1HEALTHY SPACES, HEALING PLACES:
SHARING EXPERIENCES OF WELLNESS TOURISM IN OREGON,
USA
Greg Ringer, Ph.D.
University of Oregon, USA
Fulbright Visiting Professor, Faculty of Tourism & Hotel Management,
Kotor University of Montenegro
Abstract
This paper presents an overview of the evolving trends in spa, health, and medical
tourism in Montenegro and the United States and more specifically, the State of
Oregon.  The language and practices of “wellness tourism” which prevail in Oregon
differ significantly from those widely applied in Europe, where the concept is firmly
established, both legally and culturally.  Consequently, the ideas highlighted in this
paper are intended to support further discussion of the critical benefits of health-related
tourism for Montenegro.  In addition, the visitor experiences and data from Oregon may
encourage further consideration of alternative resources and preventive therapeutic
treatments that would complement existing curative facilities, and provide meaningful
opportunities for small- and medium-sized hotels and tour operators in Crna Gora
(Montenegro).
Objectives
Wellness tourism is a relatively new concept in the United States, although the
attractiveness of health-related travel is increasingly popular across the country, as
evidenced by the varied locations of the top health spas in Palm Desert, California
(Marriott Desert Springs Resort & Spa); Washington state (Wellspring, Ashford);
Nevada (Canyon Ranch Spa Club, Las Vegas); Colorado (The Aspen Club & Spa); New
York state (Origins Feel-Good Spa, New York City); Wisconsin (Fontana Spa); and in
Oregon (Spa Wananpine at the Kah-Nee-Ta Resort in Warm Springs).  Consequently,
the objective of this paper is to briefly highlight trends in spa, health, and medical
tourism in the U.S. and more specifically, the State of Oregon in the Pacific Northwest
(Burt and Lechtman, 2001).
It should be noted that the ideas and examples which follow reflect the language and
practices that prevail in the U.S., as well as parts of Canada, Australia, New Zealand,
and selected destinations in East Asia and the Pacific region.  As such, they differ
significantly from the terminology and meaning of wellness tourism in Europe, where
the primary emphasis is curative treatment, rather than preventive therapy as is the
norm in Oregon.  In addition, it is recognized that health-related facilities in Europe are
2more clearly defined, both culturally and legally, whereas the concept is broadly
interpreted in Oregon by individual spa operators and health providers in terms of
available treatments, and in the design and operation of the spa facilities themselves
(Lang Research Inc., 2001; Mueller and Kaufmann, 2001).  
The following ideas, therefore, are intended only to highlight current approaches in
Oregon and the U.S., in contrast to those which currently prevail in Montenegro.  In so
doing, the authors hope to stimulate further consideration and discussion of appropriate
alternatives for Montenegro that may complement the excellent, internationally-
renowned facilities (such as Igalo near the Croatian border) which already exist in the
region and have long been popular for both domestic and foreign visitors.
Wellness Tourism in Oregon
The popularity of wellness tourism in Oregon is perhaps best evidenced by the growing
number of day spas and destination resort spas throughout the state, as well as the
increasing use of geothermal hot springs long enjoyed by recreational visitors who now
seek the therapeutic benefits associated with their “healing waters” as well.  With more
than 126 individual facilities to choose from, a visitor may select an urban spa with full
amenities for day or overnight use, or alternatively, a destination resort or hot spring
located in the mountainous regions and high desert of central and eastern Oregon,
where the volcanic geology provides a steady source of geothermal waters.  
Many of the hot springs consist of nothing more than a primitive shelter or hot tub
surrounding the water’s source, with primitive campsites available for overnight guests. 
Several however – such as Breitenbush Hot Springs in the Cascade Mountains – provide
rustic cabins, organic meals, and regularly scheduled workshops and conference
facilities for their guests.  For tourists in search of more luxurious accommodations, the
choices include destination resorts offering a broad range of treatments and activities,
such as Spa Wananpine at Kah-Nee-Te Resort, owned and operated by the Warm
Springs Native American reservation in north-central Oregon.  Rated one of the top
health spas in the U.S., Spa Wananpine is situated in close proximity to Oregon’s major
urban centers, Portland and Salem (the state capital), where a majority of the state’s
population resides.  Indeed, both Breitenbush and Spa Wananpine benefit from their
geographic location, with most visitors living within a 5-hour drive of either spa.
The increasing attractiveness – and economic significance – of health and wellness
tourism is further apparent in the growth in both domestic and international visitors
since 2001.  While the total number of tourists from the Pacific Northwest region,
Canada, and Europe has rebounded slightly in the past five years, the number of
international visitors from Asia and South America remains depressed, with total South
3Figure 1.  Total visitor arrivals to Oregon and the Pacific Northwest by region,
2003-2006 (source: Travel Oregon, 2006).
