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Medical, Health and Wellness Tourism Research—A Review of the Literature (1970–2020) and Research Agenda

1 Institute for Big Data Research in Tourism, School of Tourism Sciences, Beijing International Studies University, Chaoyang District, Beijing 100024, China; nc.ude.usib@anilgnohz (L.Z.); moc.361@5220niloabgned (B.D.); moc.361@gnay__uyil (L.Y.)

Baolin Deng

Alastair m. morrison.

2 Greenwich Business School, Old Royal Naval College, University of Greenwich, London SE10 9SL, UK; [email protected]

J. Andres Coca-Stefaniak

Associated data.

Data are reported in the article.

Medical, health and wellness tourism and travel represent a dynamic and rapidly growing multi-disciplinary economic activity and field of knowledge. This research responds to earlier calls to integrate research on travel medicine and tourism. It critically reviews the literature published on these topics over a 50-year period (1970 to 2020) using CiteSpace software. Some 802 articles were gathered and analyzed from major databases including the Web of Science and Scopus. Markets (demand and behavior), destinations (development and promotion), and development environments (policies and impacts) emerged as the main three research themes in medical-health-wellness tourism. Medical-health-wellness tourism will integrate with other care sectors and become more embedded in policy-making related to sustainable development, especially with regards to quality of life initiatives. A future research agenda for medical-health-tourism is discussed.

1. Introduction

In 1841, Thomas Cook organized a tour of 570 people to travel from Leicester to Loughborough’s hot springs [ 1 ]. This was the first historically documented tour arranged by a travel agent. However, far earlier, people in Ancient Greece used to travel considerable distances for medical treatment [ 2 ]. Thus, the pursuit of health and medical care has been an essential reason for travel for centuries.

Today, people continue to travel in the pursuit of relaxation, for health reasons, as well as fitness and well-being [ 3 ]. As a response to this growing demand, countries, medical providers, and hospitality and tourism organizations are adapting to offer a broader set of medical, health, and wellness tourism experiences.

The concept of medical-health-wellness tourism has emerged relatively recently as a scholarly field of enquiry in tourism [ 4 , 5 , 6 ]. Although it has been pointed out that travel medicine has existed for 25 years [ 7 ], much of the research related to this has traditionally focused on medical aspects with inadequate consideration given to travel or tourism. Medical-health-wellness tourism can be classified into two primary categories according to a tourist’s choice - obligatory or elective. Obligatory travel occurs when required treatments are unavailable or illegal in the place of origin of the traveler and, as a result of this, it becomes necessary to travel elsewhere to access these services. Elective travel is usually scheduled when the time and costs are most suitable, and the treatments may even be available in the travelers’ home regions [ 8 ]. Other studies have classified these forms of travel and tourism into specific types based on the purpose of the treatment, such as dental tourism [ 9 ], stem cell tourism [ 10 ], spa tourism [ 11 ], springs tourism [ 12 ], IVF treatment [ 13 ], hip and knee replacements, ophthalmologic procedures, cosmetic surgery [ 5 ], cardiac care, and organ transplants [ 14 ].

A consensus is yet to be established on the definitions and contents of medical-health-wellness tourism, and how they interact, including their potential overlaps. Medical travel and tourism, health tourism, wellness tourism, and other similar terms (e.g., birth tourism, cosmetic surgery tourism, dental tourism) tend to be investigated separately in tourism research [ 15 , 16 , 17 , 18 , 19 , 20 ]. Notwithstanding the apparently disconnected nature of published research in this field, medical-health-wellness tourism has become much more popular for a variety of economic, cultural, lifestyle and leisure reasons [ 11 , 21 , 22 ]. Given their rapid development, it seems appropriate to conduct a comprehensive review of the definitions, history, typologies, driving factors, and future directions for these forms of tourism.

This study firstly reviews existing scholarly research through a meta-analysis of medical-health-wellness publications in the context of tourism ( Section 2 ). Then, the method used to analyze the data collected from ISI Web of Science is outlined in Section 3 , followed by a discussion of the research findings ( Section 4 ). Finally, in Section 5 , the conclusions, future research directions, and limitations of the study are presented.

2. Scholarly Reviews and Meta-Analyses of Medical, Health and Wellness Tourism

Previous reviews of the literature and meta-analyses have contributed to clarifying the overall understanding of medical-health-wellness tourism. Existing literature reviews tend to be very broad, spanning health-oriented tourism, medical tourism, sport and fitness tourism, adventure tourism, well-being (Yang sheng in Chinese) tourism, cosmetic surgery tourism, spa tourism, and more.

Medical tourism is an expanding global phenomenon [ 15 , 23 , 24 ]. Driven by high healthcare costs, long patient waiting lists, or a lack of access to new therapies in some countries, many medical tourists (mainly from the United States, Canada, and Western Europe) often seek access to care in Asia, Central and Southern Europe, and Latin America [ 25 , 26 , 27 ]. There are potential biosecurity and nosocomial risks associated with international medical tourism [ 28 ]. One research study collected 133 electronic copies of Australian television programs (66 items) and newspapers (65) about medical care overseas from 2005 to 2011 [ 29 ]. By analyzing these stories, the researchers discovered that Australian media coverage of medical tourism was focused geographically mainly on Asia, featuring cosmetic surgery procedures and therapies generally not available in Australia. However, people tend to engage with medical tourism for a broad range of reasons. In some cases, it is better service quality or lower treatment costs that prevail. In other cases, treatments may not be available locally, or there are long patient waiting lists for non-emergency medical care. Some 100 selected articles were reviewed and categorized into different types of medical tourism depending on the medical treatments they involved, such as dentistry, cosmetic surgery, or fertility work [ 25 ]. An analysis was done on 252 articles on medical tourism posted on the websites of the Korean Tourism Organization and the Korean International Medical Association [ 30 ]. This work enhanced the understanding of medical tourism in Korea as well as identifying the key developmental characteristics. Another research study detailed patient experiences in medical travel, including decision making, motivations, risks, and first-hand accounts [ 31 ]. A literature review was conducted on international travel for cosmetic surgery tourism [ 5 ] and it concluded that the medical travel literature suffered from a lack of focus on the non-surgery-related morbidity of these tourists.

Another set of authors defined health tourism as a branch of tourism in general in which people aim to receive specific treatments or seek an enhancement to their mental, physical, or spiritual well-being [ 32 ]. This systematic literature review assessed the value of destinations’ natural resources and related activities for health tourism. It was argued that most of the research on health tourism has focused on travel from developed to developing countries, and that there is a need to study travel between developed nations [ 33 ].

Wellness tourism is a key area of relevant research as well [ 34 ]. One research study reviewed trends in wellness tourism research and concluded that tourism marketing had so far failed to tap into the deeper meaning of wellness as a concept [ 35 ]. The emergence of health and wellness tourism was explored with their associated social, political, and economic influences [ 13 ]. A review was conducted of the development of wellness tourism using the concept of holistic wellness tourism where it was found that the positive impacts of this type of tourism on social and economic well-being were key to its rising levels of popularity [ 36 ].

All in all, although earlier literature reviews provide invaluable insights into medical-health-wellness tourism, there is a lack of studies that approach this concept in a holistic way. This research seeks to redress this balance by delivering a holistic review of the literature with the following objectives in mind: (1) investigating international journal articles across the typologies of tourism outlined above; (2) identifying influential scholars that have significantly contributed to this field; and (3) summarizing key trends in markets, industry development and promotion, as well as policy-making and impacts. In order to achieve this, a systematic review was conducted to analyze research articles in medical-health-wellness tourism published over a 50-year period from 1970 to 2020.

3.1. Data Collection

A two-step approach was adopted for the development of a database of publications for analysis with CiteSpace. The first step involved a search for relevant, high-quality refereed articles in medical-health-wellness tourism. Several academic journal databases, within tourism and hospitality but also including other disciplines too, were searched for relevant articles in medical-health-wellness tourism using a set of selected keywords. The ISI Web of Science and Scopus were chosen for this purpose as a result of their international recognition and comprehensiveness. Articles included in the list of references of selected articles were also considered valid as part of this search, in line with methodological suggestions for systematic literature searches [ 37 ]. Cited articles were also collected from prominent journals, including the Southern Medical Journal, Journal of Travel Medicine, BMC Public Health, Annals of Tourism Research, Tourism Management, Journal of Travel Research, and Journal of Vacation Marketing. Non-tourism related journals were selected as well including Amfiteatru Economic, Asia Pacific Viewpoint, Public Personal Management, and Revista de Historia Industrial. Adding these references not only delivered a higher number of relevant articles to the database, but it also increased its representativeness.

The second step involved using appropriate, valid and representative search keywords. A total of 986 articles were gathered using the following keywords: medical tourism, health tourism, wellness tourism, and spa tourism. After careful sorting of these publications, using their abstracts and keywords, the number of articles in the database was narrowed down to 802. Of these, 615 were obtained using the keywords medical tourism or wellness tourism, 157 were located by searching for health tourism, and 30 were discovered using spa tourism as the search term. Using the above keywords and restricting the search to 50 years (1970–2020), the first article was found to be published in 1974. As a result, the ensuing analysis of the literature comprises the period from 1974 to 2020.

3.2. Data Analysis

The research tool used for this study was CiteSpace, which is a bibliometric analysis software developed by Professor Chaomei Chen of Drexel University based on the Java framework [ 38 ]. This software assists researchers in the analysis of research trends in a specific field of knowledge and presents scientific knowledge structures through visualization. It has been applied to numerous research fields by scholars from many countries. The data processing for this research used the software V.5.7.R2 (64-bit) version.

The data were classified and analyzed to achieve three specific goals. The first and primary goal of this review work was to analyze the content of the chosen articles, including year of publication, authors, journal impact factors, and the institutional affiliations of scholars in this field. The data were then sorted into categories. The order of authorship was not recorded. For multiple-authored articles, each author was given the same level of credit as sole authors. Second, one of the aims of this research was to discover associations in authorships, regions, and affiliations using statistical analysis. Third, the 802 articles were classified into dominant thematic categories applying the approach proposed by Miles and Huberman [ 39 ]. Three flows of analytical activities were targeted here: data reduction, data display, and verification of data. In the data reduction activity, the word count technique was adopted. Through content analysis, each article’s title and full-text body were recorded for word counting. The most frequently appearing words were extracted to represent the main topics of the collected articles. The dominant thematic categories to be explored further based on the content analysis and word count were: (1) tourism market: tourist demand and behavior; (2) tourism destinations: development and promotion; and (3) tourism development contexts: policies and impacts.

Finally, in order to refine the set of topic sub-categories, abstracts, first paragraphs, and conclusions were read to make the most appropriate assignments. This approach contributed to the more advanced stages of development of the classification of sub-categories and, consequently, the verification of findings.

This section presents the results of the data analysis carried out in this study and provides further insights on the methodology adopted.

4.1. Overview of Articles Published

The 802 articles selected were all published in English and in international peer-reviewed academic journals. Figure 1 displays the timeline distribution of the research on medical-health-wellness tourism and shows a steady growth in publications in this field between 1974 and 2020. This growth in scholarly activity is particularly significant from 2010 onwards. In fact, 74.9% of the articles were published between 2013 and 2020.

Number of articles by publication year.

4.2. Source Journals

Initially, the first stage of this literature search involved identifying academic journals publishing research articles on medical-health-wellness tourism. It was found that 38 articles had been published on this topic in Tourism Management, and 24 articles in Social Science & Medicine. Table 1 shows the top ten tourism journals for publications in this field, with Tourism Management in first place.

Tourism journals publishing articles on medical-health-wellness tourism.

Non-tourism journals in fields such as business, economics, and health, also contributed a significant number of publications in this field, as shown in Table 2 .

Non-tourism journals publishing articles on medical-health-wellness tourism.

4.3. Author Productivity and Authorship Analysis

The second aim was to identify the most prolific scholars in medical-health-wellness tourism research. This was achieved using co-occurrence network analysis of the authors of relevant research articles ( Figure 2 ). Each node in the co-occurrence map shown in Figure 2 represents a given scholar. The larger the node, the more articles the authors published on the topic, with the connections between nodes representing cooperation between authors.

Author article productivity.

Among the 2381 authors identified, 1820 (76.4%) contributed to only one article, whereas the remaining 561 (23.6%) authored two or more articles. The three most prolific authors were Jeremy Snyder, Valorie Crooks, and Rory Johnston.

4.4. Author Regions and Affiliations

Another objective was to illustrate the relationships and networks of authors publishing research on medical-health-wellness tourism. An analysis of countries this research originated from was carried out using the CiteSpace software. Figure 3 shows that scholars publishing in this field were distributed across 61 countries. The largest group of authors originated from the USA ( n =197). The second and third largest groups corresponded to Canada ( n = 88) and the UK ( n = 84), respectively, followed by Australia ( n = 70) and South Korea ( n = 65). As shown in Figure 3 , authors from the USA and Canada have made the most significant contributions to medical-health-wellness tourism based on the number of journal articles published.

Country of origin of authors in medical-health-wellness tourism.

As shown in Figure 4 , a significant number of scholars publishing in this field ( n = 47) were affiliated to Simon Fraser University in Canada. This university was followed by Sejong University in South Korea ( n = 13), and the London School of Hygiene & Tropical Medicine ( n = 13) in the UK. The top universities in terms of author frequency were based in Canada, USA, Australia, UK, South Korea, and Hong Kong.

Institutions of authors.

