Wellness Tourism: From Europe's Spa Towns to the Modern Hotel Spa

Wellness tourism traced from Roman Bath and the Great Spa Towns of Europe to Japan's onsen, Rancho La Puerta and the modern hotel spa.

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^{HOW SPA TOWNS, ONSEN AND DESTINATION SPAS LED TO THE MODERN HOTEL SPA}

Green water of the Great Bath surrounded by colonnaded terraces with Bath Abbey behind — The Great Bath at the Roman Baths, Bath, Somerset, with Bath Abbey in the background, 2025. Image: Daniel Lu, CC BY-SA 4.0, via Wikimedia Commons

Wellness tourism is travel undertaken to maintain or improve personal wellbeing, and its history runs from the thermal springs of Roman Britain and Germany to the spa within the contemporary hotel. The word spa comes from a town near Liège in Belgium. Between around 1700 and the 1930s, according to UNESCO, a network of European spa towns built pump rooms, drinking halls and colonnades for visitors who came to drink and bathe in mineral water, and in 2021 eleven of those towns were inscribed together on the World Heritage List. Japan developed a parallel bathing culture around its hot springs, recorded in texts from the 8th century. In 1940 a health retreat opened at Tecate in Mexico, and by 2024 the Global Wellness Institute counted 201,861 spas worldwide, including those inside hotels and resorts.

^{WHAT IS WELLNESS TOURISM?}

The Global Wellness Institute (GWI), whose first Global Wellness Tourism Economy report appeared in 2013, defines wellness tourism as travel associated with the pursuit of maintaining or enhancing personal wellbeing. It separates two kinds of traveller. A primary wellness traveller chooses a trip or a destination mainly for wellness; a secondary wellness traveller keeps up wellness habits, or joins wellness activities, during any leisure or business trip. The same person can be a primary traveller on one journey and a secondary traveller on the next. GWI counts both international receipts, earned from inbound visitors, and domestic spending by residents travelling within their own country, in each case for trips that include an overnight stay, and it aggregates the total across 212 countries.

The 2013 report put wellness tourism spending at $439 billion for 2012. After a fall in 2020 during the pandemic, GWI puts expenditure at $894 billion in 2024. The businesses it groups under the heading include spas, wellness retreats, thermal and mineral springs and boot camps. Two of these, the mineral spring and the spa, were travel destinations long before the term wellness tourism existed: the Romans were developing the hot springs at Bath in AD 43, and the European spa town reached its height between the 18th and early 20th centuries.

^{WHERE DID THE SPA COME FROM?}

Engraving of monks and visitors gathered around spring fountains beneath trees at Spa — Spa, Belgium: Franciscan monks at the fountains of Sauveniere and Groisbeeck, engraving by M. B. Wachsmouth, 1762. Image: Wellcome Collection, CC BY 4.0, via Wikimedia Commons

Britannica defines a spa as a spring or resort with thermal or mineral water used for drinking and bathing, and records that the name was taken from a town near Liège in Belgium. That town, Spa, is now one of the eleven components of the Great Spa Towns of Europe World Heritage property. Springs were treated as places of healing long before the word existed. In legend, Britannica records, the founding of Bath is attributed to Bladud, who in 863 BC was cured of disease by immersion in the steaming swamps there.

The documented history starts with Rome. In AD 43, according to Visit Bath, the Romans began developing Aquae Sulis at Bath as a sanctuary of rest and relaxation, associated with the goddess Sulis Minerva, and Britannica notes that Roman colonists also built a spa at Buxton in Derbyshire. In the Black Forest, the official Baden-Baden tourism site records that the Romans founded a settlement more than 2,000 years ago and called it Aquae, meaning source or bath. After the departure of the Romans the baths appear to have been long neglected, though many churches across Europe were built on ancient healing sites. In the early 18th century, Britannica records, some Roman baths were rebuilt, new watering places opened and spas became fashionable secular resorts for the upper classes.

