OriginalScientificArticle EvaluatingtheDirectandIndirectImpacts ofTourismontheHealthofLocalCommunities MaksimGodovykh UniversityofCentralFlorida, usa maksim.godovykh@ucf.edu AlanFyall UniversityofCentralFlorida, usa alan.fyall@ucf.edu AbrahamPizam UniversityofCentralFlorida, usa abraham.pizam@ucf.edu JorgeRidderstaat UniversityofCentralFlorida, usa jorge.ridderstaat@ucf.edu Tourismbringswithitbothpositiveandnegativehealthimpactsonlocalcommuni- ties.Althoughthetopicofhealthintourismistraditionallyassociatedwithtourists’ health,there are potential opportunities to study the influence of tourism on resi- dents’healthaswell.Thisstudyaimsatexploringthedirectandindirecteffectsof tourismdevelopmentonresidents’healththroughincomeandenvironmentalpol- lutioninthecaseofseveralEuropeancountries.Thelong-termandshort-termre- lationships among tourism arrivals, emissions,residents’income, and healthwere estimatedusingageneralizedleastsquares(gls)approach.Theresultsdemonstrate that tourism arrivals bring significant short-term and long-term impacts on resi- dents’healthdirectlyandindirectlythroughenvironmentalpollutionandresidents’ income.Severalimportanttheoreticalandpracticalimplicationsarerelatedtocon- sideringthelong-termhealthimpactsasmoreimportantoutcomesoftourismdevel- opmentandprovidingrecommendationsfordestinationmanagementorganizations andgovernmentalauthorities. Keywords:tourism,impacts,health,well-being,income,emissions https://doi.org/10.26493/2335-4194.15.43-52 Introduction Tourismbringswithitbothpositiveandnegativeim- pacts on tourist destinations. The traditionally de- scribed domains of tourism impacts are economic, socio-cultural,andenvironmentaldimensions(Sharp- ley,2018;Wooetal.,2018). Theeconomicimpactsof tourism include higher revenues, new employment opportunities,investments,andlowerlevelsofpoverty (Johnsonetal.,1994;Seetanah,2011). However,thenegativeimpactsareassociatedwith anincreaseinthecostofliving,chronicstress,higher pricesofgoodsandservices,dependenceonseason- ality, and economic inequality, as well as the socio- culturalandenvironmentalcostsoftourismdevelop- AcademicaTuristica,Year15,No.1,April2022 |43 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism ment(Postma&Schmuecker,2017;Uysaletal.,2016). Atthesametime,themainvaluesinhumanlife aredescribedashealthandwell-beingratherthanin- come or welfare (Bowling, 1995). The topic of health in tourism is traditionally associated with medical tourismexperiences(Connell,2006).However,there arepotentialdirectandindirectavenuesofresearchon theeffectsoftourismonresidents’health.Tourismcan positivelyimpactthehealthoflocalcitizensthrough betteraccesstomedicalservicesorbetterfood,while thetransmissionofdiseasesfromtouriststoresidents, roadaccidents,poorworkingenvironments,orpollu- tionbringsabout negativeeffectsonlocal communi- ties(Bauer,2008;Postma&Schmuecker,2017). Residents’ health can be also impacted by posi- tiveexperiences,novelty,andsocialinteractionswith tourists, which also demands empirical attention in tourismresearch.Severalstudiesinpositivepsychol- ogy and neuroscience suggestthatpositive emotions influencebloodpressureandvagaltone,decreasethe levelsofbloodsugar,andincreaselongevity(Fredrick- sonetal.,2008).Atthesametime,theemotionalcom- ponentsoftourismexperiencesarewidely described in the previous tourism literature (e.g. Hosany et al., 2015; Godovykh & Tasci, 2020a; 2020b). As tourism activities are inseparably connected with providing positiveexperiencesandinteractionbetweentourists and residents, tourism may bring better health and well-beingoutcomesforbothtouristsandresidents. The effects of tourism development on residents’ health might have different valence and power in in the short and long run (Godovykh & Ridderstaat, 2020). Although the short-term impacts may be as- sociated with spreading viruses or increasing stress levels of local people, the long-term effects might be attributed to psychological, social, and physical re- sourcesassociatedwithsocialinteractions,novelty, and positive emotions (Fredrickson & Joiner, 2018). This study aims at exploring the direct and indirect effects of tourism development on residents’ health through income and environmental pollution in the case of several European countries. Several impor- tanttheoreticalandpracticalimplicationsofthestudy are related to determining the balance between the negative short-term impacts and positive long-term impactsoftourismdevelopmentonresidents’health, consideringthelong-termhealthimpactsasmoreim- portant outcomes of tourism development, and pro- vidingrecommendationsfordestinationmanagement organizationsandgovernmentalauthoritiesondevel- opingnewprogrammesandpoliciesaimedatimprov- ingthehealthandwell-beingoflocalcommunities. LiteratureReview IndirectHealthImpactsofTourism Thehealthimpactsoftourismcanbeassociatedwith residents’ income and environmental concerns. On the one hand, increased revenues allow local peo- pletoaffordmedicalcareandbetterfood(Bauer, 2008).Tourismistraditionallydescribedasacontrib- utortoGrossDomesticProduct(gdp)thatgenerates revenues,createsnewemploymentopportunities,at- tracts investments, and reduces poverty (Sharpley & Telfer, 2015). The traditionally applied evaluations of tourismeconomicimpactsarecollectedfromborder statistics and tourist accommodation establishments for the number of tourist arrivals and expenditures. The secondary data on tourist arrivals, departures, nightsspent,expenditures,receipts,employment,and otherindicators of tourismstatisticscan be collected fromtheUnitedNationsWorldTourismOrganization (unwto,2020),theWorldBankDevelopmentIndi- cators,1andoecdtourismstatistics,2aswellasfrom nationaltourismofficesandothersources. Themostwidelyappliedmeasureofresidents’in- come is gross domestic product (gdp), which in- cludes consumption expenditures, gross investment, and government spending. The annual residents’in- come can be measured by gdp per capita from the WorldBankIndicatorsandnationalstatistics.Thedi- rect, indirect, and induced effects of tourism can be analysedbyusingInput-OutputanalysisandTourism SatelliteAccountstatisticsbasedonallgoodsandser- vices consumed by tourists (Baggio, 2019). The eco- nomic impacts of tourism also include employment, whichcanbeevaluatedbythenumberofjobsin tourismorfull-timeequivalentemployment.Thepri- 1https://data.worldbank.org 2https://www.oecd.org/cfe/tourism/tourism-statistics.htm. 44 | AcademicaTuristica,Year15,No.1,April2022 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism marydatacollectioncanalsoincludesurveyquestions aboutresidents’income,aswellasperceivedpositive andnegativeeconomicbenefitsfromtourism. Atthesametime,theincreasedusageofdesti- nation resources brings negative environmental im- pacts that also influence residents’ health. The en- vironmental outcomes include air pollution, wildlife destruction, water pollution, plant destruction, etc. (Andereck,1995;Postma&Schmuecker,2017).These environmental impacts of tourism can be quantita- tively assessed through the data on greenhouse gas emissions, pm 2.5 pollution, air quality indexes, eco- logicalfootprint,human-wildlifeconflictmonitoring, landmanagementmetrics,andavarietyofothertech- niques(Mikayilovetal.,2019). DirectHealthImpactsofTourism Negative health impacts of tourism are mostly asso- ciatedwiththetransmissionofdiseasesfromtourists toresidents.The recentsituationwith the covid-19 pandemic demonstratedthe potentially harmful im- pacts of tourism on residents’ health. Other health risksforlocalcommunitiesfromtourismincluderoad accidents,poorworkingenvironments,substanceuse disorders,andotherphysicalhealthconditions(Bauer, 2008;Doocyetal.2007;Godovykhetal.,2021;Walker &Page,2004). Atthesametime,humanhealthhasadynamicna- tureaffectedbythemixofbiological,social,andpsy- chological factors (George & Engel, 1980; Sarafino & Smith, 2014). Among the main psychological factors are social skills, family relationships, mental health state,self-esteem,etc.,whilesocialfactorsarerelated to social interactions with family members, peers, and other people (Bolton & Gillett, 2019; Lehman