4.5. Thematic Analysis of Research

The fourth research objective was to elicit the prevailing research themes using the 802 articles gathered. First, an analysis of keyword frequency was performed to identify the main research interests. High frequency keywords reflect the research ‘hotspots’ in the field. Using CiteSpace’s keyword visualization analysis function, the keyword co-occurrence knowledge map of medical-health-wellness tourism research was drawn to grasp the research ‘hotspots’ ( Figure 5 ).

Frequencies of research keywords.

Then, content analysis performed on the articles gathered for this study identified three main themes, namely: markets (tourist demand and behavior), destinations (development and promotion), and development environments (policies and impacts). An uneven distribution of research themes is highlighted in Figure 6 and Figure 7 .

Timeline of research keyword appearance.

Themes of research articles.

4.6. Markets: Demand and Behavior

Previous studies have shown that the growth of medical-health-wellness tourism in developing countries is largely linked to lower costs, shorter patient waiting lists, and better quality of care [ 40 ]. Similarly, it is suggested that the inequalities and failures in domestic health care systems often lead to people seeking treatment to travel abroad to obtain it [ 41 ]. In general terms, higher costs, long patient waiting lists, the relative affordability of international air travel, favorable exchange rates, and the availability of well-qualified doctors and medical staff in developing countries, all contribute to this situation [ 42 ].

As the demand for these forms of tourism has risen over time, processes and factors influencing decision-making have attracted growing levels of scholarly enquiry. For example, a political responsibility model was used to develop a decision-making process for individual medical tourists [ 43 ]. A sequential decision-making process has been proposed, including considerations of the required treatments, location of treatment, and quality and safety issues attendant to seeking care [ 44 ]. Accordingly, it has been found that health information and the current regulatory environment tend to affect the availability of medical care.

Multiple factors may simultaneously influence decisions related to the destination for care, including culture [ 45 ], social norms [ 46 ], religious factors [ 47 ], and the institutional environment [ 48 ]. It is suggested that socioeconomic conditions shape medical travelers’ decision-making and spending behavior relative to treatment, accommodation, and transport choices as well as the length of stay [ 49 ]. Perceived value is a key predictor of tourist intentions. More specifically, perceived medical quality, service quality, and enjoyment significantly influence the intention to travel abroad for medical-health-wellness purposes [ 50 ]. Further, perceived quality, satisfaction, and trust in the staff and clinics have significant associations affecting intentions to revisit clinics and the destination country [ 51 ]. An empirical study was conducted and found that physical convenience in willingness to stay and time and effort savings in perceived price were key factors affecting the decision-making related to medical hotels [ 52 ]. In addition, the level of perceived advantages, price perceptions, and willingness to stay were found to differ significantly between first-time patients and those with two or more previous visits. In addition, it was found that community communication was a major factor influencing decision-making. For instance, it is argued that virtual community membership has a strong influence on tourist behaviors and the way information is transmitted [ 53 ].

Compared to other tourists, the mental activity and behavior of medical-health-wellness travelers are quite different. Medical tourists are less likely to question their need for surgery and tend to be much readier to accept it [ 54 ]. The emotion and anxiety conditions of medical tourists differ from others’ experiences of travel and tourism, as well as their giving and receiving of transnational health care [ 55 ]. It has been found that language barriers and parenting responsibilities can be significant challenges, while hospital staff and their own families are often major sources of support for medical tourists [ 56 ]. Furthermore, there are significant differences among visitors from different countries in terms of choices, discomfort, preferred product items, and attitudes towards medical tourism [ 57 , 58 ].

4.7. Destinations: Development and Promotion

In response to the demands of medical-health-wellness tourism, destination development and promotion are attracting growing levels of scholarly interest. Scholars from different countries have discussed the market status of Turkey [ 12 , 59 ], the Caribbean [ 60 ] and Barbados [ 61 ], India [ 62 , 63 ], Canada [ 64 ], and Albania [ 65 ]. Table 3 outlines the most frequently researched country destinations in this respect.

Medical-health-wellness destination frequency in keywords.

The advantages and disadvantages of Turkey were examined and indicated needs for improvements [ 59 ]. In another research study, three years (2005, 2007, and 2011) of actual and projected operational cost data were evaluated for three countries: USA, India, and Thailand [ 66 ]. This study discussed some of the inefficiencies in the U.S. healthcare system, drew attention to informing uninsured or underinsured medical tourists of the benefits and risks, and determined the managerial and cost implications of various surgical procedures in the global healthcare system.

As regards medical-health-wellness tourism destination development, scholars have explored research from various perspectives. Conceptual frameworks have been developed to include tourism destinations and services in the context of medical and health tourism [ 59 , 67 ]. Advice has been provided from the perspective of public and private hospital doctors [ 68 ]. The principles of designing hospital hotels have been proposed, including proper planning, low prices of tourism services, medical education, creating websites on medical tourism, and health tourism policy councils [ 69 ]. Above all, scholars have posited that meeting or exceeding tourist expectations and requirements should remain the top priorities as regards the effective development of medical tourism destinations [ 69 , 70 ].

Once a medical-health-wellness tourism destination is developed successfully, marketing and promotion are essential to attract tourists. As part of this process, informing potential patients about procedural options, treatment facilities, tourism opportunities, and travel arrangements are the keys to success [ 71 ]. Most tourists rely on the Internet to gather information about destinations, often using mobile devices or personal computers [ 72 ], with websites and social media playing a key role in this respect, and specifically with regards to information about destinations’ medical facilities, staff expertise, services, treatments, equipment, and successful cases [ 73 ]. For example, apps for medical travel are available to attract tourists and promote medical tourism in Taiwan [ 74 ].

Numerous businesses promote medical-health-wellness travel, including medical travel companies, health insurance companies, travel agencies, medical clinics, and hospitals [ 75 ]. Among them, medical travel facilitators play a significant role as engagement moderators between prospective patients in one country and medical facilities elsewhere around the world [ 76 ]. The services offered on medical tourism facilitator websites vary considerably from one country to another [ 77 ]. Although medical travel facilitators operate on a variety of different scales and market their services differently, they all emphasize the consumer experience through advertising quality assurance and logistical support [ 78 ].

Scholarly research has also considered the factors that need to be taken into consideration in medical-health-wellness tourism promotion. This research has suggested that destinations should identify the specifics in their health tourism resources, attractions, and products, seek collaboration with others, and build a common regional brand [ 79 ]. Regional differences should be considered in the process of marketing as medical-health-wellness tourism is a global industry [ 77 ]. International advertisers need to understand the important, contemporary, and cultural characteristics of target customers before promotion [ 80 ]. Similarly, destinations need to portray safe and advanced treatment facilities to dispel potential patient worries and suspicions. Messages related solely to low cost may detract from and even undermine messages about quality [ 71 ]. However, while benefits are highly emphasized online, websites may fail to report any procedural, postoperative, or legal concerns and risks associated with medical tourism [ 81 ].

4.8. Development Environments: Policies and Impacts

The rise of medical-health-wellness tourism emphasizes the privatization of healthcare, an increasing dependence on technology, and the accelerating globalization of healthcare and tourism [ 82 ]. There are challenges and opportunities in the development of these tourism forms. For instance, it has been suggested that medical tourism distorts national health care systems, and raises critical national economic, ethical, and social questions [ 83 ]. Along with the development of medical-health-wellness tourism, social-cultural contradictions [ 84 ] and economic inequities are widening in terms of access, cost, and quality of healthcare [ 85 ]. It is argued that this tourism leads destinations to emphasize tertiary care for foreigners at the expense of basic healthcare for their citizens [ 86 ]. Moreover, in some instances, this phenomenon can exacerbate the medical brain drain from the public sector to the private sector [ 43 , 87 , 88 ], leading to rising private health care and health insurance costs [ 88 ].

While medical-health-wellness tourism is a potential source of revenue, it also brings a certain level of risk to destinations and tourists [ 89 ]. The spread of this type of tourism has been posited as a contributing factor to the spread of infectious diseases and public health crises [ 90 , 91 ]. Medical tourists are at risk of hospital-associated and procedure-related infections as well as diseases endemic to the countries where the service is provided [ 92 ]. Similarly, the safety of some treatments offered has also been the subject of growing levels of scrutiny. Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery has identified cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications [ 93 ]. Stem cell tourism has been criticized on the grounds of consumer fraud, blatant lack of scientific justification, and patient safety [ 94 , 95 ]. During the process of medical tourism, inadequate communication, and information asymmetry in cross-cultural communication may bring medical risks [ 96 ].

Medical-health-wellness tourism has emerged as a global healthcare phenomenon. Policy guidance is vital for the development of this sector in the future [ 97 ]. There are policy implications for the planning and development of medical-health-wellness tourism destinations [ 98 ]. Generally, it has been found that the medical-health-wellness tourism sector tends to perform better in countries with a clear policy framework for this activity [ 99 ]. Similarly, scholars have argued the need for a clearer policy framework regulating tourism agencies and the information and services they provide [ 100 ]. The upsurge of these tourism forms presents new opportunities and challenges for policy makers in the health sector. It has been argued that existing policy processes are mainly based on entrenched ideological positions and more attention should be paid to robust evidence of impact [ 101 ]. The UK developed policies focused on ’patient choice’ that allow people who are able and willing to choose to travel further for healthcare [ 102 ]. However, more robust policy making is still required to strengthen national health services and facilitate medical-health-wellness tourism sector development in destinations [ 103 , 104 ].

5. Discussion and Conclusions

5.1. generation discussion.

This study is based on a literature review of 802 articles on medical-health-wellness tourism from 1970 to 2020. Jeremy Snyder was found to be the most prolific author in this field with 45 articles. It has been found that the literature on this topic can be summarized into three themes: markets (tourist demand and behavior), destinations (development and promotion), and development environments (policies and impacts). The scholarly research in this growing field has undergone a shift in emphasis from tourist demand and behavior to the promotion and development of destinations, and, more recently, to policies and impacts.

To attract more tourists, destinations should explore their potential for medical-health-wellness tourism. Accessibility, procedural options, treatment facilities, travel arrangements, safety guarantees, and government policies remain influential factors. In the development and promotion of this form of tourism, childhood vaccinations, oral health, legal frameworks, evaluation systems, entrance systems, and macro-policy continue to be areas of concern and where further research is required. Above all, meeting or exceeding tourist expectations and requirements is the most important consideration to promote medical-health-wellness tourism. Similarly, appropriate policy guidelines and frameworks are necessary to support this form of tourism. Importantly, medical-health-wellness tourism may result in negative impacts on the healthcare service provision for local residents in poorer countries, with tourists from richer countries benefiting to the detriment of local communities. However, if managed successfully, this form of tourism can also be a force for good in terms of fostering the economic development of countries delivering these services.

The results indicated that the research literature is spread across a range of different disciplines and there is not one single venue for publishing in this field. A better integration of the research and improved understanding of the overlaps among medical, health, and wellness tourism is required.

5.2. Future Research Trends

5.2.1. industrial perspective.

Medical-health-wellness tourism will, over time, integrate fully with other healthcare and wellness services. Similarly, medical challenges such as disease prevention and traditional medicine remain essential directions for the future of health tourism. This form of tourism will also integrate further with industries such as wellness culinary tourism, mindfulness tourism, active tourism (including adventure tourism), and even cosmetic surgery tourism, leading to a vast array of potential research avenues linked to health tourism destinations. These futures will greatly promote the physical and mental health of wellness tourists. This is another emerging direction for future medical-health-wellness tourism research.

5.2.2. Destination Development Perspectives

Medical-health-wellness tourism will become more significant forms of tourism and impact the development of different nations and areas. For example, this tourism will integrate with Chinese traditional culture. Traditional treatments and remedies will become more of an advantage and should be a topic for future medical-health-wellness tourism research, as well as in other countries with unique health cultures, treatments, and procedures.

Thailand, Malaysia, and other Southeast Asian countries are favored by tourists from developed countries due to lower costs. In the future, these areas need to focus more on tourism product design, health tourism marketing, community participation, and cross-cultural communication. Developed countries such as the USA, Japan, and South Korea, will use advanced technology and medical equipment to take the path to high-end, high value-added tourism development. This will lead to some new research opportunities.

5.2.3. Tourist Perspectives

Compared with other types of tourists, the needs of medical-health-wellness tourists will receive more attention. Based on previous research, the psychology and perceived value of these tourists are the focus of considerable research. In the future, more emphasis will be paid to people and especially to their psychological and physiological needs. Research on demand will become a more popular topic of this tourism research. Second, the current research on medical-health-wellness tourists is concentrated on the study of tourists in the USA and Canada. Future research should be more dispersed and diversified. Tourists from emerging countries such as Eastern Europe, Asia, the Middle East, and Africa will receive more attention.

5.3. Limitations

This study, inevitably, has a number of limitations, including the relatively modest amount of articles collected. Only articles written in English were considered. The sample number is rather small to represent the general research trends in medical-health-wellness tourism from 1970 to 2020. Therefore, it is desirable to increase the number of publications and expand the time and language coverage of the research articles to gain more insights.

Although the research scope of medical-health-wellness tourism is vast, it lacks in-depth exploration. Current research is fragmented, lacks continuity and comprehensiveness, and therefore cannot be considered systematic. Also, the legal aspects of the development of this tourism, environmental capacity of medical-health tourism, wellness tourism management, and mechanisms of profit distribution for medical-health-wellness tourism are less frequently mentioned in research articles. Innovation in this field and international cooperation, and talent cultivation are also not sufficiently addressed. The methods used in medical-health-wellness tourism research are often simple. Scholars still use traditional descriptive statistics and related analysis methods. The theoretical foundation of medical-health-wellness tourism is still relatively weak. We are in the primary stage of this tourism research and in the development of related tourism products. People all over the world are eager for healthy lives. Medical-health-wellness tourism is likely to play a more important future role in travel medicine and tourism research. Beyond what has been done already, follow-up research should be focused on interdisciplinarity and based on the integration of industries. More theoretical research is necessary to support the future growth of medical-health-wellness tourism.