^{HOW BATH BECAME A RESORT FOR TAKING THE WATERS}

Caricature print of crowded Georgian visitors taking the waters inside the Bath Pump Room — Comforts of Bath: The Pump Room, by Thomas Rowlandson, 1798. Image: Thomas Rowlandson, Public domain, via Wikimedia Commons

Bath has the only thermal springs in England, Britannica notes. Its bathing culture was established before the 18th-century rebuilding. Regular royal visits between 1574 and 1663 increased the town's fame, and Visit Bath records that the Cross Bath became the most fashionable of its baths because of its privacy. Queen Anne came to Bath four times between 1688 and 1703 to take the waters, and her visits were followed by the great rebuilding that produced the city's 18th-century layout and architecture. In the 1790s the Great Pump Room was built to replace an earlier pump room of 1706, which had become too small.

Britannica describes spa therapy as based on both the drinking of and bathing in certain waters, which usually contain noticeable quantities of salts in solution. It attributes most of the medicinal effects to environmental factors: a different climate, diet and style of living, and warm bathing as an aid to relaxation. The practice of taking the waters reached its heyday in the 19th century. Bath's public bathing contracted in the 20th century: after the Beau Street pool opened in 1923 the Cross Bath lost status and became known as the Tuppenny Hot, and the Hot Bath closed in 1976, when the Royal Mineral Water Hospital stopped using it. Bath's historic spas were restored and revived in 2006.

^{THE GREAT SPA TOWNS OF EUROPE AND BADEN-BADEN}

Long neoclassical colonnade of the pump house behind formal flower beds in Baden-Baden — The pump house in Baden-Baden, Baden-Württemberg, Germany, 2015. Image: A. Savin, CC BY-SA 3.0, via Wikimedia Commons

In 2021 UNESCO inscribed the Great Spa Towns of Europe as a single World Heritage property of eleven towns in seven countries: Baden bei Wien in Austria; Spa in Belgium; Františkovy Lázně, Karlovy Vary and Mariánské Lázně in Czechia; Vichy in France; Bad Ems, Baden-Baden and Bad Kissingen in Germany; Montecatini Terme in Italy; and the City of Bath in the United Kingdom. UNESCO dates the phenomenon's highest expression to around 1700 to the 1930s, and states that the exchange of ideas between these towns influenced the development of medicine, balneology and leisure activities across Europe.

Each town was organised around its springs. UNESCO lists the building types developed to make practical use of mineral water for bathing and drinking: baths, the kurhaus and kursaal, pump rooms, drinking halls known as trinkhalle, colonnades and galleries. Around them stood assembly rooms, casinos, theatres, hotels and villas, and the supporting infrastructure ran from water piping and salt production to railways and funiculars. Taking the cure, internally and externally, was combined with exercise and social activity. Parks, promenades, sports grounds and woodland formed a managed recreational and therapeutic setting in which, in UNESCO's words, visitors could “see and be seen”.

Baden-Baden shows the water supply behind such a town. Its official tourism site counts twelve springs on the Florentinerberg, rising at between 56°C and 68.8°C and delivering around 800,000 litres of thermal water a day, about nine litres a second. The Friedrichsbad bathhouse takes bathers through 17 bathing stations, a sequence the town presents as a way to experience 19th-century bathing culture. The tourism board quotes Mark Twain on the Friedrichsbad: “After 10 minutes you will forget the time and after 20 minutes the world.”

^{HOW DID JAPAN'S ONSEN CULTURE DEVELOP?}

Traditional multi-storey wooden bathhouse of Dogo Onsen Honkan lit up at dusk — Dōgo Onsen Honkan in Matsuyama, Ehime Prefecture, Japan, 2014. Image: Japanexperterna.se, CC BY-SA 3.0, via Wikimedia Commons

Japan developed a parallel tradition around its hot springs. According to Nippon.com the country has more than 27,000 of them, together producing some 2.6 million litres of water a minute, and 3,085 lodging facilities in hot spring regions. The Izumo no Kuni Fudoki, thought to have been written in 733, describes Tamatsukuri Onsen, recording that people called its water the water of the gods and gathered there as if at a market. Dōgo Onsen in Matsuyama, Ehime Prefecture, is reputed to be the country's oldest hot spring, and it is mentioned in the Man'yōshū poetry collection, the Nihon shoki chronicle and The Tale of Genji.