American visitation still down nearly 16 percent in that period and 12 percent fewer
Asian visitors than previously.  Health tourism, in contrast, now draws  visitors from
every region, with anticipated annual growth ranging from 8 percent in U.S. and
Canadian visitors to a yearly increase of almost 20 percent in Asian visitors (figure 1).
 While much of this growth in tourism is directly attributable to direct flights recently
initiated between Oregon, Japan, Mexico, and Germany, there is no doubt that the
increase in the total number and affordable mix of day and destination spas in Oregon,
and growing awareness of the state’s reputation as a quality destination for
health-related travel, are also contributing factors to this trend.  As a result, the state
tourism marketing agency, Oregon Travel, estimates that tourism  will generate nearly
US$ 63 million in 2006 in both direct and indirect spending by tourists on spa and
health treatments, and associated recreation, accommodations, and travel (Inouye,
2006).
Oregon Visitor Profile
The total market for health and wellness tourism in Oregon is estimated to be
approximately 156 million visits per year, a significant market for a state whose total
population is only three million persons.  In large part, this is attributable to the
popularity of wellness tourism among Oregon residents, who may visit day spas in their
4communities several times a week.  It is also due to the state’s central location in the
region, and the proximity of many of the more popular hot springs and spas to the
major urban centers of Oregon and the Pacific Northwest.   
As noted above, most of Oregon’s spas draw their visitors from within a 5-hour drive,
including the cities of Portland, Seattle, and Vancouver, British Columbia.  In addition,
San Francisco is only a nine-hour drive and easily accessible by Interstate highway, and
direct flights connect these urban centers, as well as Los Angeles, Las Vegas, Denver,
and Calgary, Alberta, as well as the nonstop flights from Frankfurt operated by
Lufthansa Airlines and Tokyo on Northwest Airlines.  Consequently, the ease of
affordable access by road and airplane makes Oregon a popular attraction, as does its
national and international reputation for health lifestyles and the quality of its organic
agricultural products (Travel Oregon, 2005; Inouye, 2006). 
The overwhelming majority of spa users are women, though day spas report a higher
frequency of female visitors (91%), in contrast to resort spas (75%).  The average age
is also somewhat similar in both types of facilities, though day spas tend to attract
younger guests as well, reporting a range of 25-55 years in age, while resort spas draw
older adults (47-55 years old on average).  These variances are most likely due to the
higher costs associated with the destination resorts, where the average annual
household income exceeds US$ 35,000 (and nearly half report income exceeding US$
80,000 per year).  
It is also most certainly due to the work and family commitments of younger women
and men, who report comparable income levels, but who find the day spas more
convenient and affordable for frequent use as a supplement to their regular exercise
regime and membership in gyms and other venues for physical activity. As might be
expected, the benefits of regular exercise and preventive therapy are well-known by
guests of both types of facilities, who tend to be well educated, with 40-47 percent of
the users having earned an undergraduate university degree.  Thus, many are
knowledgeable about the diversity of treatments offered, and eager to take advantage
of them when available.  In addition, Oregon spa users are predominantly married
(more than 50%) and tend to visit alone or with other adults, as data provided by
Oregon spas indicate that only 29 percent of their guests are families, and then typically
only 1-2 children at most.
Perhaps the greatest difference between Oregon and European spas concerns the
emphasis placed on preventive treatment in the U.S., rather than curative medical
relief.  Thus, when asked why they visited an Oregon spa, the majority of tourists
indicated that their primary goals were rest and relaxation, stress reduction, and weight
loss.  Consequently, the most popular activities included massage and yoga, healthy
eating (most frequently, organic vegetarian and vegan meals), and outdoor adventure
and recreation.  Indeed, almost 42 percent of Oregon wellness tourists indicated a
5Figure 2.  Primary course of information about health
spas in Oregon (source: visitor survey to Oregon day and
destination spas, 2005).
desire for outdoor adventure activities – such as hiking, biking, and horseback riding –
to complement their spa treatment, while 11 percent sought cultural heritage programs
in addition to their spa therapy.  Both the preference for, and availability of, day spas
and interconnected outdoor or cultural activities are reportedly rare among wellness
visitors to Montenegro.
In terms of marketing, the influence of family and friends, and the use of the Internet
cannot be overstated.  Both are extremely critical to Oregon spas in attracting and
retaining visitors, with  most facilities operating their own websites on which they post
information and the opportunity to make direct reservations and inquiries.  In contrast,
the influence of advertising in the local and national media and in travel guidebooks, as
well as the reliance of wellness tourists on travel agents, were minimal, with 19 percent
of all tourists reporting these as a primary source of information (figure 2).                   