Author Contributions

Formal analysis, L.Z.; Funding acquisition, L.Z.; Investigation, L.Z.; Supervision, B.D.; Data collection and analysis, B.D.; Writing-original draft, A.M.M. and J.A.C.-S.; Writing—original draft, A.M.M.; Writing—review & editing, A.M.M., J.A.C.-S. and L.Y.; Data collection and analysis. All authors have read and agreed to the published version of the manuscript.

National Natural Science Foundation of China, Grant no: 71673015); Ethnic research project of the National Committee of the people’s Republic of China. NO: 2020-GMD-089; Fundamental Research Funds for the Central Universities of Beijing Foreign Studies University, 2021JS001.

Institutional Review Board Statement

No human subjects were involved in this research and no institutional review was required.

Informed Consent Statement

Not applicable as there were no human subjects.

Data Availability Statement

Conflicts of interest.

The authors have no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Marketing Medical Tourism on Social Media Channels

Most providers, regardless of where they are located USA or Uruguay or Uganda, simply have no expertise or resources to properly and effectively manage social media marketing and they lack the know how to track and benefit from the return on investment. Attracting strong social-media talent is a struggle across many industries, but healthcare has historically spent little on marketing and social media, are now compete with the Google, Apple and and consultants of varying skill and cultural insight to be effective. These hurdles are even more noticeable in medical tourism start-ups.

When you enter a relationship with a new friend and you visit their home, you don’t just kick in the door and announce what’s on sale at your shop.

Doing that is rude in person – as even more inconsiderate in social media networks.

The biggest hurdle is relevancy

How does a medical tourism seller or provider become relevant on Facebook, Twitter, VK, Pinterest, or some other platform? How do you prove your value and how do you overcome public distrust or lack of awareness of your brand value and existence?”

On Facebook, I run two groups for the medical tourism industry.

Medical Tourism and Travel Suppliers Medical Tourism Facilitator’s and Travel Agents Lounge

People join often and then, I get reports that they’ve done just that: barged in and plastered the group with irrelevant spammy posts.

In one group – described as the place for facilitators and travel agents and referral agents to share industry best practices and insights, they post their advertisement of medical tourism services as a facilitator – to their competitors – other facilitators. This gets them kicked out and blocked same day or shortly thereafter.

In the other group, described as the place for hospitals and sellers to market what they do, they don’t post. This gets them no return on investment because they seem to just lurk. We now realize that it is because they simply don’t know how to use Facebook for social marketing. The link to their sites and their content would make them place higher in searches if more people like their articles, but they don’t post content that’s relevant to the public. They post ads. The two are not the same.

In this sense, I don’t believe that the problem is 100% culturally driven.  Instead, I believe that what is happening is that no one taught these overly zealous, inexperienced and untrained marketers how to take the time to knock, listen, be invited in, understand what the community is about and what the norms are before they try to push their advertisements instead of content out there and engage with that audience. I see the same thing happening on LinkedIn Pulse articles, and in LinkedIn Groups and Google Communities about medical tourism that I manage. I have these groups to share content generously. But I also have them as a study lab to see what is happening in the marketplace from the consumer side, the government side, and the supplier side, as well as the facilitator side. As a medical tourism business don’t start your social media strategy at such a simplistic level as to start (and end) with your objectives, That approach doesn’t work.

Start with content that targeted patients are interested in. Do lots of social listening and responding when appropriate, not just to respond.

Avoid plastering the group with spammy ads or links to your spammy content. Instead, start discussions by talking and seeking guidance from others who are peers within the community members. Leverage your traffic analytics and engagement analytics to indicate what resonates within a community. Do they comment? Do they share? Or do they ignore you?

Many medical tourism sellers copy and paste information about diseases and conditions and procedures from National Institute of Health, Mayo Clinic and other similar authority websites. They do so without attribution. I used to think it was laziness to write one’s own content. Now I realize, they simply don’t know better, they don’t have content of their own, they have no domain knowledge or authority and someone told them they needed content so they stole it just to have something.  That tanks their search engine rankings because the webcrawlers, upon finding plagiarized content drop your site to page 43.

If you are new to medical tourism and social media marketing to attract new leads, Bring in some volunteer patients to serve as a digital advisory board and ask for help to inform content. Many are great influencers and have even created content themselves—poems, videos, songs—but they are talking about how a your product or service has helped them. That’s one way you can tie together living and managing a medical or dental or psychiatric condition but also bring your product or service into that discussion.

About Social Media Comments

If you are going to enter social media marketing, you have to plan for social listening.  But responding to comments can pose headaches. Adverse event reporting has been a concern for pharma since the advent of social media. It can also be a headache for hospitals, clinics, doctors, and the treatments and procedures they perform and prescribe.  Part of the winning social media marketing strategy will be to determine which comments require attention.

Respond to direct questions and provide supportive, encouraging comments- but be careful how you word apologies.  Sometimes people just want to let off steam and feel heard, and a response in those cases may only exacerbate the situation if not worded properly. One best practice is to only respond in those situations if you can help.

Publish community guidelines to set expectations and stick to them.  In some instances it is best not to respond at all.

Measuring KPIs

What does “good performance” look like? How is it measured?

If you are attempting to build brand awareness, then likes, shares and comments all matter because they drive your reach.

When building relationships and providing resources, content relevance and engagement are two KPIs. As a consulting firm, that’s how I determined Mercury would set its strategy and goals. Is it working? Absolutely! We have more than 350,000 followers combined across all channels who engage and share and re-share our content. They write me “thank you” notes and tell me how much the article helped them avoid mistakes, oversights, and costly errors and expenditures. As a consultant and industry authority on medical tourism, I educate and advocate for my clients’ successes.  I don’t need to sell with advertising because when they continue to read and follow and share, I know that they know who they are going to call when the time comes to ask for personalized advice or coaching.

I compare our results and follows and engagement with competitors in the industry.  Anyone can get likes by advertising.but I’d prefer a smaller community of the right clients and prospects to a large community of uninterested, unengaged “likers”. Active conversations—and the insights we can pull from them—are what success looks like to us.

Your Facebook page for your company is not going to generate medical tourism leads, in most cases. That’s not how it works. There are a lot of data points to monitor, but you must first set those up clearly at the beginning. Otherwise, you’ll find yourself in a world where you’re counting likes but see no business conversion into revenues.

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The advent of social media influencer tourism: travel health risks and opportunities

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Why Patients Are Turning to Medical Tourism

Statistics, Benefits, and Risks

Planning Ahead

Frequently asked questions.

Medical tourism is a term that refers to traveling to another country to get a medical or dental procedure. In some instances, medical tourists travel abroad seeking alternative treatments that are not approved in the United States.

Medical tourism is successful for millions of people each year, and it is on the rise for a variety of reasons, including increasing healthcare costs in the United States, lack of health insurance, specialist-driven procedures, high-quality facilities, and the opportunity to travel before or after a medical procedure.

According to a New York Times article from January 2021, pent-up demand for nonessential surgeries, as well as the fact that many Americans lost their health insurance during the coronavirus pandemic led to a surge in medical tourism once other countries re-opened.

However, there are specific risks that come with traveling overseas for surgery. If you're thinking of pursuing a medical procedure in another country, here's what to know about the benefits and the risks.

Medical Tourism Benefits

The most common procedures Americans go abroad for include dental care, cosmetic procedures , fertility treatments, organ transplants , and cancer treatment.

This is not to be confused with having an unplanned procedure in a foreign country due to an unexpected illness or injury.

Among the reasons a person might choose to go abroad for a medical procedure are:

Lower Costs

Medical tourists can save anywhere from 25% to 90% in medical bills, depending on the procedure they get and the country they travel to. There are several factors that play into this:

• The cost of diagnostic testing and medications is particularly expensive in the United States.
• The cost of pre- and post-procedure labor is often dramatically lower overseas. This includes labor costs for nurses , aides, surgeons , pharmacists, physical therapists , and more.
• High cost of malpractice insurance—the insurance that protects medical professionals against lawsuits—in the United States.
• Hospital stays cost far less in many overseas countries compared to the United States. In other words, quality care, hospital meals, and rehabilitation are far more affordable abroad for many people.

For someone who doesn't have insurance , or someone having a procedure that is not covered by insurance , the difference can be enormous.

Popular Countries for Medical Tourism

Dominican Republic

South Korea

Culture and Language

Many immigrants prefer to have treatments and procedures done in their country of origin—a sensible decision, considering just how much language barriers alone can affect the quality of their care.

Furthermore, at least 25% of immigrants and noncitizen residents in the United States are uninsured, compared to 9% of American citizens. Children with at least one noncitizen parent are also more likely to be uninsured.

Practicalities aside, many people choose to have their procedure done in their country of origin simply because it allows them to be close to family, friends, and caretakers who can assist them through their recovery .

Insurance Incentives

Some insurance companies have started promoting medical tourism. The reason behind this is simple: savings for the insured means savings for the insurance provider and vice versa.

Several insurance providers, including Aetna have programs specifically geared at promoting safe medical tourism. Some insurance providers even offer financial incentives for medical tourism, like discounts on medical bills .

That said, many insurance companies will not pay for surgery performed outside of the country unless it is an emergency.

Luxury and Privacy

Medical tourism is a lucrative business for many countries, and much of the money brought in by medical tourists is reinvested into the local economy and health infrastructure.

The effect of this is apparent in the spa-like luxury that some foreign hospitals offer, providing medical tourists the opportunity to be pampered during their stay for a fraction of the cost they would pay at home.

Some facilities offer hospital rooms that are more like a hotel suite than a traditional hospital room. Other hospitals offer one-on-one private nursing care, which is far more generous and attentive than the staffing ratios that most hospitals allow.

Medical tourists who seek that added layer of privacy can find it abroad. Many can return home from their "vacation" without anyone knowing they had a procedure at all.

Vacation in a Foreign Country

Medical tourists often take advantage of their stay in a foreign country to travel for pleasure by scheduling a vacation before or after their procedure.

This is an especially inexpensive way to travel to a foreign country, especially if their insurance provider is paying for the flight and the cost of staying is low. 

While it seems logical to recover on a beach or in a chalet by the mountains, keep in mind that it's important not to jeopardize your recovery.

Swimming isn't recommended until your incisions are completely closed. You may not feel up to doing much more than napping in the days following your procedure, either.

Don't let your vacation disrupt your recovery. Any time you have a procedure done, especially a surgery, it's important to listen to your body, take your medications as directed, and follow your doctor's recommendations closely.

Bypassing Rules and Regulations

Some travelers seek surgery abroad to bypass rules that are set in place by their own government, insurance company , or hospital. These rules are typically in place to protect the patient from harm, so getting around them isn't always the best idea.

For example, a patient may be told that their weight is too low to qualify for weight loss surgery . A surgeon in a foreign country may have a different standard for who qualifies for weight loss surgery, so the patient may qualify overseas for the procedure they want.

Talented Surgeons

Surgeons in certain countries are known for their talent in a specific area of surgery. For example, Brazilian surgeons are often touted for their strong plastic surgery skills .

Whereas in the United States, insurance companies might only cover cosmetic procedures if it is medically necessary, cosmetic surgery is often free or low-cost in Brazil's public hospitals—giving cosmetic surgeons there ample practice.

Thailand is reported to be the primary medical tourism destination for individuals seeking gender reassignment . It is often easier to qualify for surgery and the cost is significantly reduced. Surgeons are performing the procedures frequently, and as a result, many have become quite specialized in them.

It is often surprising to many medical tourists that their physician was trained in the United States. Not all physicians are, of course, but a surprisingly high percentage of them working in surgery abroad are trained in English-speaking medical schools and residency programs and then return to their home country. These physicians often speak multiple languages and may be board certified in their home country and a foreign country, such as the United States.

Medical tourism isn’t limited to countries outside of the United States, either. Many people travel to the United States for medical care due to the country's cutting-edge technology, prescription medication supply, and the general safety of healthcare.

Medical Tourism Risks

The financial and practical benefits of medical tourism are well known, and you may even know someone who had a great experience. Nonetheless, the downsides of medical tourism can be just as great if not greater. Sometimes, they can even be deadly.

If you are considering a trip abroad for your procedure, you should know that medical tourism isn't entirely without obstacle and risks. These include:

Poorly Trained Surgeons

In any country—the United States included—there will be good surgeons and bad. And just as there are great surgeons abroad, there are also some surgeons who are less talented, less trained, and less experienced.

Regardless of what procedure you are getting or where, you should always do some preliminary research into the surgeon or physician who will be treating you as well as the hospital you will be treated at.

In the United States, it is fairly easy to obtain information about malpractice lawsuits , sanctions by medical boards, and other disciplinary actions against a physician.

Performing this research from afar can be challenging, especially if you don't speak the local language. Yet countless people take the risk anyway, without knowing whether the physicians who will treat them are reputable.

A physician should be trained in the specific area of medicine that is appropriate for your procedure. For example, you should not be having plastic surgery from a surgeon who was trained to be a heart doctor. It isn’t good enough to be a physician, the physician must be trained in the specialty .

Prior to agreeing to surgery, you should also know your surgeon’s credentials : where they studied, where they trained, and in what specialty(s) they are board-certified. Do not rely on testimonials from previous patients; these are easily made up for a website and even if they are correct, one good surgery doesn’t mean they will all be successful.