et al., 2017). The positive role of psychological factors affecting health can be also conceptualized within the broaden-and-build theory of positive emotions (Fredrickson,2001;Fredrickson&Joiner,2018).Based on the broaden-and-build theory, positive emotions bring physical, psychological, intellectual, and social resources that increase people’s well-being and con- tributetohealthbyregulatingthelevelsofhormones, reducing autonomic nervous system activity, foster- ingimmuneresponses,andeliminatingnegativeout- comesofstress.Tourismactivitiesareconnectedwith positiveexperiencesandinteractionbetweentourists and residents. Therefore, tourism may bring better health outcomes for residentsthroughpositive emo- tions,novelty,andsocialinteractionswithnewpeople. Considering the previously discussed health impacts of tourism on local communities together with the potentialeffectsofpsychologicalfactorsonresidents’ health,thisstudysuggeststhatthenumberoftourism arrivalsinfluencesresidents’healthdirectlyandindi- rectlythroughenvironmentalpollutionandresidents’ income. Methodology Thestudyuseddataonnationaltourismarrivals,in- come, co 2 emissions,well-being,andhealthinthree neighbouring countries, Slovenia, Croatia, and Hun- gary,whicharemembercountriesofthe eu andhave commonborders.Thepaneldataonnationaltourism statistics,arrivals,income, co 2 emissions,well-being, andhealthwereusedinthestudy.Thedataontourism arrivals,departures,andreceiptswereobtainedfrom theUnitedNationsWorldTourismOrganization(un- wto,2020).Tourismarrivalsarethenumberoftour- istswhotraveloutsidetheirusualcountryofresidence, for business, leisure, or other personal purposes, for less than12 monthsfor a purpose not related to em- ployment(unwto,2010).Tourismdeparturesarethe number of departurespeople make from their coun- tryofresidencetoanyothercountryforapurposenot relatedtoearningmoney. ThedataonincomewerecollectedfromtheWorld Bankindicatorsintheformofgdp percapita. gdp per capita is the gross domestic product or a sum of grossvalueaddedbyallacountry’sresidents,divided bythecountry’spopulation.The gdppercapitaisof- tenappliedasaproxyforincome.Thedataonco 2 emissions, which include carbon dioxide produced duringconsumptionofliquid,solid,andgasfuelsand gas flaring, were collected from the World Bank in- dicators. The data on residents’ wellbeing were col- lected from the World Happiness Report (Helliwell et al., 2021) that uses data from the Gallup World Poll. The data on health was represented as the life expectancy at birth, which is considered an impor- AcademicaTuristica,Year15,No.1,April2022 |45 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism tant indicator of health status on a national level. The data analysis consisted of several phases. The initial phase of the study provides descriptive statis- ticsofthecollecteddata.Thedatawerealsovisualized byusinglinechartsand gis maps.Descriptivestatis- tics and data visualization helped in understanding data trends and to conduct comparisons at different timepoints.Inthesecondphase,theappliedvariables were decomposed into trend and cycle components by using the Christiano-Fitzgerald filter (Christiano & Fitzgerald, 2003). The logarithm transformation wasusedtocontrolfordataskewnessandnarrowthe rangeofthedata.Inthethirdphase,thevariableswere testedforstationaritybyusingunitroottests.Thefi- nal phase of data analysis applies a generalized least squares(gls)approachtoestimateasetofstructural equationssincethe gls estimatorisconsideredmore efficientthantheordinaryleastsquaresinthecaseof heteroscedasticity,aswellasserialandcross-sectional correlations(Baietal.,2021).Theestimatedequations canbeindicatedasfollows: health it = α 1 ×arrivals it +α 2 ×emissions it +α 3 ×income it +ε 1it (1) emissions it = α 4 ×arrivals it +ε 2it (2) income it = α5×arrivals it +ε 3it ,( 3 ) wherei=cross-section,t=time,α=coefficient,and ε=errorterm. Results The recent data on tourism arrivals, departures, in- come,health,andwell-beingforSlovenia,Croatia,and Hungaryin2018areprovidedinFigure1.Hungaryand