ITB 2023 Special Reporting
Healthy Tourism in the Caribbean
By C. James Hospedales
Saturday, 22nd September 2007
The importance of promoting a healthy physical environment - basicallyCaribbean tourism is about selling paradise - led to the landmark Environmental Health and Sustainable Tourism Development conference held in Nassau, the Bahamas.

Organized by the Pan American Health Organization (PAHO), through its Division of Health and Environment and its Office of Caribbean Program Coordination (CPC), the conference looked for ways to strike a balance between preserving the Caribbean's natural beauty, protecting the health of Caribbean visitors and the local population, and promoting tourism, the region's economic mainstay, as the tripartite key to sustainable socioeconomic development.

Following several well-publicized disease outbreaks in the Caribbean involving the travel industry, the First Caribbean Conference on the Prevention of Foodborne Disease in the Hotel Industry was held in Port-of-Spain, Trinidad.

Organized by PAHO's Caribbean Epidemiolo-gy Center (CAREC), in collaboration with the Caribbean Hotel Association (CHA), the Trinidad and Tobago Ministry of Health, the Trinidad and Tobago Hotel and Tourism Association, and the Trinidad Hilton and Conference Center, the meeting attracted hoteliers, public health and medical experts, restaurant personnel, academics, and quality management specialists from 16 countries.

In a mission statement, its organizers noted that a "proactive, preventive approach could be used to positively market our Caribbean destination as one which is working to further improve the quality of the tourism product, giving the Caribbean a marketing edge." With "Healthy Guests Are Great for Business" as its theme, the conference focused on developing recommendations for joint action by the industry and governments to improve the prevention and control of foodborne diseases in the hotel industry as a springboard to the achievement of the long-term, broader goal of safeguarding the health of Caribbean guests and residents alike.

Four major areas of action were identified:

(1) high-level private and public commitment among governments, hoteliers, and hotel associations;

(2) training at all levels, targeted to different audiences, including food service supervisors and food handlers, which raises the challenge of reaching small-scale operators, and of establishing a standardized approach to training;

(3) surveillance and research at the hotel level, at the local health department level, and internationally, since many travelers do not become ill until after returning home; and

(4) independent inspections and systems of self-audit, standardized across the Caribbean, permitting reciprocity of inspections between hotels, meaning that the score in one hotel could be compared with that of another, regardless of country.

Several precedents and foundations exist for the work ahead. Bermuda's hotel self-inspection program, presented at the conference, elicited great interest among participants, many of whom said they would introduce it upon their return home. Jamaica is perhaps the most advanced in developing a comprehensive foodborne disease prevention program, which includes airport interviews of departing passengers, hotel surveillance of traveler's diarrhea through the hotel nurse, an etiologic study of diarrhea in hotels, hotel inspection systems, and training in safe food handling.

In Saint Lucia, the Hazard Analysis and Critical Control Point (HACCP) system has recently been introduced to improve street food safety. Initially conceived as a way to provide astronauts with foods with "zero defects," HAACP has been adopted by PAHO and the World Health Organization (WHO), the United States Food and Drug Administration, and many other agencies worldwide for the preparation of safe foods at all levels-home, restaurant, and street-vending operations.

In September-October-scarcely four months after the Trinidad conference-an unforeseen outbreak of Legionnaires' disease in Antigua cost the hotel involved an estimated US$ 150,000, but the swift and successful investigation of the epidemic averted the loss of an additional US$ 2-4 million in tourism revenues. This incident helped convince public health and tourism officials that the losses to a single destination through outbreaks, compounded by the subsequent negative publicity, could easily exceed the costs of a Caribbean-wide safe and healthy hotels program.

The Caribbean Healthy Hotels Program

"This is a first-of-its-kind," says Linzey Coles of the United Kingdom-based International Hotels Environment Initiative (IHEI), referring to a public-private Caribbean partnership now being built to improve the quality and competitiveness of hotels by providing a safer and healthier environment to guests and staff while recognizing a fact overlooked in the past: the crucial role of health in creating a more profitable, sustainable, and high-quality tourism product.

The Caribbean Healthy Hotels Program (CHHP), will be similar to the U.S. Vessel Sanitation Program (VSP), a cooperative venture between the U.S. Centers for Disease Control and Prevention (CDC) and the cruise ship industry begun in 1975 that has dramatically decreased the number of gastroenteritis outbreaks aboard ships. Since ocean liners are in essence floating hotels, many lessons learned by the cruise industry could be applied to land-based hotels. Also, the cruise liner industry is the major competitor for the hotel sector in the Caribbean, making it time-critical for the latter to have good news in regard to measures to improve health and hygiene conditions.

In the VSP, ships pay a fee based on tonnage for semi-annual inspections of potable water, food-handling procedures and facilities, and general hygiene, as well as for the monitoring of diarrheal disease, investigations of outbreaks to identify problems and indicate solutions, and personnel training courses. In the CHHP, the scope of services would be similar, with greater emphasis on self-audit. Costs to each hotel would be on the order of US$ 200-4,000 per year, depending on size and the actual service provided.