Quality of Staff

Nurses are a very important part of healthcare, and the care they provide can mean the difference between a great outcome and a terrible one.

A well-trained nurse can identify a potential problem and fix it before it truly becomes an issue. A poorly trained nurse may not identify a problem until it is too late. The quality of the nursing staff will have a direct impact on your care.

Once again, it's important to research the hospital staff where you will be having your procedure done. Read the reviews but don't trust them blindly. If you can, seek out a recommendation from someone who can vouch for the medical staff where you will be going.

Quality of the Facility

While researching healthcare facilities for your procedure, you want to learn not just about the quality of the facilities themselves, but about the country's healthcare system as a whole.

In some countries, there is a marked distinction between public hospitals and private hospitals. In Turkey, for example, private hospitals are considered on-par with hospitals in the states, while many locals will advise you to steer clear of public hospitals if you can.

You will also want to seek out facilities that are internationally accredited. In the United States, the Joint Commission evaluates hospitals and certifies those that provide safe, quality care. The international division does the same for hospitals outside the United States.

Once you have a few options for potential facilities, you can start to investigate specifics. For one, you should find as many pictures and reviews of the facility as you can. Ask yourself whether the facility is state of the art or whether it seems dirty and outdated.

You will also need to find out if the facility has ICU level care available, in case something goes wrong. If not, there should be a major hospital nearby so that you can be transferred quickly.

To learn more about a healthcare facility, consider joining expat groups on social media for the city or country you will be traveling to. Ask the group for recommendations, or inquire about any positive or negative experiences they may have had at a particular facility.

Flying Home After Surgery

Any surgery comes with risks, including infection and blood clots . Flying home increases the risk of blood clots, especially on long-haul flights that are longer than four hours.

Try to avoid flying home in the days immediately after surgery; waiting a week will decrease the chances of developing a blood clot or another serious complication during the flight.

For longer flights, plan on getting up and walking up and down the aisles each hour to improve blood flow in your legs. You might also benefit from wearing compression socks with your doctor's approval.

If you are taking blood thinners or are at-risk of blood clots , be sure to talk to your doctor about how you can reduce your risk of blood clots after your procedure and while traveling.

Furthermore, you should know the symptoms of blood clots and stay alert.

Unplanned Illness

Any time you travel abroad, you run the risk of catching an illness that you have never been exposed to or that your body is not prepared to fight off. This is especially a concern when spending time in a foreign hospital.

If you have a sensitive stomach, you may also want to think long and hard about having surgery abroad. The food is often very different in foreign hospitals, and in some areas, there is a risk that even the water will be upsetting to your body.

Having diarrhea or postoperative nausea and vomiting makes for a miserable recovery experience, especially if you do not have a friend or family member nearby who can help you through it.

Before you travel abroad, check with your doctor to see if you need any vaccines to travel to your destination or if there are any foreign illnesses you should be aware of. Picking up an illness abroad, particularly after your surgery, can potentially be life-threatening.

Language Barriers

If you are having surgery in a country where English is not the primary language, you will need to make preparations in order to be able to communicate with the staff.

You may be pleasantly surprised to learn that the staff speaks your primary language well. If not, then you will need to consider how you will make your wishes and needs known to the surgeon, the staff, and others you will meet.

Whether you are at home or abroad, remember to speak up and advocate for yourself to make sure your needs are met. If you don't speak the local language, download a language translation app on your smartphone and don't hesitate to use it to communicate your needs. Hiring a translator is another option.

A Word About Transplant Tourism

Transplant tourism is one area of medical tourism that is strongly discouraged by organ and tissue transplant professionals in multiple countries. Most international transplants are considered “black market” surgeries that are not only poor in quality, but ethically and morally wrong.

China, for example, the country that is believed to perform more international kidney transplants than any other country, is widely believed to take organs from political prisoners after their execution.

In India, living donors are often promised large sums of money for their kidney donation, only to find out they have been scammed and never receive payment. Selling an organ in India is illegal, as it is in most areas of the world, so there is little recourse for the donor.

Then there is the final outcome: how well the organ works after the surgery is complete. With black market transplants, less care is often taken with matching the donor and recipient, which leads to high levels of rejection and a greater risk of death. Furthermore, the new organ may not have been screened for diseases such as cytomegalovirus , tuberculosis , hepatitis B , and hepatitis C . It is often the new disease that leads to death, rather than the organ rejection itself.

Finally, transplant surgeons are often reluctant to care for a patient who intentionally circumvented the donor process in the United States and received their transplant from an unknown physician.

It is important to arrange your follow-up care prior to leaving your home country.

Many physicians and surgeons are hesitant to take care of a patient who received care outside the country, as they are often unfamiliar with medical tourism and have concerns about the quality of care overseas.

Arranging for follow-up care before you leave will make it easier to transition to care at home without the stress of trying to find a physician after surgery .

Just be sure to inform your follow-up care physician where you are having your procedure done. After you return, they will also want to know what prescription medications you were given, if any.

What are popular countries for medical tourism? 

Mexico, India, Costa Rica, Turkey, Singapore, Canada, and Thailand are among the many countries that are popular for medical tourism.

How safe is medical tourism?

Medical tourism is generally considered safe, but it's critical to research the quality of care, physician training, and surgical specialties of each country. There are several medical tourism organizations that specialize in evaluating popular destinations for this purpose.

What countries have free healthcare? 

Countries with free healthcare include England, Canada, Thailand, Mexico, India, Sweden, South Korea, Israel, and many others.

A Word From Verywell

If you are considering medical tourism, discuss the risks and benefits with your doctor, and consider working with your insurance provider to arrange a trip that balances financial savings with safety. (Also, before you embark on a trip overseas for your procedure, make sure you are financially prepared for unexpected events and emergencies. Don't go abroad if you don't have enough money to get yourself home in a crisis.)

A medical tourism organization such as Patients Without Borders can help you evaluate the quality and trustworthiness of healthcare in various countries. Making sure a high level of care is readily available will lead to a safer, more relaxing experience.

Centers For Disease Control and Prevention. Medical Tourism: Getting medical care in another country . Updated October 23, 2017.

University of the Incarnate Word. Center for Medical Tourism Research .

Patients Beyond Borders. Facts and figures .

Kaiser Family Foundation. Health coverage of immigrants . Published July 2021.

Paul DP 3rd, Barker T, Watts AL, Messinger A, Coustasse A. Insurance companies adapting to trends by adopting medical tourism . Health Care Manag (Frederick). 2017 Oct/Dec;36(4):326-333. doi: 10.1097/HCM.0000000000000179

Batista BN. State of plastic surgery in Brazil .  Plast Reconstr Surg Glob Open . 2017 Dec;5(12):1627. doi:10.1097/GOX.0000000000001627

Johns Hopkins Bloomberg School of Public Health - Global Health Now. Brazilians' risky right to beauty . Published May 2018.

Chokrungvaranont P, Selvaggi G, Jindarak S, et al. The development of sex reassignment surgery in Thailand: a social perspective .  Sci World J . 2014 Mar;2014(1):1-5. doi:10.1155/2014/182981

The Joint Commission. For consumers .

Centers for Disease Control and Prevention. Blood clots and travel: what you need to know . Reviewed February 2021.

Hurley R. China harvested organs from political prisoners on substantial scale, says tribunal . BMJ . 2018 Dec;363(1):5250. doi:10.1136/bmj.k5250

Ambagtsheer F, Van Balen L. I'm not Sherlock Holmes: suspicions, secrecy, and silence of transplant professionals in the human organ trade . Euro J Criminol . 2019 Jan;17(6):764-783. doi:10.1177/1477370818825331

Centers for Disease Control and Prevention. Transplant Surgery. Key facts . Reviewed January 2019.

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

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What Is Health Tourism? Inside the Travel Trend That Is Going Viral on TikTok

Travelers are going abroad for medical treatments and unique procedures

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If you’ve spent any time on the health side of social media these days, you may have come across a recent phenomenon known as “health tourism” or “medical tourism.” So what exactly is this booming trend going viral on TikTok?

What is health tourism?

For those unfamiliar with the term, health tourism refers to the practice in which people will travel to different countries seeking medical procedures and treatments — but what’s the draw? According to the Centers for Disease Control (CDC), there are numerous reasons for seeking out medical care in foreign countries.

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For example, the price of treatments or procedures may be less expensive in certain countries. Many have documented trips to countries such as Turkey for discounted dental implants and hair transplant surgery.

Another draw to pursuing medical treatment in another country is cultural — receiving medical treatments and consultations from those who share your culture and language can ease a lot of the anxieties one might feel about receiving them.

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Finally, a traveler might be seeking out a treatment that is not yet available or approved within the United States.

What types of treatments are people trying to get?

“ …To dispel any misconceptions about medical tourism , not all medical travel is for cosmetic surgery procedures such as breast augmentation, liposuction, facelifts and rhinoplasty,” said Forbes in 2023.

Dream or Disaster? The Hidden Dangers Lurking Behind the Brazilian Butt Lift (BBL)

“While those are popular, it may come as a surprise that dental procedures, heart valve replacements, fertility treatments and orthopedic surgeries are standard in the medical tourism industry.”

In a recently viral TikTok video shared by user bryn.elise, the creator shared her experience traveling to Turkey, where she received “ the most in-depth checkup of my life .”

@bryn.elise Trying the VIP checkup package 🫢 Memorial Hospital Bahçelievler📍 To make an appointment i just went to the Memorial.com.tr website and filled out the contact form 🙌 Or you can email [email protected] I’ll make a followup video sharing my results soon 😊 ♬ original sound – Bryn Elise

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In the video, she outlines a day full of medical tests she underwent as a part of her check-up. These included blood work, an EKG, a chest X-Ray, an abdominal ultrasound, a thyroid ultrasound, a visit to the gynecologist, the eye doctor, a stress test, a chest ultrasound and more.

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A one-on-one meeting with an internal medicine doctor allowed her to go over the “30-plus scans, tests and cancer markers I was tested for in-depth, and I got to ask all my pressing questions about my health,” she explained. She summed up the video by sharing that the price of it all came out to $810.

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What are the risks of health tourism.

While there are benefits to medical tourism, there are also risks. Some of these risks, according to the CDC, include that of infection as well as quality of care, as some countries have different criteria for medical licensing and accreditation.

Additional risks include that in which air travel after medical procedures might pose, such as blood clots, as well as continuity of care. If follow-up appointments are necessary after a procedure, the price can add up.

If you choose to pursue medical and health tourism, be sure to do your research prior, understand the risks, bring your medical records and properly prepare for your procedure, both before and after.

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Public Health Messaging in an Era of Social Media

• 1 Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
• 2 Penn Medicine Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
• 3 Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia
• 4 Coalition for Epidemic Preparedness Innovation, Washington, DC
• 5 Massachusetts General Hospital, Boston
• Clinical Trials Update Social Media Intervention Improves Vaccine Acceptance Anita Slomski, MA JAMA
• Viewpoint Protecting the Value of Medical Science in the Age of Social Media and “Fake News” Raina M. Merchant, MD, MSHP; David A. Asch, MD, MBA JAMA
• Viewpoint The Potential Role of Social Media in Preventive Health Care Raina M. Merchant, MD, MSHP JAMA
• Viewpoint Social Media and Emergency Preparedness for the Coronavirus 2019 (COVID-19) Pandemic Raina M. Merchant, MD, MSHP; Nicole Lurie, MD, MSPH JAMA
• JAMA Forum Vaccine Misinformation and the First Amendment—The Price of Free Speech Michelle M. Mello, JD, PhD, MPhil JAMA Health Forum

Public health organizations have always used messaging to educate the public in an attempt to control the spread of epidemic diseases. Early efforts that relied on word-of-mouth communication and poster campaigns transitioned to radio and television as those technologies emerged, yet these forms of communication likely have become less effective in a crowded, noisy, and confrontational online environment. Over the past decade, emerging digital platforms have become sophisticated, targeted, and responsive in reaching and influencing the public.

Widespread physical distancing during the coronavirus disease 2019 (COVID-19) pandemic has limited informal social interactions and exposure to signage is considerably lessened as many people limit travel, order products online, and work from home. An effective messaging strategy will require meeting people where they are and through the information networks and devices they use for day-to-day interactions. As of December 27, 2020, more than 80 million people have contracted COVID-19 and 1.7 million have died. The need for effective public health messaging about community spread, prevention measures, and vaccines is more important than ever.

Digital platforms are powerful yet underused tools for engaging the public and should be considered essential for public health preparedness, response, and recovery. This Viewpoint explores the following 4 strategies to advance public health messaging during this and future public health emergencies: deploying countermeasures for misinformation, surveillance of digital data to inform messaging, partnering with trusted messengers, and promoting equity through messaging.

Misinformation Is a Public Health Crisis

Misinformation is a serious threat to public health, especially during pandemics. Misinformation has likely accelerated the spread of COVID-19 by fragmenting and influencing the response to prevention strategies like wearing a mask and physical distancing. Misinformation has emerged about nearly every aspect of the pandemic, including the origins of the virus (eg, it was manufactured in a laboratory), treatments (eg, bleach, alcohol), and vaccine safety (eg, vaccines include embedded microchips).

Misinformation is very difficult to correct because it is massive in volume, contagious, and can appear to come from trusted social networks. Because misinformation is not labeled, distinguishing it from credible information can be increasingly difficult, particularly when highly politicized and opposing views are categorized as fake news. Furthermore, misinformation is being distributed from multiple sources, including government leaders in the US and reportedly from highly organized groups in Russia and other countries.