Croatiademonstratethehighestnumbersofinterna- tionaltourismarrivals(57.67millionvisitorsin2018). The biggest number of international tourism depar- turesisinHungary(22.81milliondeparturesin2018). Atthesametime,Sloveniashowsthehighestlevelsof gdp per capita (26,116 usd), happiness score (6.25), andaveragelifeexpectancy(81.4years). The graphical representation of the standardized paneldatafor1995–2019isshowninFigures2–4.The charts generally show increasing trends for tourism Figure1 TourismArrivals,Departures,Income,Health, andWell-BeinginSlovenia,Croatia, andHungary Figure2 TourismArrivals,Health,Emissions, andIncomeinSloveniain1995–2019 arrivals in 1995–2019. The level of health in Slove- nia, Croatia, and Hungary is constantly growing be- tween 1995–2019. The level of income demonstrates anincreasinglineartrendin1995–2007withfluctua- tionsafter2007,whichcanbeexplainedbytheconse- quencesoftheeconomicandfinancialcrisis.Thelev- elsof co 2 emissionshavebeendecreasinginHungary from 2004 and in Slovenia and Croatia from 2008, whichcanbeassociatedwiththe eu legislationtore- ducegreenhousegasemissions. The data were transformed into logarithms, and the Christiano-Fitzgerald decomposition approach was applied to estimate the trend and cyclical com- ponents of tourism arrivals, income, emissions, and health. The trend and cycle components for health, arrivals, emissions, and income in Slovenia, Croatia, and Hungary are presented in Figures 5–8 (pp. 48- 49). While residents’ health and income, and tourist 46 | AcademicaT uristica,Y ear15,No.1,April2022 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism Figure3 TourismArrivals,Health,Emissions, andIncomeinCroatiain1995–2019 Figure4 TourismArrivals,Health,Emissions, andIncomeinHungaryin1995–2019 arrivalsshowedanincreasingpatterninthediscussed timeframe(withvaryingcycledistributions),thetrend of co 2 emissionsshowedadecreasinglong-termshape, indicatingthatthe co 2 releasesweregraduallyreduc- ing. Thestudyappliedthecross-sectionaldependency (cd) test to evaluate the level of correlation of the units in the samecross-sections(Pesaran,2021). The testresultsprovideenoughevidencetorejectthenull hypothesis of the lack of cross-sectional dependence (Table1).Thecross-sectionaldependencemeansthat unitsin thesamecross-sectionarecorrelated,which canbecausedbytheeffectsofsomeunobservedfac- tors common to all units, such as an economic or financial crisis. The literature suggests that the data shouldbedemeanedtocontrolforcross-sectionalde- Table 1 TestforCross-SectionalDependence Long-Run(trend) Short-Run(cycles) Arrivals .*** . Income .*** .*** Emissions .*** .*** Health .*** . Notes Underthenullhypothesisofcross-sectionindepen- dence.Thesymbol***indicatesthe1significancelevel. pendence in the case of correlation across the panel (DeHoyos&Sarafidis,2006). The variables were tested for stationarity using boththeLevin-Lin-ChuandtheHarris-Tzavalistests (Tables2and3onp.49).Thenullhypothesisinboth testsisthatallthepanelscontainaunitroot.Taking intoaccountthecross-sectionaldependency,thedata wereinitiallycorrectedfortheircross-sectionalmean inordertocontrolforcorrelation(Levinetal.,2002). Theresultsdemonstratethatallvariablesarestation- ary at the level forms, which means that they have a constant mean, variance, and covariance. Therefore, thestudyusedthelevelformsofthevariablesforfur- theranalysis. Thestudyestimatedthelong-termandshort-term relationship among tourism arrivals, emissions, res- idents’ income, and health using a generalized least squares (gls) approach.Theglsestimatoris con- sideredmoreefficientthantheordinaryleastsquares in the case of heteroscedasticity and cross-sectional correlations (Bai et al., 2021). The generalized least squaresapproach’sresultsaredemonstratedinTable4 (p.49). Theresultsshowthattourismnegativelyinfluences residents’healthintheshortterm.Morespecifically,a 1growthintourismarrivalsnegativelyimpactsresi- dents’healthby0.28.Atthesametime,tourismar- rivals, emissions, and residents’ income significantly influencethehealthoflocalpeopleinthelongrun.A 