                                                                                                                          
Finally, it is worth noting that a majority of those spa tourists in Oregon who found the
experience positive, were willing to travel nearly anywhere in the world for a similar
activity if it were easily accessed and affordable.  This is certainly good news for
Montenegrin health providers and spa owners who have expressed a desire to position
Montenegro as a regional and international destination for wellness travel, and in
attracting more visitors from North America.
6Global Opportunities for Wellness Tourism
The growth in wellness tourism is certainly not restricted to Oregon.  Instead, the
number of users worldwide is increasing 18 percent per year, while the estimated new
demand exceeds 10 percent annually.  As a result, the number of new spas opening
each year is now nearly double (36 percent) the rate of growth in wellness and health
tourists, with the greatest expansion among small to medium-sized business operators
in the U.S., Canada, Australia, and New Zealand.  
In addition, the number of “[t]ravel agencies specializing in wellness travel [has]
increased from an estimated 300 to over 500 in the last two years” (Hawaii Wellness
Tourism Association, 2006: 2). Consequently, Montenegro’s desire to become the
primary destination in the Mediterranean for health and wellness travel appears to be
well-positioned should these global trends continue  (Verschuren, 2004).
The growing interest in this travel niche should also prove especially beneficial for the
owners of 2-3 star hotels in Montenegro.  Though these businessowners may lack the
required financial capital for major investments in infrastructure development and
marketing, they can provide a limited combination of recreational and therapeutic
activities, such as those which prevail in Oregon, to capitalize on the growing number of
international tourists who seek alternative destinations along the Adriatic coast as more
popular cities, such as Dubrovnik in Croatia, are increasingly perceived as overcrowded.  
Certainly, there is tremendous opportunity for hotel owners in Montenegro to
collaborate with Igalo and the Faculty of Tourism and Hotel Management in Kotor to
construct travel itineraries which combine wellness and health tourism with cultural
heritage tours, culinary tourism, and outdoor adventure in some of Montenegro’s most
significant ecological sites and National Parks (such as mountain bicycling around
Skadar Lake, whitewater rafting in the Tara Canyon, and trekking or snow skiing in
Durmitor National Park).  In this manner, they may attract both current visitors as well
as those who would normally travel elsewhere for health and wellness tourism.
Challenges for Wellness Tourism in Oregon and Montenegro
At the same time, there can be no denying the challenges presented by the growing
number of spas and resort destinations, and the competition they represent both
regionally and internationally.  Already, annual visits to some spas have declined by
13.8 percent as tourists seek out facilities that offer a greater range of amenities and
desirable treatments at less cost, or are more easily accessed by both domestic and
foreign visitors.
The different practices and meanings ascribed to health and wellness tourism in the
7U.S., Asia, the Pacific, and Europe have also compounded the difficulty of attracting the
“right” tourist.  As a result of the limited awareness among some consumers regarding
the definition and meaning of wellness tourism prevalent in each region and country,
some visitors have expressed dissatisfaction with unrealized or unrealistic expectations,
resulting in a loss of repeat business in some areas.
Thus, the biggest challenge for spa, health, medical, and wellness providers may be to
determine how best to address these needs in a sustainable manner.  At a minimum, it
will require 1) that they provide a unique and satisfying, long-term experience for their
visitors – one that will attract new users while retaining repeat customers, and 2) will
ensure a satisfactory financial profit for the business owners and operators, so that they
may continue to provide quality services for their clientele and the growing market in
wellness tourism.
Requirements for Successful Wellness Tourism
While there are a number of specific actions that can be taken at the local and national
level to remedy these challenges, they may be generalized as follows:
1. Visitors must be better educated about the differing practices associated
with spas, medical and wellness tourism.  This is especially true for
wellness tourism, as this is primarily a European and Asian concept, and
only recently been marketed more widely in North America (and even
then, it is a term still limited to individual states, such as Hawai’i and
Oregon, and the Canadian province of British Columbia).
2. Government at all levels must unite with private business and educational
institutions, such as the Faculty of Tourism and Hotel Management in
Kotor, if Montenegro is to compete successfully with similar attractions in
the Mediterranean.  Among the ideas which may prove most useful are
the development of “spa clusters,” in which health, medical, and wellness
facilities are located near outdoor and adventure tour operators, so that
they may provide complementary package tours, rather than compete for
the same visitors.  This may require legislation by local governments to
enact restricted land use zones in which only certain kinds of activities are
permitted, and thereby ensure protection of the natural and geothermal
resources upon which they all depend.