Recent research is informing the development of approaches to counteract misinformation. Prior studies support a “find and replace” approach that includes posting timely corrections about what is false and why and frequently reiterating accurate information. 1 The vaccine hesitancy literature also suggests the importance of understanding the origin of rumors and false information. 2 This approach can help to understand the concerns and ideologies that can inform development of thoughtful and responsive countermeasures. Because each social media platform has different features and users, the strategies that public health organizations use to address misinformation should also be distinct and responsive to the nuances of each site. A study of 8 million posts about COVID-19 on 5 social media platforms (Twitter, Instagram, YouTube, Reddit, and Gab) demonstrated variability in both the content of accurate and inaccurate information and ways in which it spread across each site. 3 Sites varied in the volume of COVID-19–related messages about topics like cures, therapies, and protection advice; for example, Reddit limited the influence of questionable sources, whereas Gab increased the diffusion of questionable sources.

Public health organizations should also work with technology companies that have platforms with the infrastructure to label misinformation and limit its spread. In response to COVID-19, the World Health Organization partnered with several entities (eg, Facebook, Twitter) to address false information and promote health updates.

In the midst of this pandemic, there is an immediate need to evaluate the effectiveness of these and other countermeasures against misinformation. It will be difficult to make progress toward an unmeasured and understudied problem. Identifying misinformation as a public health crisis has the potential to bring the full weight of public health organizations and other entities toward addressing this problem.

Surveillance of Digital Data to Inform Public Health Messaging

Data from social media can provide insights about the response of the public to preventive health measures. For example, information from social media, digital platforms (eg, OpenTable, Google), and remote sensors is already being used to track the movement of populations and understand where individuals are adhering to guidelines about physical distancing and where they are not. A study of 580 million tweets posted during the early months (ie, January to May 2020) of the pandemic showed that the geographic information associated with tweets can be used as a proxy for human mobility. 4 Public health organizations can use this real-time data to inform messaging content and where to target hyperlocal messages about public health measures (eg, shelter in place).

In addition to serving as a proxy for behavioral responses, social media data can also provide information about public opinion and sentiment in response to public health interventions. Traditional approaches for assessing public attitudes and well-being rely on phone or mail surveys. Delays in the availability of these types of data limit their use for timely surveillance in evolving crises. During the early phases of the COVID-19 pandemic, the Penn Medicine Center for Digital Health and the World Well-Being Project launched a public-facing platform that uses machine learning approaches to synthesize data from Twitter about COVID-19 in real time. 5 Based on data from this platform and others and to enhance public awareness, the Washington State Department of Health posts weekly online behavioral health situation reports containing regional estimates of sentiment, loneliness, and anxiety. 6 This approach could be further harnessed to support situational awareness and enable more directed health messaging to address well-being and population-level mental health needs in response to COVID-19.

Align With Trusted Messengers

Individuals often rely on information that is passed along from people they know and respect. Community organizers and political campaign strategists invest in identifying individuals embedded in communities to help spread important information to their friends and neighbors. Similarly, public health organizations should partner with community influencers (eg, community health workers, religious leaders) who can help with propagating trustworthy messages and dismantling false ones through online channels. In the case of vaccine campaigns, trusted messengers are often engaged to disseminate information about vaccine safety. 2

Public health organizations can also learn from social movements such as #BlackLivesMatter and #MeToo in elevating the ideas and experiences of young and often marginalized groups to shape a national dialogue that leads to change. Frontline leaders for these movements are often trusted messengers that public health organizations can collaborate with when trying to access vulnerable communities. Messages crafted and disseminated by these influencers will likely reach more people and be more persuasive than those created solely by organizations. Furthermore, messages that speak to multiple facets of what people are experiencing (eg, COVID-19 and racism, anxiety, unemployment, caregiving, homeschooling, or isolation) and leverage narratives and storytelling are likely to be effective.

Equity and Public Health Messaging

To date, Black, Latino, and Native American communities are disproportionately affected by COVID-19 and its economic consequences. Conversations about equity are at the forefront of national consciousness as a result of the intersecting events of the COVID-19 pandemic and the killing of George Floyd and other Black individuals. Racism is a centuries-old construct that will not be dismantled with a series of hashtags and Instagram stories. However, social media is an important tool that public health organizations can use to address racism and equity with the same focus as the messages being deployed about COVID-19.

Inequalities contribute to how different groups access, process, and share information. Research from the H1N1 pandemic highlighted how differences in exposure to information and differences in modes of delivery could influence the response to the outbreak. 7 Structural barriers should also be addressed. Disparities in access to broadband and Wi-Fi limit exposure and access to digital content for some populations. This has been of particular salience for online public school education during this pandemic and supports the need for equity in access to technology infrastructure as well as a diversity of communication approaches.

Attentiveness to Risks and a Need for Adaptability

There are notable risks (eg, violations of privacy, data security, perpetuation of bias) with engaging on social media that must be carefully considered for deploying health messaging online. Yet, not expanding traditional approaches and engaging with the full complement of available digital strategies represents a missed opportunity. Just as communication approaches have evolved over time to respond to each emerging public health emergency, there is now urgency for harnessing new approaches to effectively engage the public.

Corresponding Author: Raina M. Merchant, MD, MSHP, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 ( [email protected] ).

Published Online: January 4, 2021. doi:10.1001/jama.2020.24514

Conflict of Interest Disclosures: Dr Merchant is funded by grant R01HL141844 from the National Heart, Lung, and Blood Institute, grant R01HG009655 from the National Human Genome Research Institute, and grant R21 1DA050761 from the National Institute on Drug Abuse. Dr South is funded by award 76233 from the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. Dr Lurie is an employee of the Coalition for Epidemic Preparedness Innovation.

Additional Information: Dr Lurie served as Assistant Secretary for Preparedness and Response in the US Department of Health and Human Services from 2009 to 2017.

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Merchant RM , South EC , Lurie N. Public Health Messaging in an Era of Social Media. JAMA. 2021;325(3):223–224. doi:10.1001/jama.2020.24514

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DESTINATION

1. Overview

Brief introduction to the country and its reputation in medical tourism.

Russia, the world’s largest country by land area, offers a unique blend of history, culture, and cutting-edge technology. While Russia may not be the first destination that comes to mind when considering medical tourism, it has been gaining traction in this field. With substantial investments in healthcare infrastructure and medical research, Russia is slowly but steadily becoming a destination worth considering for various medical procedures. The country has a growing reputation for offering state-of-the-art medical treatments, often at a fraction of the cost you might pay in Western Europe or North America.

Historical and Cultural Significance in Medicine

Russia has a long-standing history of medical research and innovation. From the times of renowned scientists like Ivan Pavlov to contemporary achievements in cardiology and neurology, the country has been instrumental in contributing to global medical science. Russian medical institutions have also been engaged in pioneering work in fields like radiology, organ transplantation, and aerospace medicine, reflecting a cultural emphasis on scientific inquiry and innovation.

The Medical Landscape

The Russian healthcare system is a mix of public and private institutions, providing an array of treatments ranging from general medicine to specialized surgeries. While public healthcare is generally available to citizens, the growing private healthcare sector caters to both local and international patients, often providing services that match global standards.

What Draws Medical Tourists to Russia?

Medical tourists often find Russia appealing due to its advanced technology, specialized treatments, and relatively lower costs. Moreover, the prospect of combining medical treatment with a cultural experience is another attractive feature. Known for its grand architecture, vibrant arts scene, and rich history, Russia offers an all-around travel experience alongside high-quality medical care.

2. Popular Medical Procedures

List and brief descriptions of procedures.

• Cosmetic Surgery : Including procedures like rhinoplasty, liposuction, and breast augmentation, Russia is increasingly becoming a destination for cosmetic surgery.
• Dental Treatments : Dental implants, crowns, and veneers are some of the sought-after treatments.
• Cardiac Surgery : With advanced technology, cardiac procedures like bypass surgeries and angioplasties are performed at specialized centers.
• Orthopedic Surgeries : Hip and knee replacements are commonly done here with a high success rate.

Specializations or Pioneering Treatments

Russia is becoming known for its cancer treatments, including specialized radiation therapies and immunotherapy treatments. Additionally, the country has been involved in research and treatment of neurological conditions, offering specialized services in this domain.

3. Top Hospitals & Clinics

Renowned hospitals and clinics.

• Almazov National Medical Research Centre, St. Petersburg
• European Medical Center, Moscow
• Moscow City Clinical Hospital

Accreditation and Affiliation

Most top hospitals are accredited by Russian healthcare authorities and some even possess international accreditations. These hospitals often collaborate with international medical institutions for research and training purposes.

Special Features, Awards, or Recognitions

Many hospitals have received awards for medical excellence and innovations in treatments. They also offer features like English-speaking staff, modern facilities, and state-of-the-art medical equipment.

4. Cost Comparison

Comparative data.

On average, medical procedures in Russia can cost 30-70% less than in Western Europe or North America. For instance, a dental implant that might cost upwards of $3,000 in the United States could be available for around $1,000 in Russia.

Price Ranges

Costs can vary based on the facility, location, and type of procedure. Always get multiple quotes and consult with healthcare providers to get a more accurate picture.

5. Quality & Safety

Medical standards and practices.

Russia is committed to ensuring high standards of medical care, supported by its educational system that produces skilled doctors and medical professionals. While there might be variations in quality between rural and urban centers, most metropolitan areas have hospitals and clinics equipped with modern technology and well-trained staff.

Accreditation Systems and Regulatory Bodies

In Russia, medical facilities are generally regulated by the Ministry of Health. While not all hospitals may have international accreditations, most top institutions meet or exceed global healthcare standards.

Quality Checks and Patient Safety Protocols

Russian healthcare providers employ a variety of safety measures such as pre-surgical consultations, sterilization protocols, and rigorous post-operative care. They also tend to follow internationally recognized best practices to ensure patient safety.

Patient Rights

Patients have the right to quality healthcare, the right to choose their physician, and the right to confidentiality. These are enshrined in Russian medical law and are generally adhered to by healthcare providers.

6. Medical Visa Information

Guidelines and requirements.

To obtain a medical visa, you generally need a formal invitation from the Russian medical institution where you plan to receive treatment. Proof of financial stability and medical insurance are often required.

Duration, Documentation, and Application Process

The visa can be valid for up to 90 days, with possible extensions in case of medical necessity. Documentation usually includes your passport, invitation letter, visa application form, and photographs. Applications are typically processed within 10 to 20 business days, although expedited services are available for an additional fee.

Travel-related Advisories or Restrictions

It’s advisable to keep an eye on travel advisories and consult your home country's embassy or consulate for the most current information.

7. Cultural Considerations

Local customs and etiquette.

While Russia is generally welcoming to tourists, being aware of local customs and etiquette can enrich your experience. A basic understanding of Russian manners, such as greetings and proper attire, can be beneficial.

Language and Communication

While the primary language is Russian, English is often spoken in large hospitals and medical centers. Nonetheless, it's advisable to confirm the availability of English-speaking staff or interpreters.

Dietary Considerations

Russia offers a variety of cuisine options, though traditional foods might be heavy in meat and dairy. Vegetarian and vegan options are increasingly available, particularly in larger cities.

8. Travel & Accommodation

Popular areas to stay.

Moscow and St. Petersburg are popular destinations with proximity to top medical facilities. Both cities offer a range of lodging options, from luxury hotels to budget-friendly hostels.

Proximity to Medical Facilities

Medical centers are often well-connected by public transportation or are just a short drive away from popular accommodation areas.

Transportation and Infrastructure

Russia has an extensive public transportation network, including subways, buses, and taxis. Apps like Uber are also widely used.

Post-procedure Relaxation and Recuperation Spots

Russia is rich in natural beauty, from the beaches of Sochi to the serene landscapes of Siberia, offering plenty of options for post-procedure relaxation.

9. Legal & Ethical Considerations

Legal rights of patients.

Patients have the right to informed consent, confidentiality, and quality healthcare as per Russian laws.

Medical Malpractice Laws and Patient Recourse

In cases of medical malpractice, patients have the right to legal recourse. However, legal proceedings can be long and complex.

Ethical Considerations

Ethical standards are generally in line with international norms. Issues such as organ transplantation are strictly regulated.

10. Benefits & Risks

Among the benefits are lower costs, high-quality specialized treatments, and the opportunity to explore Russian culture and history.

Potential Risks

Language barriers and variations in quality between rural and urban healthcare centers are some of the risks involved. Always conduct thorough research and consultations before proceeding with any medical treatment.

11. Post-procedure Care

Post-operative care.

Russian medical facilities often offer robust post-operative care programs, including rehabilitation and follow-up appointments.

Availability and Quality of Rehabilitation Centers

Rehabilitation centers, especially in metropolitan areas, are well-equipped and staffed with trained medical professionals.

12. Frequently Asked Questions (FAQs)

• Is English widely spoken in Russian hospitals? In major cities and top healthcare centers, yes. However, it's advisable to confirm this before you travel.
• How do I pay for medical procedures? Payment methods vary, but most top hospitals accept credit cards and wire transfers.
• Is it safe to travel alone? While generally safe, it is always advisable to be cautious and aware of your surroundings, especially in unfamiliar areas.
• Is medical insurance necessary? Yes, proof of medical insurance is usually a requirement for obtaining a medical visa.
• What is the quality of post-procedure care? High-quality post-procedure care is often available, particularly in specialized medical centers.

