism 66 4.6 Thermal spring health tourism 68 4.7 Thermal spring health tourism – niche, special interest or mass tourism? 69 4.8 Summary 72 CHAPTER 5: INTERNATIONAL TRENDS IN HEALTH TOURISM - THE CHANGING ROLE OF THERMAL SPRINGS 73 5.1 Introduction 73 5.2 Developing differentiated thermal spa offerings 75 5.3 Comparison of selected thermal spa products around the world 78 5.3.1 Thermae Bath Spa (United Kingdom) 79 5.3.2 Hanmer Springs (New Zealand) 79 5.3.3 Peninsula Hot Springs (Australia) 79 5.3.4 Bad Wildbad (Germany) 80 5.3.5 Blue Lagoon (Iceland) 81 5.4 Summary 82 CHAPTER 6: THEORETICAL PERSPECTIVES ON MARKETING AND PRODUCT DEVELOPMENT FOR THERMAL SPRING TOURISM 85 6.1 Introduction 85 6.2 Tourist motivation 85 vi 6.2.1 Types of motivators 86 6.2.2 Motivations for visiting thermal spring resorts 88 6.3 Market segmentation 91 6.3.1 Segmentation bases 92 6.3.2 Data-driven methods of segmentation 93 6.3.3 Activity-based market segmentation 95 6.4 Tourist typologies and typologies of health tourists 96 6.5 Product development 99 6.6 Policy environment for tourism development and marketing in the Western Cape 100 6.7 Summary 103 CHAPTER 7 THERMAL SPRING HEALTH TOURISM IN THE WESTERN CAPE – SUPPLY-SIDE ANALYSIS 104 7.1 Thermal springs in the Western Cape 104 7.1.1 Cape Winelands 105 7.1.1.1 Goudini Spa 105 7.1.1.2 Brandvlei Hot Spring 106 7.1.1.3 Avalon Springs 107 7.1.1.4 Baden Klub 107 7.1.2 Cape Garden Route & Klein Karoo 108 7.1.2.1 Warmwaterberg Spa 108 7.1.2.2 Calitzdorp Spa 109 7.1.2.3 Uhuru Guest Farm 110 7.1.2.4 Toorwater 110 7.1.3 Cape Overberg 111 7.1.3.1 Caledon Spa 111 7.1.3.2 De Kelders 112 7.1.4 Cape West Coast 112 7.1.4.1 The Baths 112 7.1.4.2 Malmesbury Mineral Spring 113 7.2 Mineral contents of the thermal waters 115 7.2.1 Data collection 115 7.2.2 Mineral contents and related medicinal properties 117 7.2.2.1 Indifferent waters 117 7.2.2.2 Chalybeatic waters 118 7.2.2.3 Salt waters 122 7.3 Summary 123 CHAPTER 8 THERMAL SPRING HEALTH TOURISM IN THE WESTERN CAPE – DEMAND-SIDE ANALYSIS 125 8.1 Demand for health tourism in the Western Cape 125 8.2 Survey of visitors to thermal spring resorts in the Western Cape 127 8.2.1 The questionnaire - planning and administration 127 8.2.2: Demographic and trip-related information 129 8.2.3 Activity preferences 131 8.2.4 Reasons for visiting 135 8.2.5 Visitor perceptions regarding the health benefits of the water 138 8.2.6 Visiting nearby tourist attractions or places of interest while staying at a thermal spring resort 139 8.3 Market segmentation of the thermal spring visitors 141 vii 8.3.1 Cluster analysis as a segmentation technique 141 8.3.2 Description of the clusters 142 8.4 Summary 147 CHAPTER 9: GENERAL DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 149 9.1 Key findings 149 9.2 A framework to guide the development of thermal springs for health tourism 153 9.2.1 Medical tourism 154 9.2.1.1 Balneotherapy 154 9.2.1.2 Recovery and rehabilitation 157 9.2.2 Wellness tourism 158 9.2.3 Conservation and sustainability 160 9.2.4 Development of backward linkages with local communities 161 9.3 Key recommendations 161 9.4 Concluding remarks 163 REFERENCES 164 APPENDICES APPENDIX A: The questionnaire used in the empirical survey 176 APPENDIX B: Methodology for analysis of water samples for cations and anions 180 APPENDIX C: Analysis of water samples for radon content 181 viii LIST OF TABLES PAGE NO.