About the European Spas Association

We promote spa medicine as a curative and preventive approach using natural remedies, rehabilitation techniques and education as part of a healthy lifestyle

The European Spas Association was founded 1995 in Brussels as an umbrella spa industry organisation representing 20 European countries with natural remedies. It is a non-profit and non-governmental association based on Belgian law (A.I.S.B.L.).

Unity is strength

We believe it is important and indeed the norm for just one European association to be the authorised representative of a sector vis-à-vis the European Commission and the European Parliament and to be involved in the relevant procedures. The core principle of the European Spas Association is “Unity is strength!”. We are therefore taking up the challenge to fulfil the tasks that result from the opening of borders in Europe and the extension of the EU, to achieve the defined common aims of its members.

Our mission

Our mission is to align health resorts within the European healthcare market. One of our most important objectives is promoting spa medicine as a curative and preventive approach using natural remedies, rehabilitation techniques and education as part of a healthy lifestyle

Our activities

1. Recognition of local natural resources
2. Highlighting the significant role of medical/health tourism in healthcare
3. Promoting of quality spa services and education
4. Influencing media partners in Spa Business

Become an ESPA member

and gain access to

  • Networking opportunities in the Spa business: rehabilitation centers and clinics, medical research and education partners, spa hoteIs and medical spas, spa operators and investors
  • Cooperation in EU working groups and searching for EU calls
  • Know-how transfer from leading partners – specialized architects, providers of innovation in spa technology and cosmetics, specialized tour-operators (on new and overseas markets) and health insurance companies.

Our aims

  1. To build a great network of contacts with policymakers as well as leading representatives of science and business -this goes to benefit above all our members
  2. To develop programs for health and wellbeing products and strategies for prevention and rehabilitation for all living within Europe
  3. To promote the exchange of experience, best practices and know-how of innovative products, development and promotion, medical and market research and up-date information from all parts of our business
  4. To establish, promote and improve the standards in all spas and health resorts within Europe
  5. To define and harmonize common training programs and to determine a professional structure for the European spa business industry
  1. To establish a framework for collaborative marketing and stimulate spa research opportunities for ESPA member countries

The board of the European Spas Association



Thierry Dubois, France

1. Vice President:

Gunnlaugur K. Jónsson, Iceland

Vice Presidents:

Dr. Janka Zálešáková, Slovakia

Martin Plachý, Czech Republic

Siyka Katsarova, Bulgaria

Hans-Jürgen Kütbach, Germany

Iuliana Tasie, Romania

Secretary General

Csilla Mezösi, Hungary

Hon. Secretary General:

† Joachim Lieber, Germany


Hans-Jürgen Kütbach, Germany

Further Members of the Board

Claude-Eugène Bouvier, France

Kristina Citvarienè, Lithuania

Carlo Diederich, Luxembourg

Luis Miguel López Carral, Spain

Marlies Sobczak–Boumans, Netherlands

Iztok Altbauer, Slovenia

Zoltán Kántás, Hungary

Lana Petrovic Blajic, Croatia

Maret Sukles, Estonia

Rasma Valdmane, Latvia

Reiner Wieben, Denmark

Natasa Ranitovic, Serbia

Marina Lalli, Italy

Credo of the European Spas Association


The European Spas Association is formed by members from 19 European countries, among them national and regional spas associations, public medical spas and health resorts. Here the focus lies on underlining the common features that have paved the way to a membership in the European Spas Association and, on the other hand, on describing the differences between the member countries.

These result from a different basic situation of the individual spas and health resorts in the national associations, from a different development in politics and the subjects they put a main emphasis on.
Facing a Europe that is growing together a common policy between health resorts and medical spa facilities is absolutely necessary. And even more with respect to the association’s policy since a harmonisation through the EU will only be realised or expected in parts.

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

With respect to the political discussion in the EU countries the credo of the European Spas Association can serve as an important basis. The working groups of the ESPA have to solve several tasks with regard to the quality structure in health resorts, definitions, approximate figures and other aspects like remedies, for example.

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

Spas and Health Resorts in Europe


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


The ESPA is taking up the challenge to fulfil the tasks that result from the opening of borders in Europe and the extension of the EU. With the present credo the ESPA intends to set up clear and comparable structures that make the collaboration between the countries much easier. These papers will help organisations to support their demands with political institutions on a national level by additional European arguments.


1. Naturally occurring local remedies
form the basis of medical spas, health resorts and spa facilities. Naturally occurring local remedies are the basis to differentiate between several types of spas and health resorts such as mineral spas and thermal spas, peloid, spas at the seaside and in a healthy climate and Kneipp spas. A formal structure of this kind and to such an extent cannot be found in all countries. In some countries a structure is also part of being recognized (by the state). Here the common objective must be to establish a standardized structure in order to create more transparency on the European market.2. The recognition of spas, health resorts and spa facilities
should be generally recognized by the state and on a legal basis. This recognition should not only be based on the local natural remedy, but has to include the entire health resort or facility with all its specific and therapeutic offers. The present credo and the respective conditions in the different countries form the basis for the recognition.