3. Efforts must also be taken to create a distinct product from the exercise
rooms, yoga, and massage common at most 3-5 star hotels.  This will
require a critical emphasis on quality in site design, management, and
marketing.
8Summary – the Oregon Experience
While the steps undertaken in Montenegro will obviously differ from those in Oregon –
for reasons that are political, social, legal, and economic – it may be worth reiterating
select actions undertaken by state and local governments, universities, and
businessowners in Oregon to attract and maintain its growing reputation as a health
and wellness destination.  Perhaps the most basic, but certainly the most significant, is
the clear preference for “high end” visitors in Montenegro who seek only curative
treatments.  There is also a stated disdain for day spas, which are nonexistent in the
country at the present time.  In contrast, both the private and public sectors in Oregon
have fully embraced both “high” and “low end” tourists, a choice reflected in the
number of self-described wellness and health facilities.
Rather than cater to only one visitor demographic, the operators of day spas,
destination resorts, and hot springs in Oregon have consciously targeted the broadest
possible visitor market by providing a diverse range of facilities, treatments, and
activities for their tourists – from “primitive” hot springs encompassing nothing more
than a retaining wall for privacy to resorts which offer a full spectrum of amenities.  The
mix of accommodations is equally varied, with guests able to choose from 5-star lodges
and hotels, to rustic cabins, campsites, and yurts (a tent like structure adapted from the
Mongolian nomads and now widely employed by Oregon’s State Park system as well,
where they are immensely popular).  
Included in the mix of activities offered by Oregon’s day and destination spas are
personal therapies, such as herbal baths, Onsen tubs, and traditional massage.  Most
facilities also emphasize preventive health education, especially women’s workshops and
specialized conferences, and some – such as Breitenbush – report that half of their
annual income is derived from these events.  Of equal interest to many visitors are
interrelated wellness offerings, such as culinary tourism centered around organic
vegetarian and vegan meals, and ‘fitness adventures,” including yoga, meditation, and
active outdoor recreation, such as hiking, bicycling, and horseback riding (Robinson,
2006).
Since almost 57 percent of Oregon’s lands are publicly owned, many of the facilities are
dependent on partnerships with the Federal government, particularly the U.S. Forest
Service and the Bureau of Land Management, to lease and maintain their geothermal
resources and surrounding environment.  Consequently, both agencies and their
partners are actively engaged in comprehensive land use planning to assure strong
natural and cultural resource management policies, appropriate regulations, and the
necessary transportation networks and infrastructure.
The State of Oregon also provides joint funding through its marketing agency, Travel
Oregon, in cooperation with private businesses and hotels.  A one percent tax levied on
9all hotel guests statewide now provides approximately 6,7 million Euros each year for
direct marketing to establish the Oregon “brand.”  Much of the promotional material is
available on the Internet, where it is intended to enable the visitor to obtain
information, make reservations, and communicate with businesses, in hopes that it will
facilitate those who seek to go from “idea to purchase” online.  
This ease of access and referral also aids in establishing a long-term relationship with
repeat customers, who are able to communicate directly with spa owners and provide
immediate feedback about their experiences.  Funding is also available through the
state’s community college system for business training for micro-enterprises and
entrepreneurial opportunities in sustainable health tourism, and for operators who seek
to expand their programs to provide lifestyle education, nutrition counseling, stress
management and depression, and naturopathic, alternative, or Eastern medicinal
practices (Travel Oregon, 2005).  
By supporting such a broad range of activities, facilities, and partnerships for existing
and potential business operators, Oregon affords its potential tourists a full menu of
options, based upon individual preferences in desired comfort, length of stay, favored
treatment, and available budget.  In this manner, it makes clear the desire to
encourage sustainable businesses, communities, and tourism and in doing so, to create
a relationship that is economically and ecologically healthy for the residents of Oregon,
and those who visit!
Acknowledgments
Dr. Ringer wishes to express appreciation to the U.S. Fulbright program for funding his
lecture and research grant in Montenegro.  In addition, he is extremely grateful to his
colleagues in Oregon and New Zealand – particularly Dr. Alexander Murphy, Dr. Mike
Hibbard, and Dr. Simon Milne for their continued encouragement – and to the Dean
and Faculty of Tourism and Hotel Management in Kotor, most especially Dr. Andriela
Vitic and Dr. Alexsa Vucetic, whose generosity and friendship enabled him to share in
Montenegro’s hospitality, and to better understand the benefits of wellness tourism in
their country as well as his.  Equal gratitude goes to Teresa Weaver, whose
understanding and unfailing support was critical to the success of this work.   
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