Canada Communicable Disease Report
Volume 29 ACS-9
1 October 2003

An Advisory Committee Statement (ACS) 
Committee to Advise on Tropical Medicine and Travel (CATMAT)*^†

STATEMENT ON ETHICS AND TRAVEL

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Preamble

The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides Health Canada with ongoing and timely medical, scientific, and public health advice relating to tropical infectious disease and health risks associated with international travel. Health Canada acknowledges that the advice and recommendations set out in this statement are based upon the best current available scientific knowledge and medical practices, and is disseminating this document for information purposes to both travellers and the medical community caring for travellers. 

Persons administering or using drugs, vaccines, or other products should also be aware of the contents of the product monograph(s) or other similarly approved standards or instructions for use. Recommendations for use and other information set out herein may differ from that set out in the product monograph(s) or other similarly approved standards or instructions for use by the licensed manufacturer(s). Manufacturers have sought approval and provided evidence as to the safety and efficacy of their products only when used in accordance with the product monographs or other similarly approved standards or instructions for use. 

Tourism is one of the fastest-growing industries at the beginning of the 21st century and has been used as a reliable indicator of economic growth in both developed and developing countries. Many nations see tourism as a quick and easy solution to combatting economic difficulties. Increasingly, countries are choosing to develop and promote their natural resources to attract more tourists in what is a very competitive market. This has posed several ethical challenges to the travel and tourism industry, the traveller, destination host cultures, and travel health professionals. 

Travel and Tourism Industry

Any industry that balances the "good of the market" with the "good of the people" must hold both in ethical tension. According to the World Travel and Tourism Council, travel and tourism have overtaken the auto, steel, electronics, and agricultural industries and are now regarded as one of the largest global industries⁽¹⁾. With more than 100 million people in the tourism industry serving an annual tourist population of more than half a billion, this enterprise generated an estimated annual economic force of US $2.0 to $3.5 trillion by the mid-1990s^(2,3). 

Many of the problems faced by the tourism industry are ethical in nature, including destruction of the environment, pollution, depletion of natural resources, economic imperialism, and sexual exploitation⁽⁴⁾. Tourism has been defined as "the industry of the holiday companies, travel agents, transport firms, building companies, caravan manufacturers, cable railway operators, ski manufacturers, souvenir sellers, the car industry, banks, insurance companies . . . an industry with its own laws, its own legitimacy"⁽⁵⁾. Each sector of the tourism industry is competing for a greater share of the market, using whatever marketing methods work to reach target economic goals, where market precepts, and not ethics, predominate.

In response to these ethical tensions, there has been a recognition of the need to consider the concept of "sustainable tourism" if the economic gains of the industry are to continue being realized. Sustainable tourism is defined as the development of global tourism industry capacity and the quality of its products without adverse effects on the environment that maintains and nurtures the industry⁽⁶⁾. Within this framework has emerged a branch of tourism known as ecotourism, which accounted for up to 10% of the tourism industry by 1994⁽⁷⁾. Ecotourism is defined as "responsible travel to natural areas which conserves the environment and improves the welfare of local people"⁽⁸⁾. According to the Canadian Environmental Advisory Council, ecotourism should promote positive environmental ethics, be biocentric rather than homocentric in philosophy, and should benefit the wildlife and the environment socially, economically, scientifically, managerially, and politically⁽⁹⁾. 

The subject of ecotourism has generated considerable interest in the travel industry, partly because of increasing consumer interest and obvious economic impact, but also because of increasing concern for the conservation and sustainable development of tourism's most valuable resource - the natural environment, which is the primary attraction for tourists. However, the popularity of ecotourism has also given rise to a plethora of ecotourism imitation companies that do not meet the standards of minimal environmental impact, maximal benefits for tourist areas, and conservation ethics⁽¹⁰⁾. Although proposals have been made to monitor the level of sustainable development and conservation practised by the tourism industry^(11-13), there currently exists no regulatory body or mechanism with which to evaluate the impact of tourism. 

The Traveller

Numerous codes of ethics have been developed that are aimed first at tourists and second at the tourist industry as a result of a growing concern over alleged irresponsible practices by tourists, the tourist industry, and governments⁽¹⁴⁾. These codes generally address ethical principles focusing on a sense of responsibility rather than precise conduct, or an exhortation and moral suasion rather than an enforceable set of rules⁽¹⁵⁾ (see Appendix). According to one author, "codes are meant to translate the more formal philosophical theories of ethics into a set of guidelines that can be applied to the day to day decision making"⁽¹⁶⁾. 