The healthy hotels program will be delivered as part of the Caribbean Action on Sustainable Tourism (CAST) program recently launched by the CHA, IHEI, and Green Globe. CAST's current focus is principally environmental. The healthy hotels program brings a complementary focus on cleanliness. Both the "green and clean" approaches are vital to truly sustainable tourism and socioeconomic development.

Each of the principal players brings a unique strength and visibility to the partnership. Ministries of health and tourism will be joined by the CHA, whose leadership in providing services to 1,100 member hotels in 28 countries and motto of "The Caribbean Cares" attest to the Association's historical commitment to promotion of a quality Caribbean vacation stay. PAHO/WHO brings its international public health expertise, along with the technical know-how of health and environment experts working out of its local country offices and specialized centers located throughout the region-CAREC, CPC, and the Caribbean Food and Nutrition Institute (CFNI).

CAREC will be the executing agency. It developed the program's surveillance system, with input from the CDC and the European Union, which is now being pilot-tested in Antigua. It is also working with others in the area of training. In September, for example, a training-of-trainers workshop was held in Puerto Rico, in which restaurant chefs and environmental health officers received joint training in safe food handling practices and are now teaching these skills to their own respective staffs.

The CPC will develop the HACCP-based inspection system, assist in developing a training program for CHHP inspectors and staff, promote the initiative in the smaller islands where PAHO/WHO does not have a local office, and has secured funding to develop a healthy ho-tels handbook. CFNI will expand its Healthy Meals initiative and broaden its current food safety training in Jamaican hotels to other countries. Local PAHO/WHO offices will advocate for the healthy hotels program with the ministries, respond to and monitor outbreaks, and develop country-specific activities, such as the highly successful training course already undertaken for Bahamian hotels and environmental officers on wastewater plant operation by sanitary engineer "Ton" Vlugman.

An Ambitious Agenda

CHHP participants have set a timetable within which to reach their initial goals: more than 50% of participating hotels will exceed a passing score on a standardized CAREC/PAHO healthy hotel audit, and 75% by 2006. In order to decrease the occurrence of preventable illness and disease among guests and staff, the audits will include examination of the hotels' water and food supplies and storage, hotel refrigeration plants, employee personal hygiene practices, the hotels' general cleanliness and physical condition to ensure the absence of rodents and insects and their breeding grounds, wastewater collection and treatment facilities, and hotel training programs in environmental and public health practices to determine their scope and effectiveness. In addition, the hotels will provide all guests with health and safety tips to encourage healthy behaviors and minimize the possibility of illnesses, outbreaks, or injuries.

The Importance of Tourism to Caribbean Development

Travel and tourism represented US$ 25 billion of gross output. There were more than 12 million stay-over tourist arrivals (10-15% from within the Caribbean) and 6 million cruise ship arrivals. Over the next 15 years, visitor arrivals and the number of hotels are predicted to double, and tourism will likely become even more important to the Caribbean economy given the direction of global trade liberalization and the probable loss of some or all of the region's preferential trade status for staple export commodities, such as bananas, sugar, rum, and rice.

Popular wisdom has it that "tourism is to the Caribbean what oil is to the Middle East." The motto of the Caribbean Tourism Organization, "Caribbean Development Through Quality Tourism," reinforces the widespread consensus that the social and economic well-being of the Caribbean region will become increasingly dependent upon tourism in the coming years.

Yet the future of the industry is not guaranteed. High energy costs, the importation of most hotel supplies and equipment, and natural disasters-in particular, the annual hurricane season-are challenges. Safety, health, and environmental issues, among increasingly discerning customers, also challenge the region to continuously strive to improve its tourism product in an intensely competitive market.

Two global changes have also upped the ante for the Caribbean. The arrival of the Internet here in 1995 has made it possible to spread both good and bad news almost instantly. Secondly, the European Commission Directive on package tours makes European tour operators liable if anything goes wrong during the tour, no matter where in the world the tour takes place. The directive holds special significance for the Caribbean, considering that its regional economy is the most tourism-dependent in the world and many of its tourists are European.

Beyond food- and waterborne diseases-by far the most common risk to travelers worldwide-there are a number of other important health issues related to Caribbean tourism. The region's ever-growing volume of international arrivals increases the possibility of new, emerging, and reemerging diseases being imported from other parts of the world, affecting resident and tourist alike, and poses a threat to the Caribbean's polio- and mea-sles-free status. Communicable diseases, such as HIV/AIDS, dengue fever, malaria, and Legionnaires' disease, are of particular concern, as are issues of recreational safety and injuries.

As Trinidad and Tobago's Minister of Trade and Industry, Mervyn Assam, pointed out in his welcoming address in Port-of-Spain, "While this conference focuses on the hotel industry, ultimately the entire hospitality industry across the board-restaurants, street vendors, fast food chains, and water and sewage authorities-will have to become involved."

The conference's vision statement-for the Caribbean "to be the safest, happiest, and healthiest of comparable destinations in the world"-implies a future need for standardized legislation in the other areas of which Minister Assam speaks, which will benefit large segments of the Caribbean population. For the time being though, the movement afoot will go a long way toward assuring that world-class tourists keep returning to enjoy the Caribbean's natural beauty for years to come.

James Hospedales is a medical epidemiologist and currently Acting Director of CAREC in Port-of-Spain, Trinidad.
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