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BALNEOTHERAPY HAS A PARTICULAR ROLE TO PLAY FOR PATIENTS WHO HAVE FAILED TO RECEIVE TREATMENT.

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.

THE EUROPEAN MEDICAL SPAS WERE THE FIRST TO TREAT POST AND LONG COVID PATIENTS.

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.

THERMAL SPAS ARE PARTIUCLARLY WELL SUITED TO THE IMPLEMENTATION OF PREVENTION.

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.

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: https://europeanspas.eu/e-library.

Csilla Mezosi, Secretary General of the European Spas Association is one of the authors. Together with Szilárd Szigeti, Vivien Pásztóová from the J.Selye University – Faculty of Economics and Informatics in Komárno, Slovakia they have examined the impact of Covid-19 on the labour force and recovery peculiarities in the selected countries of Europe. Their goal was to reach patients with post-Covid-19, long-Covid-19 symptoms who were treated since 2020 in different medical spas around Europe.

Csilla Mezosi explained: “More and more people complained of prolonged COVID-19 symptoms after contracting the virus. As April 2022, more than 504.4 million confirmed COVID-19 cases and over 6.2 million related deaths had been reported to WHO. Patients were no longer just knocking on the doors of doctors’ surgeries or hospitals but also on the certified medical spas in Europe. Demand has led European health resorts with hydrotherapy centers and medical spas to develop different treatments (packages of treatments) for each condition, some specialising in respiratory, cardiovascular, neurology, musculoskeletal, mental problems. In the context of COVID-19 disease, the issue of not only the end-stage condition but also changes in work and performance at work and return to work has become a hot topic. In our research, we linked illness and work. How did the illness and subsequent recovery affect work and other aspects of life.“

Complete research can be found at: europeanspas.eu/post-corona-treatments

* ENTREPRENEURSHIP AND SUSTAINABILITY CENTER (ESC) is a public non-profit company, which aims to meet public needs acting in the areas of education, life-long learning, training, scientific research, organizing of scientific, cultural and other events.

COVID-19 leaves many with long-term health problems that must be addressed as soon as possible. One of the ways to help post-covid patients is rehabilitation care in medical spas.

The range of long-term health complications after overcoming COVID-19 is broad and not only limited to breathing issues. In fact, respiratory problems are not even the most common. The subsequent problems can affect almost all organs of the human body, including the heart, blood vessels, peripheral nerves, brain, kidneys, joints and muscles.

A diversified offer of treatments

All spa resorts in Slovakia provide a broad spectre of treatments for patients. As spa care is a complex institutional health care in the medical field of physiatry, balneology and medical rehabilitation, the resorts use the following methods:

• Balneotherapy – using a local source of natural healing water for internal and external procedures
• Climate therapy – treating patients in a location where the climatic conditions are recognised as suitable for treatment
• Physiotherapy – a wide range of treatment methods such as massages and exercise
• Ergotherapy – training fine motor skills and self-care
• Physical therapy – a broad range of procedures, including hydrotherapy, electrotherapy and oxygen therapy

All treatments are carried out by multidisciplinary teams of professionals specialising in rehabilitation. When arriving for rehabilitation treatment, each patient undergoes an initial medical examination to ensure the healthcare professionals decide which treatment works best.

The commendable initiative by Slovakian spa resorts will help further advance the treatment of patients infected with COVID-19 and foster the growth of the health and spa industry. With an increasing number of guests deciding to visit spa resorts, such campaigns will help raise the prominence of Slovakia and the health and spa industry in general.

Covid recovery program by Heilsustofnun Rehabilitation Clinic, Iceland

Comments from the jury: The programme for post-Covid rehabilitation has been created in connection with thermal and local resources, and a scientific approach. Exercise, both physical and mental, more healthy food make part of the cure. The continuous tests on patients, during their stay, allowed them to define scientific results.

Special Jury Award – Innovative Health Spa Programme
Covid recovery program in Strimon Garden Medical SPA Hotel, Bulgaria
In response to the disarray in the Bulgarian health system caused by the pandemic, medical spa center Strimon Garden created tailor-made programmes for restoring the health status of people infecred with COVID-19.

Prime Minister of Saxony-Anhalt, Dr. Reiner Haseloff, who took part in our panel discussion on the topic of Long Covid / Post Covid, was quite impressed by the fact that the other panellists, across all the disciplines they represented, completely agreed with the top of our association and its Kneipp PremiumClass in one statement:

With all their medical expertise and modern infrastructure, the German spas and health resorts are ready to help with the treatment and recovery of hundreds of thousands of people with long-Covid and post-Covid symptoms, which are seen as a major and current challenge by society as a whole, by politics and the health care system has to be dealt with. The Kneipp spas and Kneipp health resorts in Germany, with their naturopathic and integrative approach and their preventive and rehabilitative orientation, definitely see themselves as a spearhead of the German spa industry as a whole. It is now also necessary that this offer is now accepted by the health insurance companies and insurance carriers with the encouragement and influence of politicians.

Dr Haseloff has had the criticism of the reticence of the cash register and insurance system described in detail. He saw the need for a quick and flexible response to the current challenge posed by Post Covid / Long Covid and can also imagine the granting of experimental clauses. The Prime Minister promised to follow up on this next day at the meeting of the Prime Ministers with the Federal Chancellor and the Federal Minister of Health.

The podium discussion, which was attended by prominent participants alongside the Prime Minister, was even more successful with Professor Dr. Kraft from the University of Rostock, Secretary General Mezösi from the European Spa Association, Prof. Dr. Karl Ludwig Resch from the Saxon Spa Association, Dr. Christian Kirchner from the Brandenburg Spa Association, Mayor Welzel from the Kneipp town of Bad Wörishofen and Dr. Schmidt as a doctor director of the Bad Schmiedeberg rehabilitation clinic. The discussion was moderated by President Achim Bädorf and the director of Kneipp PremiumClass, Deddo Lehmann. The association of Kneipp spas and health resorts is proud of the high quality of health services that are state-recognized and certified.