Global Provider Members

Russian Ruble

144,500,000

With an area the size of Russia, it is difficult to give any sort of general advice about the climate and weather, except that summers are warm to hot, and winters get very cold in some areas. In general, the climate of Russia can be described as highly continental, with warm-to-hot, dry summers and (very) cold winters with temperatures of -30°C or lower. Heavy snowfall is not uncommon.

Facilitators

Featured treatments.

MedicalTourism.com

MedicalTourism.com is a free, confidential, independent resource for patients and industry providers. Our mission is to provide a central portal where patients, medical tourism providers, hospitals, clinics, employers, and insurance companies can all find the information they need. Our site focuses on patients looking for specific knowledge in the fields of medical tourism, dental tourism, and health tourism.

Call to transform tourism via social media

Expert emphasises importance of virtual tours, campaigns to attract more visitors

The arduous journey from Pakistan's plains to the northern highlands of Khyber Pakhtunkhwa is instantly rewarded as travelers encounter the breathtaking beauty of Saiful Malook Lake.

In today's digital age, there is growing recognition of the potential for leveraging social media to enhance mountain and eco-tourism as well as archaeology for economic development. Manzoorul Haq, a former Pakistani ambassador, attested to the lake's exceptional charm, citing its lasting impression compared to other global lake destinations.

Abu Zafar Sadiq, President of the Alpine Club of Pakistan, highlighted how digital and social media can transform Pakistan's tourism landscape.

"Saiful Malook and similar breathtaking sites offer stunning vistas and significant economic promise for Pakistan, subject to government patronage," he said. Despite its immense potential, Pakistan's tourism sector has struggled to reach its full economic potential, mainly due to natural calamities, terrorism, and COVID-19. In 2017, tourism contributed only $8.8 billion, or 2.9% of GDP, a stark contrast to the $15 billion, or 5.7% of GDP, in 2019. The COVID-19 pandemic and security issues exacerbated these challenges, leading to a notable decline in tourism revenue and employment in Pakistan.

Abu Zafar emphasised the importance of embracing digital innovations, such as virtual tours and social media campaigns, to attract more visitors. He advocated for hiring digital professionals and utilising platforms like GPS and artificial intelligence to promote Pakistan's diverse tourism offerings. The potential for tourism growth is evident, with initiatives like the "One Belt, One Road" and the China-Pakistan Economic Corridor (CPEC) playing pivotal roles in improving infrastructure and boosting the tourism, transport, and hospitality industries.

Abu Zafar emphasised the importance of embracing digital innovations, such as virtual tours and social media campaigns, to attract more visitors. He advocated for hiring digital professionals and utilizing platforms like GPS and artificial intelligence to promote Pakistan's diverse tourism offerings. The potential for tourism growth is evident in Pakistan, with the "One Belt, One Road" initiative and China-Pakistan Economic Corridor (CPEC) playing pivotal roles in improving infrastructure and boosting tourism, transport and hospitality industries.

Ambassador Manzoor also suggested that developing attractions like a chairlift between Naran and Saiful Malook could generate significant revenue and enhance the socio-economic conditions of the region.

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Health and Human Physiology

Work and leisure reimagined.

Mary Oliver closes Poem 133: The Summer Day with a question: “Tell me what is it you plan to do with your one wild and precious life?” Interestingly, that is the same question Ben Hunnicutt has asked in four books, and thousands of lectures, over a 50-year career. 

Though Ben's first book, Work Without End: Abandoning Shorter Hours for the Right to Work (Philadelphia: Temple University Press), was published six years before I arrived in Iowa City. I remember the University of Iowa campus still buzzing over the book’s success when I got here. 

These were good days to be known as a “leisure studies professor” and Hunnicutt's questioning of the new theology of work had reignited a public debate. During this time, he regularly appeared in the national media, including The Charlie Rose Show , ABC News, The New York Times, and he played a central role in the popular PBS special, Running Out of Time .

In 1994, I was accepted into the Leisure Studies graduate program and was picked to be Ben’s first teaching assistant. Two years later, I stood alongside Ben as he spearheaded a national conference entitled, Our Time Famine: A Critical Look at the Culture of Work and a Re-evaluation of ‘Free’ Time . The list of presenters who traveled to Iowa City to join in the gathering was astounding. It included feminist writer and activist Betty Friedan, acclaimed sociologist Arlie Russell Hochschild, economist Juliet Schor, and former United States Senator Eugene McCarthy. Not wanting to miss out on the event, economist John Kenneth Galbraith, 88 years old at the time and unable to travel, prepared a special video presentation. Even the Canadian government sent an observer. It was a transformational event indeed to witness some of our country’s leading sociologists, economists, and labor leaders gather in the Iowa Memorial Union to discuss how a more equitable, meaningful organization of work and leisure could be achieved. There were no honorariums offered or formal dinners planned, but this gathering of thought leaders chose to interrupt their big city lives to come to Iowa, nevertheless. Why? Because it was the home of Ben Hunnicutt.

"Ben is a towering figure in the history of work time. His analysis of developments in the first half of the twentieth century us remains the definitive account. For me personally, work without end has been one of the books that most influenced my thinking and my own research — that puts Ben in a category with Karl Marx, Pierre Bourdieu, and John Maynard Keynes." -Juliet Schor, Economist and Sociology Professor at Boston College, April 28, 2o24

A beloved teacher, who is persistently learning, Ben’s classes are constantly evolving to reflect national issues of the day. While the majority of Ben’s fifty-year academic career has focused on the historical mystery behind “the end of shorter hours,” it has meaningfully intersected with countless disciplines including sociology, economics, women’s studies, classics, tourism, American studies, religion, health and wellness, and positive psychology. One need only look at how Ben’s four major books – Work Without End, Kellogg’s Six-Hour Day , Free Time: The Forgotten American Dream , and The Age of Experiences: Harnessing Happiness to Build a New Economy – are utilized around the world to see the impact of his scholarship. On our campus alone, the same work has been included in courses with content as diverse as work and family issues and social innovation.

In turn, Ben’s graduate courses are populated by a variety of young scholars hoping to add a unique layer to their studies. A longtime admirer of Ben’s scholarship, former University of Iowa President Willard “Sandy” Boyd once described Ben as among the “most important” UI faculty members of his tenure.

Being the torchbearer for a forgotten American Dream has never been easy, however. As higher education has slowly doubled down on preparing students for the workforce, and consumption continues dangerously unchecked, Ben’s message of more and more lives living freely has often been ignored. In fact, Ben writes about how a 2014 Politico article found him in the crosshairs of FOX News, receiving hate mail and death threats simply for choosing to teach and write about leisure.

"His writing has been pathbreaking. Moreover, unlike me, he has actually practiced what he preaches in the free time in his own life, even as he has continued to teach and write way past the age of his peers." -Gary Cross, Distinguished Professor Emeritus of Modern History Penn State College of  Liberal Arts, April 28, 2024

A tireless advocate for the liberal arts, Ben argues that the eternal questions— “Who am I?” “Why am I here? “What is the meaning of my life?”—once framed in a context of loyalty to ideals bigger than oneself, are now being answered through the lens of work. Who am I? I’m a banker. A doctor. A teacher. A maid. “Purpose once reserved for the activities of the soul,” explains Ben, “is now found in the religion of work.” While financial success has certainly varied among Ben’s countless students, the common thread that runs through everyone Ben has mentored is a life committed to family, community, and service to others – the characteristics of a “good society.”

It has been said that Ben not only walks the talk but dances it. While I can still plot the 1920 – 1940 American fight over working hours on a blackboard, and lead a discussion on Plato’s Phaedrus, my favorite lessons from Ben are more subtle. Like the time a film crew came to interview Ben for the PBS special Running Out of Time . The visit took place during a historic flood, and the interview was moved inside Ben’s home to avoid the rain. When the interview was over, Ben played the piano for his visitors, before leading them on a hike along the flooding Iowa River. Ben then returned home to care for his grandson, and there is a scene in the documentary where Ben is seen pushing his grandson on a swing and tenderly singing “Swing Low, Sweet Chariot.” Ben didn’t need to tell the filmmakers what he would do with more free time, he simply showed them.

"When America would seem to have forgotten the struggle for more time, Ben reminded us of it. And where many become  pessimistic about controlling the monopolization of life by work, in the age of experiences, Ben Hunnicutt points to positive trends." -Arlie Hochschild, Professor Emeritus of Sociology at the University of California, Berkeley, April 25, 2024

Over the past month, I have corresponded with a number of distinguished scholars who see Ben’s work as fundamental to their own. Interestingly, the word that comes up over and over to describe Ben is “pathbreaking.” As economic and social theorist Jeremy Rifkin wrote me, “There are times in history where a single individual steps forward on the world stage with a new idea for improving the lot of humanity.” And Rifkin concludes, “We have an entire generation now coming of age who I think will be more than grateful.”

"When I first read Work Without End sometime in the late 1980s, I felt as if the missing piece of a large and frustrating jig saw puzzle had finally been found and put in its rightful place. Since then, Ben Hunnicutt’s work has been an ever-present guide to my own, explaining and exploring the most profound calculus that trades leisure for labor and how that misanthropic deal has done so much to reshape consciousness and conflict for tens of millions of workers both high and low." -Nelson Lichtenstein, Research Professor, Department of History, University of California, Santa Barbra, May 1, 2024

Professor Benjamin Hunnicutt received his MA and PhD in American History from the University of North Carolina, Chapel Hill. He has served as chair of Leisure Studies and head of the Division of Physical Education at the University of Iowa. He has worked as a consultant to unions and businesses interested in shorter work hours and the potential of leisure to improve the community and workplace. Hunnicutt is a member of the Academy of Leisure Sciences and past co-director of the Society for the Reduction of Human Labor. He has been a professor at the University of Iowa since 1975. For most of his academic career he has focused his research and writing on the historical mystery: "the end of shorter hours." With writers such as Joseph Pieper and Hannah Arendt, he has also explored the “rise of the world of total work”—the unique modern glorification of work as a crypto-religion and the resulting trivialization of leisure that for centuries was progress’ ultimate destination. Hunnicutt is the author of several books, book chapters, and articles, including Work Without End: Abandoning Shorter Hours for the Right to Work (1987), Kellogg's Six-Hour Day (1995) Free Time: The Forgotten American Dream (2013), The Age of Experiences: Harnessing Happiness to the New Economy (2020). Currently, he is working on a two-volume history of work, tentatively entitled: The Rise and Fall of Work (the second volume subtitled, Saving Work, A Failing Faith) and a trade, self-help book, What to Buy To Make You Really Happy, And Then Some . Hunnicutt has written for The Wall Street Journal , Politico , and the Huffington Press , and appeared in a variety of nationally and internationally broadcast television and radio programs including: ABC News, NBC News, the Canadian and British Broadcasting Corporations, the Today Show , the Charlie Rose Show , and appeared in the PBS special, Running Out of Time , and the German Television documentary “Frohes Schaffen - Ein Film zur Senkung der Arbeitsmoral.”

Our Response to COVID-19 →

Medical Tourism

Understanding the role of social media in medical tourism.

Social media has transformed the way businesses connect with their audience. In medical tourism, social media platforms can be powerful tools for building trust and credibility.

Social Media as a Trust-Building Tool:

1. Transparency and Engagement: Social media platforms enable you to communicate openly and directly with potential patients, answering their questions and addressing their concerns.

2. Patient Testimonials: Sharing patient testimonials on social media can provide powerful social proof of the quality of your services.

3. Education and Information: Social media can be used to educate potential patients about your services, procedures, and staff qualifications.

Maximizing the Potential of Social Media:

1. Regular and Consistent Posting: Regular posting of valuable content can keep your audience engaged and interested in your services.

2. Interactive Content: Use interactive content, such as polls, quizzes, and live Q&A sessions, to engage with your audience and learn more about their needs and concerns.

3. Influencer Collaborations: Collaborating with influencers in the healthcare sector can help you reach a wider audience and boost your credibility.

Social media, when used effectively, can significantly enhance trust and increase patient conversion rates in the field of medical tourism.

One of the key ways to build this trust is through accreditations from internationally recognized organizations like Global Healthcare Accreditation www.ghaaccreditation.com . GHA provides a robust framework for hospitals and clinics to deliver safe, high-quality care to medical tourists. Its accreditation is a globally recognized trust signal that asserts an institution's commitment to maintaining international healthcare standards, ultimately making it a valuable tool in building patient confidence. The future of medical tourism indeed looks promising with resources like GHA fortifying trust in global healthcare.

Top Metabolic Surgery Specialists in Antigua and Barbuda

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Leveraging social media to boost online reputation in health tourism.

In 2015 , a London couple – Cillian Nemas, 60, and Robert Nemas, 67 were in search of centers of excellence for eye surgery in India. One challenge they met was the dearth of direct channels through which Indian hospitals could be assessed and evaluated for their quality and success rates of medical procedures. ‍

The couple turned to the internet, tracking down several hospitals in Hyderabad until they found  Maxivision Super-specialty Eye Hospitals  as the perfect center to undergo an optiwave refractive analysis laser cataract surgery.