1growthintourismarrivalsleadstoa0.19increase inresidents’health,whilea1growthincreaseinresi- dents’incomehasa0.76increaseinhealth.However, emissionshavenegativelong-termeffectsonhealth.A 1 growth in emissions leads to a 0.77 decrease in residents’health. AcademicaTuristica,Year15,No.1,April2022 |47 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism Figure5 TrendandCycleComponents ofResidents’Health Figure6 TrendandCycleComponents ofTourismArrivals Figure7 TrendandCycleComponents of co 2 Emissions In addition to the direct impacts of tourism ar- rivals on residents’health, the study revealedsignifi- cant relationships between tourism arrivals and co 2 emissions, as well as between tourism arrivals and residents’ income. A 1 growth in tourism arrivals leadstoa0.39increasein co 2 emissionsintheshort term and a 0.29 increase in co 2 emissions in the long term. At the same time, tourism arrivals have not demonstrated significant short-term impacts on residents’ income but showed significant impacts on incomeinthelongterm.A1increaseintourists’ar- rivalsleadstoa0.50increaseinresidents’incomein thelongrun. Discussion The results indicate that tourism brings both short- run and long-run impacts on residents’ health. The studyfoundthattourismdevelopmentnegativelyin- 48 | AcademicaTuristica,Year15,No.1,April2022 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism Figure8 TrendandCycleComponents ofResidents’Income Table 2 StationarityTestResultsforTrendComponents Item llc ht Integration Level Firstdifference Level Firstdifference Arrivals –.*** –.*** . –.*** I()orI() Income –.*** . . –.*** I() Emissions –.*** . –.* –.*** I()orI() Health –.*** . –.*** –.*** I()orI() Table 3 StationarityTestResultsforCyclicalComponents Item llc ht Integration Level Firstdifference Level Firstdifference Arrivals –.*** –.*** –. –. I()orI() Income –.*** –.*** . –. I()orI() Emissions –.** –.*** . . I()orI() Health –.*** –.*** –. –. I()orI() Table 4 TheInfluenceofTourismArrivalsonHealth Item Health Income Emissions Long-term Short-term Long-term Short-term Long-term Short-term Arrivals .*** –.** .** –. .* .*** Income .*** –. Emissions –.*** . Notes Thesymbols***,**,and*indicatethe1,5,and10significancelevels. fluencesresidents’healthintheshortrunandhaspos- itiveimpactsinthelongrun.Theseshort-termresults areconsistentwiththepreviousstudiesbyGodovykh and Ridderstaat (2020) and can be explained by res- idents’ negative feelings and stress from overcrowd- ing, noise, environmental pollution, traffic conges- tion, crime rates, etc. The recent situation with the covid-19 pandemic also demonstrates that tourism AcademicaTuristica,Year15,No.1,April2022 |49 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism mobilityisassociatedwiththespreadingofdisease.At thesametime,thelong-termpositivehealtheffectsof tourismcanberelatedtopositiveexperiencesreceived byresidentsandthesocialinteractionsbetweenresi- dentsandvisitors(Chida&Steptoe,2008;O’Connor &Gartland,2019). Inadditiontothedirecteffectsoftourismarrivals onresidents’health,tourismmayhaveindirecteffects on the health of local people through environmen- tal and economic impacts. The study found signifi- cant relationships between tourism arrivals and co 2 emissions,aswellasbetweentourismarrivalsandres- idents’ income. The influence of tourism arrivals on carbondioxideemissionscanbeexplainedbythein- tensetransportationandincreaseddemandforenergy fromhotels,restaurants,andtouristattractions(Katir- cioglu et al., 2014; Paramati et al., 2017). The effects oftourismarrivalsonresidents’incomeareconsistent withthepreviousstudiesthatdescribethedirect,indi- rect,andinducedeconomicimpactsoftourismonlo- caleconomies(e.g.Eeckelsetal.,2012;Chatziantoniou etal.,2013;Qinetal.,2018).Tourismbringsnewjobs, attractsinvestments,increasestaxrevenues,etc.which positivelyaffectsthewelfareoflocalpeople(Comerio &Strozzi,2019). Theseresultsbringimportanttheoretical,method- ological,andmanagerialimplications.Therecentsit- uation with the new coronavirus disease reveals the negative health outcomes