Part of the tourist's responsibility when entering a foreign culture is to have respect for the host culture and customs. However, travellers are usually primarily concerned with their personal risks, including theft, assault, accidental trauma, and infection. Rarely does the idea that the traveller poses a potential risk or danger to the host population and its environment receive much consideration. Such hazards include the spread of infection from tourists to local populations, the introduction of pollution by tourists, destruction of the environment, the increased consumption of valuable resources, such as water and electricity, by tourists, increased costs of living, inflation of land values resulting from tourists' demands, conflicts created by the display of leisure and prosperity amid the pervasive poverty of many receiving host cultures, the sexual exploitation of local populations, and the lack of economic opportunities for local populations who generally do not enjoy ownership in the tourism industry. 

Tourists are often eager to escape the stresses of (usually Western) society and may not be interested in discussing or being reminded of such challenging ethical issues. Nevertheless, a growing resentment towards tourists in receiving host cultures⁽¹⁷⁾ and the potential consequences of some tourist activities, such as the introduction or spread of HIV⁽¹⁸⁾, make it necessary to address appropriately the ethical behaviours of travellers. The problem rests in how and by whom these issues should be addressed. Strict rules or codes of conduct for travellers will not be easily enforceable and therefore may not ultimately be useful. However, awareness and education should not be underestimated. Those disseminating pre-travel advice, including travel medicine specialists, passport offices, travel agents, and tourism companies, will need to consider what constitutes adequate education and information concerning travel ethics. Travellers need to be equipped not only with appropriate disease prevention messages but also with an ethic that will ensure preservation of the host culture and its environment, ultimate survival of the tourism industry, and a safer and more  rewarding experience for all travellers.

The Destination Host Culture

The modern roots of global opposition to tourism can be traced back to a conference convened in Manila in 1980 by religious leaders from developing countries who were concerned about the negative impact of tourism on their hosting cultures. Out of this gathering came the bold "Manila Statement" asserting that "tourism does more harm than good to people and to societies of the Third World". Subsequently, the Ecumenical Coalition on Third World Tourism was instituted and has since become one of the foremost international organizations advocating responsible tourism⁽¹⁵⁾ (see Appendix).

The benefits of tourism to host cultures are often listed as primarily economic, including generation of foreign exchange, creation of employment, additional revenue for the host government through taxation of tourists, and improvement of local economic structures. Other potential, but indirect, benefits include improved roads, availability of electricity, access to hospitals, improved water and sewage systems, and better health services.

Are the potential benefits of tourism realized by host cultures? The current evidence suggests that they are not. The majority of revenues generated by tourism in the developing world is repatriated to developed countries by transnational corporations. This so-called "tourism industry leakage" results largely from Western ownership of hotels, resorts, restaurants, travel agencies, airlines, and car rental agencies used by tourists heading to developing countries⁽¹⁹⁾. In addition, many of the commodities used by the tourism industry sector in developing countries, including building supplies, construction equipment, food, and beverages, are imported. Despite these leakages, tourism may still benefit local cultures through employment generation. However, this potential benefit has also been questioned⁽¹⁹⁾. Local populations employed by the tourism sector may receive grossly inadequate salaries in local devalued currencies for the menial jobs that they are often assigned⁽²⁰⁾. The more financially lucrative managerial, financial administrative, and public relations opportunities are often reserved for foreigners⁽²¹⁾. Therefore, the economic benefits of tourism to local host cultures may be overstated.

Are the indirect benefits of tourism realized by host indigenous peoples? Improved transportation, electricity, water, and sewage systems are often mentioned as indirect benefits of the tourism industry. However, tourists consume disproportionately more water, food, and electricity than local populations, occasionally resulting in reduced availability of such resources for these populations⁽²⁰⁾. Evidence also suggests that the health of local populations may be worsened by the influx of tourists^(21,22). As previously mentioned, tourism may have contributed to the introduction and spread of HIV in at least one destination host culture⁽¹⁸⁾. Tourist revenues are seldom used to improve the health status of local populations. 

In addition to unrealized potential benefits, what other tourism-related risks are host cultures subject to? The environmental costs of tourism, such as disruption and destruction of ecosystems, pollution, land erosion, depletion of natural resources (food, water, land, fossil fuels), and waste created by disposables, have been well documented^(21,23). The social costs of tourism are not so clearly linked to the tourism industry. The loss of cultural traditions and local languages, and the increase in problems such as burglary, robbery, prostitution, gambling, and violent crimes have all been attributed in part to tourism^(24-26). Increases in drug and alcohol abuse with subsequent increases in sexually transmitted diseases have been clearly linked to tourism in some areas of the developing world⁽²⁷⁾. Finally, local peoples may often be denied access to those natural resources that have attracted the tourist in the first place⁽²⁸⁾. For tourism to be sustainable in the long term, the benefits to local host cultures will need to outweigh these significant risks. 