Not only was the procedure successful, the couple saved an extra £4000 by having it done in India. Robert noted that the poor social media presence of many Indian hospitals reduced their visibility and in turn the number of international patients from the UK, for instance. ‍

This emphasizes the value of social media to healthcare tourist destinations. Social media plays an integral role in brand marketing and online reputation building which, in turn, is critical to maintaining international clientele and patient volume. ‍

Technology has begun to sweep through healthcare revolutionizing it as we know it. Patients are beginning to seek answers to their health questions on their mobile devices.  Pew National survey of 2014  revealed that no fewer than 72 percent of Americans search online for health information and one of every four of them read about someone else’s experience with a similar condition they have. ‍

In the past, online reputation never mattered to physicians and healthcare providers but given the recent paradigm shift created by digitalized healthcare, online reputation of these providers have become a priority. ‍

Stakeholders in medical tourism are starting to employ the social media market to its full potential. Traditional means of brand marketing are giving way for tech-enhanced methods, using social media platforms to build strong online reputations to expand international patient reach. ‍

Recent findings  have revealed that international patient departments and healthcare providers are starting to see the benefits of building a strong online reputation by harnessing the opportunities on social media. This trend is expected to experience a huge rise as health tourism market becomes more competitive. ‍

As individuals become more social media-friendly, they share their personal opinions about certain organizations, including healthcare providers, and medical travelers tend to rely on these anecdotes than details obtained from the social media pages of the provider or by contacting the provider. ‍

Role of Social Media in Promoting Online Reputation

Social media can make or break the online reputation of a health tourist site. A poor review by a user would only leave a negative impression and a drop in interest for such a healthcare provider. Therefore, providers are required to maintain high standards of quality and professionalism if they must reap the benefits of the social media factor. ‍

Dr. Kevin Pho , a leading social media voice and past speaker at the Medical Tourism Congress  noted  a few ways in which social media promotes healthcare providers and their online reputation, as well as healthcare delivery in general. ‍

Improve Accessibility

This remains a crucial marketing element for stakeholders in the health tourism industry. Health tourist destinations are only as successful as their brand visibility and how accessible they are to patients. ‍

Patients get to read tweets or Facebook posts, for instance, and get engaged by the health information posted. These platforms are strong influencers in the decision-making process of medical tourists. In the case of Robert and Cillian Nemas, visibility made the difference, setting Maxivision Eye Hospitals apart from the rest. ‍

Proactive Online Brand and Reputation

Social media creates an avenue for external brand ambassadors – the customers – to communicate, in their words, what a provider’s brand stands for. Healthcare providers could engage patients for whom they have provided healthcare treatment in the past.

Furthermore, social media provides an avenue for providers to display their areas of competences, innovations, contributions to health care, cutting-edge technological advances, and success stories. ‍

Dr. Pho, in his speech, described the features of a proactive social media platform as one in which patient reviews and provider ranking are expressed and appropriate feedback is given to negative reviews to keep the provider’s online reputation intact. ‍

Interaction with Patients

It isn’t unusual for patients to search online for information regarding symptoms, the kind of treatment required, as well as prevention for a number of common conditions. Healthcare providers can use social media platforms as an avenue to educate patients through articles, blog posts, and podcasts, thereby connecting with the patients on a personal and emotional level. ‍

Additionally, providers can, via social media, provide patients with information regarding treatment best practices, updates on treatment protocols, and preventive measures against certain diseases. Some providers post live procedures on their social media pages to give viewers firsthand knowledge of the steps required in performing a surgical procedure. ‍

This also serves as a learning model for medical students and other healthcare professionals who may improve their skills by watching such videos. ‍

Connecting with patients on this level creates a bond which not only serves a benefit of high patient volume to the provider but ensures that patients maintain a high quality of health in and out of the hospital. ‍

Offer Perspectives on Breaking News

Healthcare reform, for instance, is a trending topic in the health sector and it affects employers, employees, and even retirees. Part of building a strong online reputation is providing useful perspectives to such news articles as it concerns the patient.

Social media should serve as an avenue for dialogue and interactions on topical issues concerning health with these discussions centered on helping patients make informed choices concerning their health. ‍

Another vital role of social media in health tourism is creating a bridge between medical tourists and the healthcare providers. International patient departments can create social media contacts through which prospective medical travelers can access details regarding treatment in the tourist destination.

In addition, a well-trained customer service team, as the internal brand ambassadors, should be in place to respond to inquiries and give patients a good impression up front. ‍

Social media is indeed one tool that, if tapped, would lead to an immense growth of the medical tourism industry. With the platform bringing patients and providers across different geographical locations in one place, it serves as a strong channel for creating a solid online reputation and expressing one’s brand to a large audience.

Unveiling the Power of Social Media Marketing in Medical Tourism

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The Medical Tourism Magazine (MTM), known as the “voice” of the medical tourism industry, provides members and key industry experts with the opportunity to share important developments, initiatives, themes, topics and trends that make the medical tourism industry the booming market it is today.

Brat summer is almost over. Get ready for 'demure' fall, a new viral TikTok trend.

Brat summer 's been fun. But now it's time to get "demure."

The internet has a new buzzword, aesthetic and mindset − and it comes in stark contrast to this summer's trend of embracing all things messy and brat . (And, if you understand every word of that sentence already, you should probably spend less time on the internet.)

It's called being "demure," an attitude that's going viral in major part thanks to Jools Lebron, a TikTok personality with 1.2 million followers who has clarified what the trend means and what it stands for in several videos.

Basically, being "demure" is all about being cutesy, clean and mindful. It's not drawing attention to yourself. It's not being messy or loud. It's getting things done and going about your day with quiet confidence and gentility. Dressing modestly at work? That's demure. Patiently waiting to get out of your seat until the plane is ready to de-board? So demure.

"You see how I do my makeup at work? Very demure, very mindful," Lebron says in one video with more than 10 million views . "I don't come to work with a green-cut crease. I don't look like a clown when I go to work. I don't do too much. I'm very mindful while I'm at work. See how I look very presentable? The way that I came to the interview is the way I go to the job."

What does it mean to be demure?

It's unclear whether the trend is sincere or satirical. Still, people can't stop talking about or embracing it, even if in an ironic way.

Bob the Drag Queen, for instance, posted a TikTok putting on outrageous makeup to Lebron's audio describing a demure makeup look in the workplace. Another TikToker said it was demure to take psychiatric medication.

"You see how I take my antidepressants every day? Very demure, very mindful, so I don't fall into a manic episode, depressive episode," the TikToker says. "Be mindful of why your doctor prescribed you an antidepressant. Very demure."

Being demure isn't just an aesthetic, but a way of life. Lebron has described how to be demure while boarding a plane , responding to drama and ordering food .

"I don't do too much. I do just enough," Lebron says in a video . "I don't go overboard. I don't go underboard. I'm not the basement. I'm not the attic. I'm where you live. I'm very demure."

Brands have gotten in on the trend too. "Not standing immediately when the plane lands is so demure," United Airlines commented on TikTok. "Vacation responder set to on, very demure," Google added.

Is 'color analysis' real? I put the viral TikTok phenomenon to the test − and was shocked.

Are you demure or brat?

The demure trend stands in stark contrast to the brat trend. Inspired by the Charli XCX album of the same name, "brat" is all about unabashedly embracing your messy side. This includes loud makeup, clubbing, partying and general chaos.

Esthetician Sean Garrette indicated a tide seems to be turning, declaring on X : "brat summer, demure fall."

In a  TikTok interview , Charli XCX broke down her definition of the word "brat": “You are just that girl who is a little messy and maybe says dumb things sometimes, who feels herself but then also maybe has a breakdown but parties through it. It is honest, blunt and a little bit volatile. That’s brat.”

'Brat summer' is upon us. What does that mean? Kamala Harris is game for it.

Charli XCX fans aren't throwing tantrums like a badly behaved child; being a brat to them means indulging in pleasure and not concerning yourself with societal expectations. Rather than conforming to the status quo − on matters of aging, clean living or etiquette − brats focus more on having fun, embracing their community and unapologetically embracing individuality.

More: Kamala Harris is embracing 'brat summer.' It could be cool or cringe. It's a fine line.

It's "being confident, putting yourself out there, being out, being about, being the center of attention."

It's pretty much the opposite of demure, which has made some social media users excited for the switch-up. As one X u s er put it: "This demure lore is way more fun than the brat nonsense."

Contributing: Alyssa Goldberg

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IT Ministry Directs Immediate Compliance with Supreme Court's Order on Trainee Doctor Case

The it ministry has asked social media platforms to remove all references, including name, photos, and videos, of the trainee doctor who was raped and murdered in kolkata's rg kar medical college. the directive follows a supreme court order mandating the removal to protect privacy and dignity..

The IT Ministry on Wednesday mandated immediate compliance from social media platforms with a Supreme Court ruling for the removal of all references, including name, photos, and videos, related to the tragic case of the trainee doctor who was brutally raped and murdered in Kolkata's RG Kar Medical College and Hospital.

The ministry emphasized the importance of safeguarding the privacy and dignity of the victim, warning that failure to act could result in serious legal and regulatory consequences. Social media platforms must inform the ministry of actions taken to conform with the apex court's order.

The Supreme Court directive, dated August 20, 2024, specifically calls for the removal of all identifiable references of the deceased across social media platforms, following the alarming circulation of sensitive material about the incident. The court's injunction aligns with prior rulings in the Nipun Saxena case concerning the disclosure of identities of sexual assault victims.

Bangladesh Unrest Causes Drop in Medical Tourism to Kolkata

Stranded in kolkata: the plight of bangladeshis amid turmoil, tragic death of female doctor in kolkata hospital sparks controversy, mystery surrounds death of pgt doctor at kolkata hospital, tragic discovery: trainee doctor found dead in kolkata hospital.

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Seven Insights From Teens About Social Media and Mental Health

For better or for worse, social media has become the go-to for hot takes and heated debate, whether it’s about the election, movies, or pizza. But for parents and others who care about kids, the most important discussion at the moment is about the existence of social media itself, and how it affects the mental health of children, teens, and young adults.

For many, Instagram, TikTok, X/Twitter, Snapchat, YouTube, and so on are at best a time suck, and at worst a virtual-world cesspool bubbling with bullies , braggarts, and bad ideas. It seems logical, then, to think that these platforms—which zoomed to prominence only within the last two decades—are somehow to blame for the concurrent rise in the youth mental health crisis .

And, indeed, lawmakers and public health officials are seeking measures to restrict social media’s hold on a population that still has a lot of growing up to do. Earlier this year, the U.S. surgeon general, in an opinion piece in the New York Times , even recommended warning labels on social media, alerting users to the platforms’ association with mental health problems in teens.

But other experts point out that there haven’t been enough studies to prove causation, only correlation, and they feel that efforts to limit young people’s access to these platforms are misdirected. What’s more, they say, oversimplifying the problem distracts us from finding the true culprits behind the rising anxiety, depression, self-harm, and suicidal thoughts among young people.

Now, a new survey , funded by Hopelab with support from Common Sense Media , offers a slightly different perspective. Aiming to deepen our understanding of social media among teens and young adults, the researchers reached out to young people themselves—instead of their parents, teachers, or doctors. Their results illuminate just how complex the relationship between young adults and social media actually is.

The youth POV

The survey’s title describes it best: A Double-Edged Sword: How Diverse Communities of Young People Think About the Multifaceted Relationship Between Social Media and Mental Health . Distinguishing itself from other recent surveys on teens and social media (such as those from Gallup and the Institute for Family Studies , and the ">Pew Research Center ), this one is a collaboration of sorts between the researchers and young people across the country aged 14 to 22.

Teens (age 14 to 17, in this study) and young adults (age 18 to 22) not only helped to design and survey, they also assisted in interpreting the nationally representative data once it was collected. In all, a racially diverse group of 1,274 young people participated. Some of the questions were open-ended, which allowed respondents to share their personal experiences. The outcome? Findings that feel richly nuanced and strikingly authentic. A few highlights:

Young people rely on social media for a range of needs. Almost a quarter said they are on social media almost constantly throughout the day (about the same as in 2020). More than half said social media is important for seeking support or advice, and that they use social media to feel less alone.

The vast majority said that social media is important for fun and entertainment (89%), communicating with friends (85%), and unwinding when stressed (83%). It’s also a creative outlet, as Amy Green, head of research at Hopelab, points out. For instance, some said they create mood boards on Pinterest, which they turn to when they need a mental boost.

In fact, almost 40% of teens and young adults who use social media said that it cheers them up when they’re feeling sad, stressed, or anxious—the same number as those who reported feeling neither good nor bad. Only 8% said social media makes them feel worse, and 13% said they experience both negative and positive feelings.

They are aware of social media’s downsides and try to control their use. Almost three-quarters admitted they reach for it when they’re bored; almost half said they use it more than they intend to or can’t control their use; 46% acknowledge that it has taken time away from activities they care about.

The good news, says Green, is that many young people also took action to limit and shape their social media use so that it felt healthier to them. Across all age groups, more than three-quarters had, in the previous 12 months, taken measures to control what they see—curating their feed to get rid of posts they prefer not to see (67%); or taking a temporary (63%) or permanent (41%) break from a social media account.

Older adolescents (age 18 to 22) were likelier than the younger group (14 to 17) to identify the downsides of social media and then take action. For instance, half of young adults admitted that social media gets in the way of sleep, compared to 34% of teens. And 51% of young adults believe social media has chipped away at their attention span and ability to concentrate, compared to 39% of teens. This suggests that perhaps teens can get better at navigating social media as they get older.

Negative interactions occur, but so do positive ones. More than half of young people who reported using social media said they often or sometimes encountered body shaming, sexist remarks, transphobia, homophobia, and racism, directed at themselves or others. White respondents were more likely to report coming across hurtful comments than their non-white peers, perhaps because they’re also less likely to curate their feeds to avoid potential hurtful comments (more on that below).

At the same time, young people also reported seeing positive comments—including those that celebrated a range of body shapes, sizes, and capabilities (68%); affirmed different racial and ethnic backgrounds (63%); and affirmed lesbian, gay, bisexual, transgender, and queer (LGBTQ+) identities (63%).

