Claude-Eugène Bouvier: “The Covid crisis has underlined the legitimate role of thermal medicine”

Interview with Claude-Eugène Bouvier, Board member of the European Spas Association


Claude-Eugène Bouvier is the creator and founder of an online library, which collects all scientific studies of balneology/spa medicine in one place at the European Spas website and makes them available free of charge. 

What health problems and outcomes are most important in today’s society?

The health expenditures of European countries have been undergoing a paradigm shift since the beginning of this new century. Previously burdened by the cost of treating contagious diseases (tuberculosis, influenza, measles, STDs, etc.), health budgets are now strained by the cost of treating non-communicable diseases, many of which are so-called civilizational diseases, related to diet, lack of physical activity, addiction (alcohol, tobacco, drugs) and the effects of a potentially harmful environment. Many of these diseases are chronic: they are long-lasting, progressive, and can be controlled but rarely cured. In most Western countries, these chronic diseases now account for 80% of the annual increase in healthcare spending. 

What is the potential of natural resources such as natural healing water, peloids, gases, and climatic conditions for treatments? How do you see future development?

In the context of these chronic diseases, balneotherapy has a particular role to play for patients who have failed to receive treatment, have no therapeutic alternative, or simply need a treatment that complements the one offered to them through their general practitioners. When we look at the complaints of chronically ill patients, those most frequently expressed are pain, limitation of abilities, i.e. discomfort or handicap in the execution of daily life gestures (climbing stairs, tying shoes, grooming, etc.), and reduction in quality of life. These are precisely the areas in which the spa treatment provides benefits.


France is a case example of how scientific studies and market information can be used in disputes with health decision-makers. They regularly conduct and sponsor studies in cooperation with the members. Where is balneology most recognized and successful?

In France, as in all other countries, public health budgets are under great pressure. Hence the need for public decision-makers to finance only those services and procedures that are useful to the community. This context has encouraged the emergence of evidence-based medicine. Since 2003, the balneotherapy sector has been contractually obliged to finance studies evaluating the medical service rendered by spa treatments. That is an essential condition for maintaining the 65% reimbursement rate by Health Insurance. The thermal operators have financed more than 15 million euros worth of studies with positive results, mainly in the field of rheumatology, fibromyalgia, chronic venous insufficiency, psychosomatic affections and dermatology.

Which studies are read the most in the ESPA e-library and why?

The ESPA e-library is unique as it is an exclusive collection of studies on balneotherapy, regularly updated and freely accessible to the general public, physicians, policymakers and researchers. It contains more than 1,300 references. In most European countries, rheumatology (osteoarthritis, arthritis, low back pain, etc.) is the predominant indication. It is, therefore, quite normal that this is the subject most investigated by researchers and also the most read. But current events can change the interests of e-library users. In 2022, the researches related to the contribution of balneotherapy to the management of the long-Covid were the most frequent.


What are the newest and hottest topics in thermal medicine?

The health crisis linked to Covid has underlined the legitimate role of thermal medicine in the management of pathologies linked to long Covid. It has also opened the debate on the interest of the thermal cure on the reinforcement of immunity. There are many a-priori and ready-made ideas on the subject and some sort of empirical evidence, but we lack a robust study on the subject. The European medical spas were the first to treat post and long covid patients, starting in 2020. We are proud to say that we have one of the greatest know-how in this area. According to our study from 2022, 16 European countries with natural remedies offer Long covid treatment. 

Among the other hot topics, I notice a strong interest in the microbiome, a fashionable topic that has invited itself into thermal research. There is a current interest to study the modifications induced by thermal treatment on the microbiome, whether it is intestinal or urinary, or even the microbiome of the skin.

How do you see the importance of health prevention? Is the percentage of prevention programs growing compared to rehabilitation programs? Can we expect that national health insurance will cover health prevention programmes in the following decade?

Thermal spas are, unlike other types of health facilities, particularly well suited to the implementation of prevention. The patient is available for a long period of time and is pro-active. The cohorts of patients are homogeneous, facilitating the messages and the prevention programs, especially since the medical and paramedical skills are already in place. There are three fields where thermal medicine is particularly relevant; these are:

– the prevention of overweight and obesity (According to a WHO report dated May 2022, Europe is facing an “epidemic” of overweight and obesity that affects nearly 60% of adults and nearly one child in three),

the prevention of cancers and their relapses (NB: in France, the health insurance funds a program of thermal treatment for women in remission from breast cancer),

– prevention of loss of autonomy: healthy ageing is a major issue, and spas that welcome many seniors are well placed to participate. For example, at the end of 2023, French Health Insurance will finance a program for the detection of frailty in spas based on the ICOPE program promoted by the WHO.

Karlovy Vary, Czech Republic

What is your personal and professional goal for better recognition of balneology? Where should it be positioned in 10 years?

Thermal medicine is still perceived as a second-class medicine in the “blind spot” of health policies. Its resources are not sufficiently harnessed and often the spa treatment is not part of a patient’s care plan. I am convinced that this is going to change because thermal medicine has many assets: it is natural, without iatrogenic side effects and efficient for some chronic pathologies. It must stop being a “catch-all” medicine and better identify the fields in which it is really adapted. That calls for a better evaluation of the efficiency of the classic thermal cures, but also of the new prevention programs. It also requires a more solid place of balneology in the medical teaching, and also better training and information of the prescribing doctors.

Read more about the e-library at:

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