Medical use was formalised in the Edo period (1603 to 1868), when doctors officially began to use hot springs for therapy; Nippon.com names Gotō Konzan (1659 to 1733), a master of traditional medicine, as the originator of such treatments. In 1604 Tokugawa Ieyasu went to Atami Onsen in Shizuoka Prefecture for a week of hot spring therapy, and the isshūkan hitomeguri, or one-week visit, became the basic unit of hot spring therapy some 400 to 500 years ago. At Dōgo, the Honkan public bath consists of four interconnected buildings erected from 1894 to 1935, designated an important cultural asset in 1994, the first public bath in Japan to be so recognised. The district around it is lined with ryokan inns, and bathers can change into a rented cotton yukata after bathing.

^{HOW WELLNESS TOURISM MOVED INTO THE HOTEL SPA}

Rooftops of Bath with the modern Thermae Bath Spa building and its rooftop pool — The Thermae Bath Spa with its rooftop pool, seen from the tower of Bath Abbey, 2010. Image: NH53, CC BY 2.0, via Wikimedia Commons

The 20th century added the destination spa. In 1940, KPBS reported, Deborah Szekely, then a teenager, and her husband Edmond Szekely opened a health retreat in Tecate, Mexico, the start of Rancho La Puerta. Szekely later recalled that the couple paid $50 a year to lease a small piece of land, that every guest climbed the mountain in the morning, and that the ranch served a healthy diet. GWI defines the destination spa as offering a full-immersion spa experience in which all guests participate.

GWI defines hotel and resort spas as spas located within a hotel or resort property, providing services on an à la carte basis to hotel guests and outside visitors; its other categories are the day spa, the destination spa and the thermal or mineral springs spa. GWI's description of the day spa lists the core services as massages, facials and body treatments given by trained professionals. Its first study estimated 71,800 spa establishments worldwide in 2007, earning $47 billion. By 2024 the count had reached 201,861 and revenues $157 billion, a 7.4% annual revenue growth rate, which GWI attributes to rising incomes, a growing middle class, the expansion of wellness tourism and higher consumer spending on wellness.

Natural water remains a separate category. GWI counts thermal and mineral springs establishments only where waters with special properties are used for wellness, recreation or therapy, and excludes sites that use ordinary heated water. It estimates 31,386 such establishments worldwide in 2024, earning $72 billion, with Asia-Pacific and Europe, the regions of the onsen and the spa town, accounting for over 93% of establishments and revenues. Establishments that also offer spa services earn over two-thirds of the industry's revenue, and around 365 new thermal and mineral springs projects opened between 2020 and 2025, with more than 250 in the pipeline.

^{THE SPA AT MANDARIN ORIENTAL JUMEIRA, DUBAI}

The Spa at Mandarin Oriental Jumeira, Dubai, was completed in 2019 to a DesertScape concept drawn from the curved, ridged forms of sand dunes. Set within a hotel, it belongs to the category GWI calls the hotel or resort spa, one of the four types included in its count of 201,861 spas worldwide in 2024. Its nine treatment rooms have full-height windows facing the beach and the Gulf. The spa also has a VIP suite and a hammam suite, and seating is in cocoon-shaped linen pods.

The vitality room centres on a circular dark mosaic pool. Curved, stratified marble walls enclose it under a rippled, cove-lit ceiling, and the marble is laid so that its grain runs continuously. Its treatment rooms, hammam suite and vitality pool bring together in one hotel spa the professional treatments of GWI's spa definition and the bathing that towns such as Bath and Baden-Baden built around their springs, a model GWI still counts as a separate category when the water is naturally sourced.