More on Teen Mental Health

Discover five ways to help prevent teen depression .

Learn how we can help young brains fight off anxiety .

Explore whether smartphones are bad for teen mental health .

Find out how to help teens feel good about themselves .

LGBTQ+ youths report experiencing support and identity affirmation with social media, but also exposure to harassment and stress. Almost three-quarters of these social media users say the platforms are important in helping them feel less alone, compared to only about half of self-described cisgender, heterosexual teens and young adults. Yet almost the same number of LGBTQ+ youths say posting to public accounts would open themselves up to harassment. More of these youths, compared to their non-LGBTQ+ peers, also reported bearing the brunt of the negative aspects of social media, including sleeping less and spending less time doing other activities they care about, such as exercising and spending time with friends.

These youths were also more likely than others to proactively minimize the hurtful comments. A whopping 89% said they’ve tried to avoid content they don’t like (compared to 74% of non-LGBTQ+ peers) or tinkered with their feed to tailor it to their needs. Still, a little over half said they prefer connecting over social media than in-person—that’s significantly more than the non-LGBTQ+ respondents who said they felt the same way (38%). When asked why, many LGBTQ+ users explained that they actually felt safer online.

More Black teens and young adults than non-Black youths cite social media as an important tool for specific tasks. For instance: keeping up with the news (80% of Blacks vs. 65% of whites); learning about professional or academic opportunities (80% of Blacks vs. 63% of Latinos vs. 53% of whites); and keeping up with influencers or creators (63% of Blacks vs. 52% for both whites and Latinos). (The sample sizes for Asian and Asian Pacific Islander young people were too small to be able to conduct significant testing, even though those individuals are included in the overall sample.)

Green says that, like other marginalized groups, Black youths saw social media as a way to connect with people who look like them or share their culture. It’s also a way to access resources they don’t necessarily have in their own community, such as information on universities, scholarships, and applications.

“We think of social media as being social,” says Green. “But it’s also a resource, and that’s something that often gets left out of the conversation.”

Black and Latino young people are more likely to quit a social media platform. Black (42%) and Latino (40%) teens and young adults are about twice as likely as white (21%) youth to report taking a permanent break from a social media account because of harassment or other negative experiences online. Black and Latino young people are also about one-and-a-half times more likely to take a temporary break.

In interviews, the youths explained that the racism they’ve had to deal with offline lowers tolerance for online harassment and discrimination. “The online world is sometimes safer and easier than day-to-day for them,” says Green, “because they can just block the negative comments or take a break from the platform.”

More teens and young adults with depressive symptoms experience negative feelings from social media—but they’re also more likely to use it as a source for support. Almost two-thirds of those with moderate to severe depressive symptoms and more than half of those with milder symptoms said that when they use social media, they felt that other people’s lives were better than theirs. Only 38% of non-depressed users said the same. In this report, we see similar discrepancies when it comes to feeling stressed about the bad news seen on social media, as well as feeling bad about their body or appearance.

Nevertheless, those who reported elevated depressive symptoms were also more likely to say that “social media is important for cheering them up” (78%) than those reporting no symptoms of depression at all. Those with elevated depressive symptoms were also more likely to find social media to be a good creative outlet and helpful for feeling less alone.

How adults can think about teens and social media

As Hopelab’s survey makes clear, the effects of social media on young people can’t be described with a blanket statement, and there probably isn’t a one-size-fits-all solution to the problems it has created.

“Social media can be harmful when used in some ways for some people,” says Green. “But used in a different way, it can also be a helpful resource.”

Most experts would agree with her—the impact of social media on an individual level depends on the person and the circumstances. What they don’t agree on is how, exactly, social media affects mental health on a population level and how to address that.

Candice Odgers , associate dean and professor of psychology and informatics at University of California, Irvine, points out that the science to date “does not support the widespread panic around social media and mental health.” She notes that, in addition to findings from multiple large-scale meta-analyses and reviews, an expert committee , convened by the National Academies of Sciences, reported in 2023 that the available research on social media and kids’ health and well-being shows only “small effects and weak associations.”

Efforts to limit social media use, then, seem hasty and, for some kids, even harmful. She fears that calling normal behavior shameful or dangerous can have bad consequences, leading to “conflict within families and may result in young people being shut out of spaces where they find community, support, and often help that they cannot otherwise access in their lives,” she explains in a written statement. Blaming social media also distracts from other possible reasons behind the adolescent mental health crisis, such as family- or school-related stressors.

Zach Rausch—the lead researcher on Jonathan Haidt’s recent bestselling book The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness —has a different perspective. He points out that some of social media’s benefits can simply be found online; for instance, mental health information can already be searched for and discovered on, say, a mental health website. As he puts it: “How much did hyper-viral social media platforms add to those benefits?”

He also adds there is more harm than good when it comes to social media. “You have hundreds (if not thousands) of kids who are harmed by TikTok challenges, pervasive and anonymous cyberbullying, sextortion, online predation, widespread sexual harassment—with all of these things, there is causality of harm there,” says Rausch, who is also an associate research scientist at New York University Stern School of Business.

“It’s happening on these platforms, through these platforms, and would not have happened without them. With any other consumer product designed for kids that is doing this on this scale, we would immediately take it off the shelves and fix it.”

Until that happens, most experts believe that parents should take a balanced approach when helping kids navigate social media. “Social media is more complicated than things like nicotine, which you should abstain from,” says Amy Green. “It’s about helping you recognize and work to minimize some of the more negative and challenging parts that might not be good for you—but still allow you to develop deeper connections with friends and find resources.”

About the Author

Joanne Chen

Joanne Chen is a writer and editor in New York City. Her articles on children and parenting have appeared in The Bump , Parents Magazine , and the New York Times .

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HHS Office for Civil Rights Celebrates the 28th Anniversary of Health Information Privacy and Security Law - HIPAA

Today, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) celebrates the 28th anniversary of the signing of the Health Insurance Portability and Accountability Act of 1996 (better known as “HIPAA”). Twenty-eight years ago today, President Bill Clinton signed this historic bipartisan legislation into law. HIPAA ushered in many needed health care reforms. Today, HIPAA is best associated with requiring, for the first time, a set of standards for safeguarding the privacy and security of individually identifiable health information; it is administered and enforced by OCR.

“HIPAA is the cornerstone law that advances patient privacy, data protection, and health information security in our nation’s health care system. Importantly, HIPAA, through the HIPAA Rules, empowers patients and consumers to take their own health data into their own hands and instills trust in the patient-provider relationship to allow for better care and outcomes,” said Melanie Fontes Rainer, Director of the Office for Civil Rights. “With the rise of cyberattacks breaching patient privacy, HIPAA is more relevant than ever. OCR continues to prioritize health information privacy by updating and rigorously enforcing the HIPAA Rules that safeguard our national security in the health care system.”

OCR has implemented the requirements of HIPAA and related statutes with the creation and modifications of the HIPAA Privacy, Breach Notification, Security, and Enforcement Rules . These rules set forth the requirements that health plans, health care clearinghouses, and most health care providers , and their business associates ( e.g. , third party administrator that assists a health plan with claims processing, accountant providing services to a health care provider, medical transcriptionist services to a physician) must follow relating to the privacy and security of protected health information (e.g., medical records, personally identifiable information). The HIPPA Rules work together to protect the privacy and security of health information and ensure continuity of our nation’s health care systems, including critical protections against cybersecurity threats, specifically:

• The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records, sets limits and conditions on the uses and disclosures of protected health information, and gives individuals certain rights, including the right to timely access and to obtain a copy of their health records.
• The HIPAA Breach Notification Rule establishes requirements for health care providers, health plans and health care clearinghouses, and their business associated when a breach occurs to help notify the public, ensure patients understand the implications of the breach to their privacy and ensure continuity of care.
• The HIPAA Security Rule establishes national standards to protect individuals’ electronic personal health information, and ensure the confidentiality, integrity, and security of electronic protected health information.
• The HIPAA Enforcement Rule contains provisions relating to compliance and investigations, the imposition of civil money penalties for violations of the HIPAA Administrative Simplification Rules, and procedures for hearings.

Key Biden-Harris Administration advancements on HIPAA:

• HIPAA Privacy Rule To Support Reproductive Health Care Privacy Final Rule, Fact Sheet, Social Media Tool Kit, and Video
• Confidentiality of Substance Use Disorder Patient Records Final Rule , Fact Sheet, and Webinar
• The HIPAA Security Rule Risk Analysis Requirement Video
• How the HIPAA Security Rule Can Help Defend Against Cyber-Attacks Video
• Guidance on Telehealth Privacy and Security Tips for Patients
• Guidance on Educating Patients about Privacy and Security Risks to Protected Health Information when Using Remote Communication Technologies for Telehealth
• HIPAA Recognized Security Practices Video
• Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet Guidance
• HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care Guidance
• HIPAA and Audio-Only Telehealth Guidance
• HIPAA and Disclosures of Protected Health Information for Extreme Risk Protection Orders
• HIPAA, COVID-19 Vaccinations and the Workplace Guidance
• 55 Completed HIPAA Enforcement Actions by OCR, including ransomware, hacking, phishing, protected health information (PHI) on unsecured servers, media access to PHI, improper disposal of PHI, malicious insiders, and patients access to their health information

If you believe that your or another person’s health information privacy or civil rights have been violated, you can file a complaint with OCR at: https://www.hhs.gov/ocr/complaints/index.html .

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Canberra Health Services deletes social media video where endometriosis, arthritis described as 'not an emergency'

By Lottie Twyford

By Geo Donaldson

Topic: Endometriosis

Canberra Health Services has been criticised after posting a video to its social media accounts that appeared to imply conditions like endometriosis and arthritis were not emergencies. 

The video has since been deleted, with Canberra Health Services acknowledging parts of it were not "well executed" and "open to misinterpretation". 

What's next?

Canberra Health Services has apologised for any confusion and distress the video may have caused and will meet with representatives from endometriosis support group QENDO next month.

Canberra Health Services (CHS) has agreed to meet with members of an endometriosis support group after it came under fire for a recent video posted to its social media accounts. 

The video, which has since been deleted, appeared to imply that conditions like arthritis and endometriosis were not emergencies. 

Jess McGowan, who is the Canberra community lead for endometriosis support group QENDO, said the video left her "angry" and "disappointed".

A second woman, Jade, who also has endometriosis, told the ABC the video deterred her from attending the emergency department when she was experiencing extreme pain during a flare. 

She said she felt dizzy, was vomiting, and collapsed on the floor with pain at a level of "10 out of 10".

"The reason I did not present to ED, no matter how desperately I wanted help was due to the video," she said.

"I did not see the point in going in if this was how I would be met."

Called 'Stop! Is it an emergency?', the video stated that "not all emergency department visits need a hospital admission". 

It then went on to state that "life and limb-threatening situations" were prioritised. 

"Sometimes, our tests will reveal conditions that aren't an emergency, such as an endometriosis or arthritis," the video stated.

It said that these conditions were not treated in the emergency department but were referred back to a GP for further treatment and tests. 

Canberra Health Services deleted the video and posted this statement. ( Supplied )

In a statement posted to its Instagram, CHS said it had received a "lot of feedback" on the post and had removed it for fear of it being "misinterpreted".

They said the intention of the video had been to give a general overview of how emergency departments worked and had been in reference to the "incidental discovery of conditions" which may occur when a person presented to an emergency department. 

"The post is not about people with severe, uncontrollable pain, whatever the cause," the comment read. 

"These people should come to the ED or seek medical attention. This includes people who have acute complications of endometriosis or flare-ups."

'Sometimes we have no choice' 

Ms McGowan said she acknowledged the messaging CHS had been trying to convey but the video didn't hit the mark. 

"To specifically call out endometriosis and arthritis, it feels very targeted at us," she explained.

She said she, like many members of the group, had experienced having pain minimised when seeking health care. 

"It's one of those things that, although things have got a little bit better ... it is still an ongoing issue where we're not taken seriously, or we're just completely dismissed altogether," Ms McGowan said. 

She expressed concern that anyone would think going to an emergency department was a choice for people with endometriosis, pointing out that it was really only done when there was no alternative. 

"It's because they're bleeding out, or they're vomiting from pain, or they're fainting from pain, or they've got an unusual kind of pain," she said. 

Jess McGowan is the Community Lead for Canberra/ACT endometriosis support group QENDO. ( ABC News: Lottie Twyford )

Ms McGowan said QENDO hoped to survey its members about their experiences attending Canberra's emergency departments before next month's meeting with CHS. 

But she said ultimately they hoped to be able to give CHS a better understanding of how those living with endometriosis were feeling and the kind of education they'd like to see given to staff.

"We don't want to go there and we don't want to bother them, but sometimes we have no choice," she said.

'Not well executed and open to misinterpretation'

In a lengthy statement provided to the ABC, CHS acknowledged the part of the video which referenced endometriosis was "not well executed and open to misinterpretation".

It also apologised for any "confusion or distress" caused by the video. 

A spokesperson said the video had been intended to give a general overview of how emergency departments worked and that the incidental discovery of chronic conditions during an emergency department visit were best referred to a GP for "long-term, ongoing management".

"We do not want people to think they should not attend the ED with acute pain, or to appear dismissive of those who experience chronic conditions that can result in acute pain," the statement read. 

"When this concern was drawn to our attention, the video was removed."

CHS said it recognised that people with endometriosis did not always experience supportive care across the broader health system and "further work" was needed to improve understanding of the condition. 

The spokesperson said EDs had recently established a pelvic pain pathway to ensure anyone who presented with pelvic pain received "consistent, evidence-based care".