3. 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.

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

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

These resorts usually apply 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.


By increasing health expectancy our members provide in a relaxing, unpolluted environment, far away from stress to maintain the vital heritage of our guest and patient with natural therapies, offering enriched care programs with a Preventive, Predictive, Personalized care services using natural remedies.

Cooperation in EU working groups for firsthand information and being in Experts teams and searching for participation by EU calls.

Better acknowledged that medical spa operators are health providers, offering a complementary treatment to follow-up on cancer, diabetes, arthritis, overweight and obesity, respiratory diseases, the loss of autonomy among elderly people and some other chronic conditions. To bring about this change of perception among public authorities, health funds and medical doctors, the actual medical benefit of spa cares should be better established. ESPA are convinced that balneology should be viewed as evidence-based medicine and that it is our duty to make it happen.

Lobbying and Promotion

In terms of lobbying activities ESPA is focusing on the following key aspects:

  • Meetings with representatives of the European Parliament, the European Commission and other EU related facilities; linked to health, tourism and current themes of interest;
  • Strengthen the relevance of the role of the European medical spa destinations (of the ESPA members) in prevention of diseases, treatment of chronical disease, and rehabilitation;
  • Emphasise the importance of quality in all spa services and education;
  • Highlight the significant role of medical/health tourism in the overall healthcare, medical
    wellness and tourism market e.g. the economic factor in most of the regions with a less
    employment opportunities;
  • Participation on tourism promotion like ITB Medical Tourism Pavillon, SPA-CE the only B2B work-shop for health tourism, on sales events organized by European Travel Commission and ETOA, activities in China organized by OBOR and HiSeas International;
  • Contact to influencer media partners in Spa Business;
  • Yearly conference to exchange the best practice of innovative product development and promotion, medical and market researches and up-date information from all part of our business;
  • Our members take care of the most valuable asset, of the health of the guest. European Spas Association members investing constantly to expand and improve their health and tourism services.

Startegic Partnerships

  • European Spas Association is partner by EU working group of DG Sante DIET, PHYSICAL ACTIVITY AND HEALTH, AGORA NETWORK, by a new inter-service group on the promotion of healthy lifestyles and by European Week of Sport #BeActive.
  • Active Partner of European Tourism Manifesto for Growth and Jobs, which represent 43 European private and public tourism stakeholders.
  • Strategic Cooperation Framework with Europe China One Belt One Road Tourism & Culture Development Committee and HiSeas International (China).
  • Application for “Towards an EU-Strategic Framework for the Prevention of Non-communicable Diseases”.

Long-term objectives of the European SPAs

  • Membership in EU Commission working and expert groups, to be visible and to influence effectively the decision-making processes;
  • Membership in EU Commission platforms and forums, to work together with other stakeholders and contribute concretely and actively to the health and tourism agenda of the EU Commission;
  • The sustainable management of the Balneotherapy Research Initiative;
  • The coordination of the EU funded further projects of ESPA members’ consortiums;
  • The organization of a hearing in the relevant EU Parliament Committee on prevention, regional developments and tourism;
  • The development of a common European spas and health resorts statistic.

Tools of Activities


Healthcare services based on Balneotherapy the cross-border association “Quality in Health Prevention” constitutes a milestone for quality in international health tourism. This association founded by ESPA, representatives of tour operators, other associations, health insurance companies, scientific institutes and other operators of medical spa hotels and facilities, will serve as a unique multi-stakeholders platform of the European medical spa and balneology industry regarding quality aspects.


The Innovation Awards reflects the ESPA aim to stimulate Innovation and Excellence. It is made for destinations, facilities or initiatives that represent “innovation” in the true sense of the word; that is, the development of a new, more creative or more effective approach to any aspect of spas and health resorts management, operations or marketing. This is accomplished through more effective products, processes, services, technologies, or ideas that are readily available to the market.

Learn More…



To identify:

  • The different diseases and conditions treated by balneotherapy in different European countries
  • The health profile of the patients
  • The treatments delivered to the patients in the thermal care facilities (TCF)
  • European profile for balneotherapy indications and treatments.
2. Post Corona, Long Covid Treatments in European medical spas. (2022)


as part of its commitment to promote evidence-based medicine, ESPA has developed this unique e-library exclusively dedicated to balneology. It aims to disseminate high-quality information towards health professionals and others engaged in basic research and clinical care, public health, health policy development, or related educational activities as well as professionals from the spa industry. Contrary to other databases that return thousands of references, the ESPA e-library is a friendly tool focusing on comprehensive information selected by the ESPA scientific experts, most valuable in the assessment of the medical and economic interests of balneotherapy.

Learn More…


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