Travel Health Professionals

Should pre-travel clinics educate the traveller with respect to ethical patterns of behaviour and cross-cultural interactions as well as disease-preventing behaviours? Should pre-travel advice focusing on ethical issues be included in the information provided for travel to certain destinations? Unfortunately, pre-travel health advice is sought by less than 50% of travellers journeying from a developed to a developing country⁽²⁹⁾. When it is obtained, travellers tend to seek advice from previous travellers, travel agents, tour groups, or embassies/consulates of host countries, often receiving inaccurate information^(30-33). Travellers receiving pre-travel advice from health care providers, including specialized travel clinics, often do not receive appropriate and accurate information^(34,35). Furthermore, travel medicine advisors have little or no training in the ethical and cultural aspects of travel. Just as with disease prevention messages, there is clearly a need to improve the education of health care professionals concerning the ethics of travel and tourism. This may be accomplished by including travel medicine and tourism ethics in health sciences curricula, improving and increasing continuing medical education programs for travel health advisors, and setting standards for the profession by examination or certification. In addition, more attention needs to be given to appropriate sources and content of ethical travel recommendations, such as cultural guidebooks for travellers or pamphlets outlining codes of ethics for travellers. Finally, international travel medicine organizations, such as the International Society of Travel Medicine, should become engaged as advocates of more responsible action by all players involved in travel and tourism. 

Conclusion

Tourism will likely continue to be a global growth industry. Comprehensive pre-travel assessment goes far beyond personal health risks to the individual traveller. Since the role of the travel medicine advisor is to make travel possible, the ethical aspects of travel and tourism do fall within his or her scope, provided that the additional information does not dilute or take away from the issues of health and safety, the primary mandate of the travel medicine practitioner. Tourism that markets and sells to the tourist as the primary target population of interest, ignoring environmental and sociocultural risks to host cultures, may reach short-term profit goals but will ultimately not be sustainable. Global codes of ethics for tourists and the tourist industry will only be effective to the extent that awareness of current ethical issues concerning tourism increases. Travel health professionals can play an important role in increasing this awareness in the tourist industry and the travelling public.

Recommendations

*Evidence-based medicine 

Expiration

This document will be updated every 4 years or when new information becomes available. 

References

1. The WTTC report: travel and tourism in the world economy. Brussels: World Travel and Tourism Council, 1992.

2. Whitney DL. Ethics in the hospitality industry: an overview. In: Hall SSJ, ed. Ethics in hospitality management: a book of readings. East Lansing, Michigan: Educational Institute of the American Hotel & Motel Association, 1992.

3. Exploring tourism [editorial]. The Nation 1997;265:3.

4. Payne D, Dimanche F. Towards a code of conduct for the tourism industry: an ethics model. J Business Ethics 1996;15:997-1007.

5. Krippendorf J. Towards new tourism policies. In: Medlick S, ed.
   Managing tourism. Oxford, England: Butterworth-Heinemann, 1991.

6. Hawkes S, Williams P. The greening of tourism - from principles to practice, GLOBE'92 tourism stream: case book of best practice in sustainable tourism. Vancouver, BC: Sustainable Tourism, Industry, Science and Technology, Canada, and the Centre of Tourism Policy and Research, Simon Fraser University, 1993.

7. Frank P, Bowerman J. Can ecotourism save the planet? Conde Nast 1994(Dec):134-37.

8. Western D. Defining ecotourism. In: Lindberg K, Hawkins DE, eds. Ecotourism: a guide for planners and managers. North Bennington, Vermont: The Ecotourism Society, 1993:7-11.

9. Canadian Environmental Advisory Council. A protected areas vision for Canada. Ottawa: Minister of Supply and Services Canada. Cat. No. EN 92-14/1991E.

10. Arlen C. Ecotour, hold the eco: polluting rivers and bagging wildlife may be on the agenda. U.S. News & World Report 1995(May 29):61-3.

11. Hiller H. Environmental bodies edge closer to green ratings for travel. The Ecotourism Society Newsletter 1991(summer):1.

12. Holland R. Rating and recommending ecotourism enterprises [abstract]. Presented at First World Congress on Tourism and the Environment (Belize City), Belize, April 1992.

