Credo of the European Spas Association

Preface

The European Spas Association is formed by members from 21 European countries,among them national and regional spas associations, spas, health resorts and spa facilities.

It is about time to describe the basic principles of the policy pursued by the association. Here the focus lies on underlining the common features that have paved the way to a membership in the European Spas Association and, on the other hand, on describing the differences between the member countries. These result from a different basic situation of the individual spas and health resorts in the national associations, from a different development in politics and the subjects they put a main emphasis on. It has to be discussed which of the existing differences shall be maintained in the future and which of them demand convergence on a European level.

Facing a Europe that is growing together a common policy between spas, health resorts and spa facilities is absolutely necessary. And even more with respect to the association’s policy since a harmonisation through the EU will only be realised or expected in parts.

The ESPA is taking up the challenge, especially since spas, health resorts and spa facilities are of major importance in the health sector: They represent an excellent health culture, are an important economic factor in most of the regions with a less developed infrastructure and also preserve jobs.

This credo has been worked out by the member associations during several conferences. As a central point it describes the necessity of recognition by the state in the different countries that does not focus on the local remedy alone, but also includes the entire resort or spa facility.

At the same time it is of essential importance to develop national credos, if not available yet. These will be used in those cases where an adequate legal basis has not yet been established. With respect to the political discussion in the EU countries the credo of the European Spas Association can serve as an important basis.

By means of their credo and their contents the working groups of the ESPA have to solve several tasks with regard to the quality structure in health resorts, definitions, approximate figures and other aspects like remedies, for example.

By establishing the credo the European Spas Association has taken a constructive step towards a united Europe, for a better positioning and thus for the future of spas, health resorts and spa facilities.

 Spas and Health Resorts in Europe

Basic Position

Spas, health resorts and spa facilities in Europe represent an indispensable part in the health system of their country. They influence the cultural background of the region, are an important economic and social factor and preserve many jobs.

Most important duty to be fulfilled by the association

The ESPA is taking up the challenge to fulfil the tasks that result from the opening of borders in Europe and the extension of the EU. With the present credo the ESPA intends to set up clear and comparable structures that make the collaboration between the countries much easier. It will then be the duty of the national spas associations to define their national conditions by a „national credo“ if they have not done so yet. These papers will help organisations to support their demands with political institutions on a national level by additional European arguments.

Positions in detail

1. Naturally occurring local remedies
form the basis of spas, health resorts and spa facilities.
Yet, they are not sufficient to be recognised as a spa. There is more to it than that.
Naturally occurring local remedies are the basis to differentiate between several
types of spas and health resorts such as mineral spas, brine spas, thermal spas,
peloid spas, spas at the seaside and in a healthy climate and also Kneipp spas.

A formal structure of this kind and to such an extent cannot be found in all
countries. In some countries a structure is also part of being recognised (by the
state). Here the common objective must be to establish a standardised structure in
order to create more transparency on the European market.

Apart from that, more therapy forms are offered in spas, health resorts and spa
facilities. Here, a standardised structure is not to be realised at the moment, given
a multitude of references and experiences that differ too much from each other.

2. The recognition of spas, health resorts and spa facilities
should be generally recognised by the state and on a legal basis.
This recognition should not only be based on the local natural remedy but has to
include the entire health resort or facility with all its specific and therapeutic offers.
The present credo and the respective conditions in the different countries form the
basis for the recognition.

3. Spas, health resorts and spa facilities
are usually located in a beautiful and idyllic landscape which offers optimal
conditions for a relaxing holiday.
Some small spas with a historic town centre have developed into big cities in the
past years. Here, the major aim should be to organise the spa area in a positive
way in accordance with this credo. And spa facilities should not be forgotten in this
process.

4. Regulations on environmental protection
are a specific task of spas, health resorts and spa facilities. They do not only follow
the general regulations for places of residence, but even want to exceed those
regulations with respect to air purity, water and sewage, traffic and noise. They
want to be and must be better than others.