of tourism, while there are potential long-term benefits of tourism development for public health. Destination stakeholders should analyse the effects of tourism development on resi- dents’healthanddevelopnewprogrammesandpoli- ciesaimedatimprovingthehealthandwell-beingof localcommunities.Thebalancebetweenthenegative short-term impacts and positive long-term impacts of tourism development on residents’ health can be determinedtodevelopstrategicplansfordestination development. However, long-term health outcomes thataredifferentfromshort-termimpacts shouldbe consideredas more importanteffectsof tourism and be taken into account by tourism statistics, tourism bodies, and destination management organizations. Theproposedmethodsandmodelswillalsobeuseful inincreasingtheresilienceandsustainabilityoftourist destinationsandallowcommunitydecision-makersto modelandpretestsustainableinterventionsandpoli- ciesduringandafterthe covid-19outbreak.Thecur- rent pandemic situation makes it possible to explore theimpactsoftourismprogressivelyatdifferentlevels of tourism development as tourism destinations will reopen and attract more visitors. The optimal level of tourism development for each type of destination can be determined based on the maximum positive impactsonresidents’qualityoflife,health,andwell- being. Exploringboththelong-termandshort-termim- pactsoftourismmakesitpossibletobetterunderstand the impacts of tourism in comparison with consid- ering undecomposed results.The decomposed trend and cycle components represent the long-term and short-termbehaviourofthedataontourismarrivals, co 2 emissions,income,andhealth.Thetouristdesti- nations’ characteristics, tourist density and intensity, growthrate,tourismcontributiontogdp,theinten- sityoftransportation,etc.canalsobeincludedinthe proposed models. In addition to measuring destina- tion community residents’ outcomes, tracking tech- niquescanbepretestedtoreceiveinformationonvisi- tors’behaviourbasedongeopositioningdata,geoloca- tion devices, geo-referencedphotos, and the analysis ofspecificsitesinatouristdestination(Padrón-Ávila &Hernández-Martín,2020).Thenewcompositemet- ricsoftourismimpactsonresidents’healthandwell- beingcanbedevelopedbasedonthesecondarydata fromthenational,regional,andlocalstatisticsandpri- marydatacollectedfromresidents’surveysandsocial mediaanalytics. Theselectionofindependentvariablescanbecon- sidered as a limitation of the study as it was limited bytheavailabilityofdata.Firstofall,theaveragelife expectancydoesnotrepresentthewholespectrumof healthevaluations,includingitsphysical,mental,so- cial,andwell-beingcomponents.Futurestudiesofres- idents’ health might include subjective, self-reported evaluations of residents’general health, physical dis- tress, and mental distress, as well as additional psy- chophysiologicalandpsychosocialindicators.Second, the gdp indexasameasureofincomecanbeinflu- encedby governmentpolicies,unemploymentlevels, 50 | AcademicaTuristica,Year15,No.1,April2022 MaksimGodovykhetal. EvaluatingtheDirectandIndirectImpactsofTourism inflation, and other causes (Aitken, 2019). Therefore, thedistributionofincomecanalsobetakenintoac- countinthecaseoftheavailabilityofthedata.Third, future studies can also investigate the effects of ad- ditional determinants of residents’ health, including access to health services, governmental policies, and residents’healthybehaviours.Itwillalsobeusefulto apply subjective self-reported indicators of residents’ healthandincomebyconductingsurveysoflocalpeo- ple.Additionally,similarstudiesshouldbeconducted indifferentcountriesandtourismdestinationstoex- plore the effects of destinationtypes and cultural di- mensions. References Aitken,A.(2019).Measuringwelfarebeyond gdp. National Institute Economic Review, 249(1), r3–r16. Andereck,K.L.(1995).Environmentalconsequencesof tourism: A review of recent research. In S. McCool & A. E. Watson (Eds.), Linking tourism, the environment, and sustainability (pp. 77–71). Intermountain Research Station. 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