13. Shores JN. The challenge of ecotourism: a call for higher standards [abstract]. Presented at Fourth World Congress on National Parks and Protected Areas (Caracas), Venezuela, February 1992.

14. Malloy DC, Fennell DA. Codes of ethics and tourism: an exploratory content analysis. Tourism Management 1998;19(5):453-61.

15. Kutay K. The new ethic in adventure travel. Buzzworm: The Environmental Journal 1989;1(4):31-6.

16. Dean PJ. Making codes of ethics "real". J Business Ethics 1991;10:99-110.

17. Chandrapurkar J. Tourists' haven, locals' hellhole. Herald (Calangute, Goa) 1997 (July 18).

18. Figueroa JP, Brathwaite A, Ward E et al. The HIV/AIDS epidemic in Jamaica. AIDS 1995;9(7):761-68.

19. Hundt A. Impact of tourism development on the economy and health of Third World nations. J Travel Med 1996;3:107-12.

20. Ascher F. Tourism: transnational corporations and cultural identities. Paris: UNESCO, 1985.

21. Stonich S, Sorensen JH, Hundt A. Ethnicity, class, and gender in tourism development: the case of the Bay Islands, Honduras. J Sustainable Tourism 1995;3:1-28.

22. Bezruchka S. Tourism and the health of local populations [editorial]. Wilderness and Environmental Medicine 1997;8:73-4.

23. Green H, Hunter C. The environmental impact assessment of tourism development. In: Johnson P, Thomas B, eds. Perspectives on tourism policy. London: Mansell, 1992:29-48.

24. Mathieson A, Wall G. Tourism: economic, physical and social impacts. New York: Longman, 1982.

25. Harrison D, ed. Tourism and the less developed countries. New York: Halstead Press, 1992.

26. Hitchcock M, King VT, Parnwell MJG, eds. Tourism in south-east Asia. New York: Routledge, 1993.

27. Hobson JSP, Dietrich UC. Tourism, health and quality of life: challenging the responsibility of using the traditional tenets of sun, sea, sand, and sex in tourism marketing. J Travel and Tourism Marketing 1994;3(4):21-38.

28. McKee DL, Tisdell C. Developmental issues in small island economies. New York: Praeger, 1990.

29. Lobel HO, Campbell CC, Pappaioanou M et al. Use of prophylaxis for malaria by American travelers to Africa and Haiti. JAMA 1987;257: 2626-27.

30. Centers for Disease Control. Imported malaria among travelers - United States. MMWR 1984;33:388-90.

31. Demeter SJ. An evaluation of sources of information on health and travel. Can J Public Health 1989;80:20-2.

32. Nettleman MD, Wenzel AH. Health advice for travelers from embassies and consulates [letter]. N Engl J Med 1990;322:136.

33. Sawyer LJ, Keystone JS. Travel advice from embassies and consulates of developing countries. Can Med Assoc J 1987;136:693.

34. Keystone JS, Dismukes R, Sawyer L et al. Inadequacies in health recommendations provided for international travelers by North American travel health advisors. J Travel Med 1994;1:72-8.

35. Townend M. Sources and appropriateness of medical advice for trekkers. J Travel Med 1998;5:73-9.

APPENDIX
Code of Ethics for Tourists⁽¹⁵⁾

1. Travel in a spirit of humility and with a genuine desire to learn more about the people of your host country. Be sensitively aware of the feelings of other people, thus preventing what might be offensive behaviour on your part. This applies very much to photography.

2. Cultivate the habit of listening and observing, rather than merely hearing and seeing.

3. Realize that often the people in the country you visit have time concepts and thought patterns different from your own. This does not make them inferior, only different.

4. Instead of looking for the "beach paradise", discover the enrichment of seeing a different way of life, through other eyes.

5. Acquaint yourself with local customs. What is courteous in one country may be quite the reverse in another - people will be happy to help you.

6. Instead of the Western practice of "knowing all the answers", cultivate the habit of asking questions.

7. Remember that you are only one of thousands of tourists visiting this country, and do not expect special privileges.

8. If you really want your experience to be a "home away from home", it is foolish to waste money on traveling.

9. When you are shopping, remember that the "bargain" you obtained was possible only because of the low wages paid to the maker.

10. Do not make promises to people in your host country unless you can carry them through.

11. Spend time reflecting on your daily experience in an attempt to deepen your understanding. It has been said that "what enriches you may rob and violate others".

[Canada Communicable Disease Report]