5. Qualified prevention and rehabilitation
With respect to their equipment and experience spas, health resorts and spa
facilities are well prepared to offer qualified prevention and rehabilitation. Therefore
they play an important role in health supply, especially in the treatment of chronic
diseases considering the age of clients.
Spas and facilities focus on a different use of prevention and rehabilitation and inpatient
and out-patient offers; they want and they can offer more than only healthy
holidays. In this context prevention means that it is in accordance with the
international definition of exercise, nutrition and relaxation, uses local remedies
and, like rehabilitation, aims at sustainability.
With regard to the above mentioned differences standardisation should not be
urged here.

6. The role of spas, health resorts and spa facilities in social systems
differs very much in the member countries of the ESPA and refers to rehabilitation
and prevention as well as to the treatment of mainly chronic diseases. Facing their
respective systems and in times of difficult economic and socio-political conditions
countries are struggling to maintain their actual standards or even to improve them.
Therefore, a standardisation of social systems in Europe does not yet become
apparent. Borders, however, are opening, also with regard to the law for
supranational supply, e.g. as a consequence of the jurisdiction by the European
Court of Justice. Prices and quality will be of crucial importance for the respective
national supply level.

Corresponding tasks, definitions and the quality of spas, health resorts and spa
facilities according to this credo represent good basic conditions for the future
development.

7. Health resort doctors
are a must in spas, health resorts and spa facilities. Here, the focus lies on the
qualification for a proper use of naturally occurring local remedies (specific
treatment methods), of physical therapies and of prevention and rehabilitation.
Treatment methods with dominating disorders and chronic diseases should be paid
special attention in this context.
It is important to harmonise different educational programmes and training periods
with the qualification of specialised doctors that prepare them for their job in spas,
health resorts and spa facilities. This is the task of health resort doctors. The
structural assignment and recognition of the necessary qualification depends on
the respective national structures.

8. The spectrum of guests
in spas, health resorts and spa facilities is very wide and does not only differ from
country to country but also from resort to resort. It goes beyond the pure longing for
recreation and includes healthy and ill people, covers all stages of prevention
(primary – secondary – tertiary) until rehabilitation and the treatment of chronic
diseases. It includes out-patient and in-patient treatments and also stays of several
weeks with well-structured treatments as well as short stays with different
purposes. It would not make sense to strive here for standardisation.
On the basis of prevailing conditions and experiences spas, health resorts and spa
facilities have developed different main topics.

9. The equipment
of spas, health resorts and spa facilities is organised according to the spectrum of
their clients and, due to a concentration with respect to treatments, e.g. only inpatient/
out-patient, often is very one-sided.
Especially healthy holiday guests are offered hotels and guest-houses of different
categories. With a focus on medical aspects clients find central and decentralised
therapy facilities for out-patient, in-patient and partly in-patient therapies and
even highly qualified clinics for acute treatments.
Efficient offers for medical treatments and an adequate number of
accommodation offers should be a prerequisite for being recognised as a spa,
health resort or spa facility.

10. Wellness
Spa guests more and more expect to find wellness programmes. These are offered
in spas, health resorts and spa facilities. With respect to their original meaning and
their competence healthy aspects are the essential element of these programmes.

11. Naturally occurring local remedies
Naturally occurring local remedies play an important role for spas, health resorts
and spa facilities (see position 1) - also to be reflected through state recognition.
They are most effective when they are included in integral that means complex
concepts of treatments. A natural remedy alone does not form the basis for being
recognised as a spa, a health resort or a spa facility.
Despite common EU law there are still considerable differences in the use of
these remedies depending on the country - definitions, parameters or legal basic
conditions have been developing from different traditions.

Considering the general objective of this credo which is to prove oneself in the
common market, certain differences with these remedies will be maintained. The
individual countries, however, will be striving for an approach towards each other
with the aim of common objectives.

