3. Medical spas, health resorts and spa facilities are usually located in a beautiful and idyllic landscape, in unpolluted nature which offers optimal conditions for a healthy holiday, where sustainable development is in the focus.

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

5. Qualified prevention and rehabilitation
With respect to their equipment and experience spas, health resorts and spa facilities are well prepared to offer qualified prevention and rehabilitation. Therefore, they play an important role in health supply, especially in the treatment of chronic diseases considering the age of clients. Medical spas and facilities focus on a different use of prevention and rehabilitation and in-patient and out-patient offers; they want, and they can offer more than only healthy holidays. In this context prevention means that it is in accordance with the international definition of exercise, nutrition and relaxation, uses local remedies and, like rehabilitation, aims at sustainability. Spa guests more and more expect to find wellness programs. These are offered in spas and health resorts. With respect to their original meaning and their competence healthy aspects are the essential element of these healty lifestyle programs.

6. Health resort doctors/specialist

are a must in medical spas and health resorts. Here, the focus lies on the qualification for a proper use of naturally occurring local remedies (specific treatment methods), of physical therapies and of prevention and rehabilitation. Treatment methods with dominating disorders and chronic diseases should be paid special attention in this context. It is important to harmonize different educational programs and trainings. The structural assignment and recognition depend on the respective national structures.

7. The spectrum of guests
in spas, health resorts and spa facilities is very wide. It goes beyond the pure longing for recreation and includes healthy and ill people, covers all stages of prevention (primary–secondary–tertiary) until rehabilitation and the treatment of chronic diseases. It includes out-patient and in-patient treatments and also stays of several weeks with well-structured treatments as well as short stays with different purposes.

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

ESPA has to develop reliable definitions and parameters from a professional and scientific point of view or at least an approach with respect to those points that still differ from each other. In this process the different legal regulations should be neglected as much as possible. A focus should be rather placed on the remedy and the expectations of the remedy.

a. Springs with medicinal water for therapeutic use

are in many spas and health resorts the basic and relevant aspect for being recognized as a health resort or a spa facility (by the state). Both areas of application are of importance, the internal use, e.g. for drinking and inhalation as well as the external use in bath/pools or active therapies for example. Active therapies usually are open to the public and have to fulfil the existing legal requirements in the respective country. Here, all member associations of the ESPA share the same point of view. Different views, however, are to be stated with respect to the understanding and handling of definitions, relevant parameters and the adaptation to the laws in the different countries, especially the protection of springs.

c. Spas, spa facilities and health resorts at the seaside

These resorts usually apply Thalasso therapies which are inevitably connected to the sea. The therapeutic use is linked with the immediate neighborhood of the sea and its climatic influence. Regard to thalassotherapy the distance to the seaside has to be fixed as an aspect for the recognition of spas and spa facilities – then called Thalasso centers (not more than 600-800m). Isolated substances of the sea (algae, silt) are also considered as part of a thalassotherapy. Since they may be well preserved in distant areas, however, they are also offered in resorts far away from the seaside.

d. Peloids in medical spas

play an important role in European spas. According to their definition as local remedies they are applied for therapies. Nearly all member countries agree on a definition of peloids which were produced during geological and/or biological processes and are used in treatments in form of compresses, packs or also in bath. Depending on their composition – organic and/or inorganic proportions – physical effects, e.g. thermal or mechanic, and also chemical effects may be achieved.

e. Bioclimate/healing climate

is a very important factor for health resorts. A suitable bioclimate that has been proven by an expert is an absolute must for these resorts in order to fulfil their task to spend health. Together with air purity that supports the therapeutic use of the climate it is an important requirement for these resorts. Healing climate is based on the therapeutic use of the local climate that, as a local remedy (stimulus-reaction concept), is the basis for being recognized as a health resort.

f. Kneipp therapy

In order to be recognized as an individual spa type it has to apply the complex and well-structured treatment concept according to Kneipp.

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

10. Other important conditions

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

• The character, the appearance of a spa, part of the town or a spa facility must correspond to the guests’ expectations and has to be in line with its task as a healthy place. Parks, infrastructure for physical activities, offering healthy food for example, must always be part of a spa city.
• A spa, health resort or spa facility must be well-prepared for the needs of handicapped persons.
• One of the basic requirements for being recognized as a health resort is the equipment with reasonable fittings for the treatment with local remedies (also for physical therapy). These are centers for therapy and baths, special rooms for relaxation, physical exercise and sports/sports therapy, the use of healing water, Kneipp therapy, healing climate etc. in order to give concrete indications not only with respect to the demands of health insurances.
• There should be scientific evidence. Cultural and entertaining programs are part of an integral concept of offers in a health resort.