1. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica.
August 2010.
1
EXECUTIVE SUMMARY
RUPRECHT-KARLS UNIVERSITÄT HEIDELBERG - Germany
Department of Tropical Hygiene and Public Health
Im Neuenheimer Feld 324
D-69120 Heidelberg, Germany
Teléfono: +49 (0) 6221 56-4905
Email msc_ih@uni-heidelberg.de
Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica.
August 2010.
Researcher: Felipe Mejia Medina, Chemical Engineer, M.Sc. in International
Health.
Supervision: Valérie R. Louis Valerie.Louis@uni-heidelberg.de
Email:
Personal: alephoric@gmail.com,
Work: mejiafa@paho.org
Universities: afmejiam@unal.edu.co
felipe.mejia@uni-heidelberg.de
Web Site: https://sites.google.com/site/felipemejiamedina/
Executive Summary
Tourism is one of the most important world‟s economic activities and it has showed
continuous growth up to 2009 when different political situations as well as natural disasters in
different parts of the world, the financial crisis and the A(H1N1) influenza pandemic, caused a
decline in tourists arrivals by 4% in 2009 with an upswing of 2% in the last quarter of the year
after the tendency had gone down by 10%, 7% and 2% in the first three quarters respectively.
However, unemployment is expected to go up while oil prices may remain volatile.
Since the increase of tourist arrivals makes the places overcrowded, it has been
suspected to generate an overexploitation of resources. Indeed, human mobility has been
considered an important reason for massive exchange of species putting at risk the biological
diversity and the correct function of the ecosystem. Furthermore, an increase in A(H1N1)
cases are expected “Transmission of tuberculosis (TB) on board of commercial aircrafts during
long distance flights was reported during the 1980s” (WHO International Travel and Health
2010). However, it was showed that the probability of transmission of severe acute respiratory
syndrome (SARS) in 2003 in the same condition was very low.
The tourism impact under study, from a global point of view, is related basically to:
1. On Biodiversity:
-Land cover/use.
1. Accommodation.
2. Traffic infrastructure.
3. Leisure activities
4. Indirect impacts
- Wild species related.
1.Coming species to tourist destination
2.Disturbance, collection, trampling of local species populations.
By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health @FelipeMejiaMedi
alephoric@gmail.com

2. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica.
August 2010.
2
2. On population
- Health related.
1. Direct Health impacts
1. Malaria, leishmaniasis, dengue fever, others.
2. VIH and other sexual transmitted diseases.
3. Accidents and injuries.
4. Behavioral changes related
5. Tourism workers‟ health.
2. Indirect Health impacts
1.Economic health impact
2.Environmental health impact
3.Socio-cultural health impact
4.Political health impact
- Energy Use
- Perception and understanding.
- Water Use.
Since the 1990s, tourism in Costa Rica has been promoted as an important industry
due to its natural beauty and environmental commitment and it has become one an important
destination for eco-tourism in the world. It is one of the most important and dynamic areas of
the Costa Rica‟s economy and has recovered considerably after the global tourism depression
in the beginning of the past decade. However, after a 7% growth in 2008, foreign direct
investment in Costa Rica fell by 50% in the middle of 2009. This is partly explained some
contraction in sectors such as tourism due to the financial crisis and the A(H1N1) pandemic
which caused a downturn in tourists arrivals.
Costa Rica is positioned as one of the leading eco-touristic destinations offering a wide
range of options from nature treks, fishing, rafting, beach resort tourism, etc and it has been
boosted by fiscal incentives such as tax credits of 25-50% regarding the amount invested. The
number of tourist has been raised thanks to a set of strategic alliances and package sales of
different and specialized international operators Indeed, since 1999 the number has increased
by 92% in 2008.
By middle of the last decade, tourism industry has become an important source of
employment: approximately 22% of the working population belong to the tourism industry.
In regard to transportation, governmental efforts and policies have given strongly
invests in improving the current road infrastructure at the point that y 2008, 49% of the roads in
Costa Rica are paved. Partly because of tourism demands as well as urban populations and
export sector requirements. A new passenger terminal is under construction in one of the two
main airports of Costa Rica: Daniel Oduber due to the increase of international flights. It was
planned to be finished by the third quarter of 2009, however, it is has been delayed to date.
The study of tourism is a recent academic field and despite already the analysis about
the environmental impact of tourism especially on the economy, biodiversity, and use of land,
among others, there is no further analysis about the impact in a sector highly sensitive to the
population such as health or about the perception of this impact on health and its relations to
biodiversity and water, energy, waste and infrastructure utilization among different
stakeholders. Travel is a Public Health issue but it has not been adequately linked with the
touristic activities. Furthermore, certifications on sustainable tourism have been raised to
develop sustainable processes and there have not been studies about the perception of this
tool as a mitigation-adaptation measure.
By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health @FelipeMejiaMedi
alephoric@gmail.com

3. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica.
August 2010.
3
The following research question was addressed in the study: which are the perceptions
among different stakeholders about the impact that the tourism industry has on population
health in parallel to biodiversity and water, energy, waste and infrastructure utilization as a
consequence of the travel, the stay and the contact to a new environment for leisure purposes
and about the importance of the tourism certification schemes to reduce this impact?
The field research was a qualitative and quantitative exploratory study which uses
descriptive statistics. In order to achieve the objectives of this study and in order to establish
common and/or specific tendencies about tourism: impact interviews with closed questions
were made to tourists, local population and representatives of hotels and tour operators and
in-depth interviews were carried out in hotels and tour operators. Informal conversations were
engaged and recorded with few local people as well. The field study took place between 17 th of
June and 29th of July in 2010
The data collection was developed considering the type of stakeholder under study.:
Tourists, Residents in Costa Rica (working in tourism), Resident in Costa Rica (NOT working in
tourism). Because of tourism is very close to the population nearby Poas Volcano as well as
accommodation establishments, restaurants, shops, etc; in occasions were not easy to clearly
differentiate which a primary or secondary service provider is.
It was designed a questionnaire with 44 close questions and items inquiring about
attitudes and perceptions of tourism. Each statement was situated on a five-point scale as
recommended by Maddox, with 1 representing a response of „„strongly disagree‟‟ and 5
representing „„strongly agree‟‟ and 1 representing “strongly decrease” and 5 representing
“strongly increase”. For just one yes/no question 1 representing “yes” and 0 representing “no”.
The questionnaire was tested previously in a pilot for each stakeholder in order to develop a
unique tool which applied for all.
Since 32% of the costa-rican people for 2008 have access to internet concentrated
mostly in the urban areas, all hotels, tour operators and the expected local population in the
cities of Costa Rica are highly probable users of internet. Due to that fact, it was designed also
an online survey using the service of Survey Monkey to test some of the possible answers.
The link to the site was sent to the pilot participants by e-mail, explaining what the purpose of
the survey was and how to fill it out with the contact information and finally asking to send it
back. Likewise, the same questionnaire was designed in an Excel sheet which allowed to only
fill out the blanks due to the other cells were blocked. At the end, there was a suggestion box.
This Excel file was sent also to the pilot participants by e-mail.
In-depth interviews were conducted using an interview guide, after obtaining a written
or verbal consent from the interviewee. The privacy of the interviewees was respected and all
was done in private rooms. Answers were categorized according to the same items used for
the questionnaire. All interviews were taped. The in-depth interview was tested with the
workers at the places close to the student„s hotel.
Informal conversations were planned to be held, specifically with the local population
who had indirect contact to tourists. The purpose of this idea was to have an extra point of
view of the tourist‟s behavior at the place of study and general remarks about the local
background and social issues. Almost all conversations took an average time of 20 minutes.
Both methods inquired about attitudes and perceptions about seven topics: 1) increase of
number of tourists; 2) impact on use of land; 3) impact on biodiversity; 4) impact on health
including diseases dispersion, fast food, alcohol, tobacco and illegal drugs consumption and
stress impact; 5) impact on energy; 6) impact on water and waste use; and 7) usefulness of
certifications of sustainable tourism.
Analysis of coefficient of variations and an analysis of variance (ANOVA) were carried out
By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health @FelipeMejiaMedi
alephoric@gmail.com

4. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica.
August 2010.
4
for each question of the questionnaire, followed by a Scheffé test to establish which
stakeholders had different perceptions. In-depth interviews were analyzed by content analysis
in order to establish common characteristics.
Costa Rica is a country which receives and holds an increasing number of tourists who
come to experience the tropical adventure and the possibility to have contact with different
expressions of biodiversity and culture. However, the excess of tourists‟ arrival is a global
concern because of the negative impact that this industry may have in the long term on
different settings such as ecosystems, cultures, money sources and health.
In spite of diverse studies made on the perception of biodiversity or economic impact of
tourism in similar countries or carried out in Costa Rica, none has been made approaching the
health impact considering different stakeholders. Although previous researches have studied
the impact on health related to traveling, there is no connection between this concept and
tourism per se.
Tourism is for Costa Rica one of the biggest source of income and a national pride
making it a very sensitive issues for the general population. This involves or touches directly or
indirectly almost all governmental and non governmental institutions as well as all locals.
In order to develop adequately policies for such an industry, there must be a balance
between how far people are willing to be controlled by those policies if afterwards they may re-
elect the politicians and the facts about its positive and negative impacts in the short and long
term on different settings.
The objectives of this study have been achieved by studying some of the common and
specific tendencies about the perception of the tourism impact on different aspects. However,
there is a need to make wider and specific studies focus on each of these aspects but without
losing their interrelation.
Tourists do not always see tourism as a positive activity, neither for tourists nor for
locals. A negative perception about their possible influence was found. On the other hand,
locals in general perceive tourism as a convenient activity with not truly important negative
impacts. This may be because tourism is also their source of income and a good national
image for the world.
The tourism impact and influence on local‟s behavior seems to be neglected or
misunderstood. The process of transculturation1 has been part of different societies which deal
with the presence of a new approach to life. This may lead under certain conditions to the
consequent creation of new cultural patterns. There is a need to better understand, in the case
of health to name one, how the constant presence of tourist may influence the health of the
population regarding different issues: sexual behavior, practice of sports, food, alcohol,
tobacco consumption, transmission of infectious diseases and finally if so, the health system
itself and its policies.
The perception of the usefulness of the certifications in sustainable tourism is a very
important topic since Costa Rica is the only country that can certify its touristic services. This is
relevant especially considering that sustainability must cover ecological, economically,
culturally and health-related sustainability. Ecological sustainability is the only one considered
by the population and by the tourists. However, the impact on health in this study has been
only addressed in a general manner.
And considering that Certifications on Sustainable Tourism have good reputation among
the stakeholders, it should also include other aspects such as cultural interaction and health
impact in its activities and procedures. Bias about sexual tourism in relation to sexual behavior
1
Understood as the process of creating one new cultural phenomena.
By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health @FelipeMejiaMedi
alephoric@gmail.com

5. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica.
August 2010.
5
was found out. In general, people relate immediately topics such as “sexual transmitted
diseases”, “unwanted pregnancies” or “use of condom” with sex tourism. Other sexual
intercourses as consequence of the interaction among the group of tourists or between tourists
and locals are not normally considered, thus neglected as a possibility. This may lead to risky
sexual behaviors.
Costa Rica is a small but highly touristic country. Throughout, there are different types
of population and different types of touristic services. Studies about perceptions and related
policies must consider these differences and should be carried out for each of these areas.
In regard to the common and specific tendencies, the process of classification of
stakeholders was difficult. Almost all residents have contact with the touristic activities, thus to
clearly differentiate, who are the residents who work for this industry and who are not, was not
a precise task.
The history of civilizations is the history of migrations and huge health impacts have
occurred because of the introduction of new people to new environments as it happened from
1492 when Christopher Columbus arrived in the Americas initiating the conquest from Spain to
establish the Empire in the so-called New World. The death of the native population through
the first century was caused by sustained hard work but was especially due to the presence of
new pathogens which were unknown and for which the natives did not have any immune
defense. There was a change in their behavior and in how they used to approach life. And this
historic example is also a situation that may happen with the presence and uncontrolled
increase of tourism. To name a present example, the virus H1N1 was easily spread to the
world because of the mobility of the people. That is why the measures of previous vaccination
are so important not only for tourism but for all travels.
Not all impacts are negative. And not all changes have bad consequences. Healthy or
ecologically conscious behaviors are also considered as an influence to the locals. In that
sense, policies should boost these pros and control the negative ones.
The perception of the negative impact is not always the same for all stakeholders,
especially when it comes to a new topic such as health impact. There is confusion among all
groups about what may happen through the continuous presence of people with their own
patterns of behavior and who come from different settings and have different cultures.
There is finally a misunderstanding about what a health impact is. In general, the world
health is only related to health system and hospitals. Consequently in the case of Costa Rica,
this ends up in the concept of medical tourism.
This study has underlined that dealing with different perception of not-easily-classified
stakeholders is a very complex issue and therefore the policies should also deal, consider and
include all. In this study differences were found especially on tourists‟ perceptions about
tourism impacts compared to the other groups. But in general, health impact did not seem to
be an issue for the stakeholders maybe precisely because of the lack of proper information.
Every person has a different perception of the same situation and it depends upon its
own background and context. The perception of groups, representing a determined number of
individuals and understanding group as a unity, is hence the result of the integration of these
perceptions in a common perception which relies in the center of the social network.
Policies are usually made, considering either all affected groups in their totality or their
division in subgroups, divided by factors such as gender or education to name a couple. The
subgroups may be built in order to take into account the expected variety in perception
amongst them.
Making policies for tourism, being based on social, economic, cultural and health issues
means considering these different perceptions and balancing them. The measures derived
By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health @FelipeMejiaMedi
alephoric@gmail.com

6. Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica.
August 2010.
6
from policies should neither be too invasive, nor too loose.
This implies that the awareness through communication and education must cover the
whole community and the coming tourists by informing not only the possible touristic offers or
possibilities but also its probable impacts. This may help the stakeholders to take informed
decisions but also to increase the satisfactory experience of all.
This study has been useful to establish that the perceptions of the tourism impact on
different issues vary along the actors involved. Besides, it shows that there are no major
concerns about negative health impacts or impacts not related to ecological consciousness. It
means there may be an increase in the risk of any touristic activity or action within the region
boosted by tourism, if there is the perception that negative impacts are unlikely. This study
opens the next questions for possible researches.
By Felipe Mejía Medina, Chemical Engineer, M.Sc in Internationa Health @FelipeMejiaMedi
alephoric@gmail.com