Together with its working groups the ESPA has to develop reliable definitions and
parameters from a professional and scientific point of view or at least an approach
with respect to those points that still differ from each other. In this process the
different legal regulations should be neglected as much as possible. A focus should
be rather placed on the remedy and the expectations of the remedy. This will form
the basic condition for a legal assignment and also to demand political decisions in
the different member countries.

a. Springs with medicinal water for therapeutic use
are in many spas and health resorts the basic and relevant aspect for being
recognised as a health resort or a spa facility (by the state). Both areas of
application are of importance, the internal use, e.g. for drinking and inhalation as
well as the external use in bath-tubs or active therapies for example. Active
therapies usually are open to the public and have to fulfil the existing legal
requirements in the respective country. Here, all member associations of the
ESPA share the same point of view.
Different views, however, are to be stated with respect to the understanding and
handling of definitions, relevant parameters and the adaptation to the laws in the
different countries, especially the protection of springs. (The ESPA will be
working on the necessary approach. In many places the owner of a spring can
decide on the use of the spring/water and is legally categorised according to this
decision; the water may be applied as food, drug or for distribution).

b. Healing gases
Healing gases are also to be found in spring water, irrespective of being part of a
solution (see 11a). Radon, H2S, CO2 are the gases to be applied. The recognition
as a local remedy is subject to the law in the respective country.

c. Spas, spa facilities and health resorts at the seaside
These resorts usually apply thalassotherapies which are inevitably connected to
the sea. The therapeutic use is linked with the immediate neighbourhood of the
sea and its climatic influence (e.g. salinity of the air, possibility of swimming in the
sea). Also with regard to thalassotherapy the distance to the seaside has to be
fixed as an aspect for the recognition of spas and spa facilities – then called
thalasso centres (not more than 600-800m). Here a European standard has be
established.
Isolated substances of the sea (algae, silt) are also considered as part of a
thalassotherapy. Since they may be well preserved in distant areas, however,
they are also offered in resorts far away from the seaside.

d. Peloids in spas, health resorts and spa facilities
play an important role in European spas, health resorts and spa facilities.
According to their definition as local remedies they are applied for therapies.
Nearly all member countries agree on a definition of peloids which were produced
during geological and/or biological processes and are used in treatments in form
of compresses, packs or also in bath-tubs. Depending on their composition -
organic and/or inorganic proportions - physical effects, e.g. thermal or mechanic,
and also chemical effects may be achieved.
Facing the differences in the member countries the ESPA is striving for
standardisation in physical-chemical analyses, quality control, re-use and
regeneration.
Generally, a mixture of natural peloids in the health resort with synthetic
material will not be approved. All in all, a shortage of peloids is not to be
expected.

e. Bioclimate/healing climate
is a very important factor for spas, health resorts and spa facilities. A suitable
bioclimate that has been proven by an expert is an absolute must for these
resorts in order to fulfil their task to spend health. Together with air purity that
supports the therapeutic use of the climate it is an important requirement for
these resorts.
Criteria in order to evaluate and control the bioclimate are not yet worked out in
all member countries, but have to be agreed on.

Healing climate is based on the therapeutic use of the local climate that, as a
local remedy (stimulus-reaction concept), is the basis for being recognised as a
health resort. Some member associations have defined it as a separate health
resort type. Empirical data have to be examined and evaluated and have to be
harmonised by the member countries.

f. Kneipp therapy
Often mixed with elements of the Priesnitz therapy it is frequently applied in spas,
health resorts and spa facilities – though often only applied in parts. In order to be
recognised as an individual spa type it has to apply the complex and wellstructured
treatment concept according to Kneipp.

12. Other important conditions
One single remedy does not yet define a spa, health resort or spa facility as
such. Other important factors are:

• The character, the appearance of a spa, part of the town or a spa facility must correspond to the guests’ expectations and has to be in line with its task as a place to spend health. Parks, for example, must always be part of a spa.

• Restaurants in a spa have to offer healthy food.

• A spa, health resort or spa facility has to be well prepared for the needs of handicapped persons.
  

• One of the basic requirements for being recognised as a spa or health resort is the equipment with reasonable fittings for the treatment with local remedies (also for physical therapy). These are centres for therapy and baths, special rooms for rest and relaxation, physical exercise and sports/sports therapy, the use of sea water, Kneipp therapy, healing climate etc.
  

• There should be scientific evidence in order to give concrete indications not only with respect to the demands of health insurances.
  

• Cultural and entertaining programmes are part of an integral concept of offers in a health resort.

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