Stakeholder perception of impact of tourism on health and biodiversity in Costa Rica. Thesis presentation

1. Stakeholder perception of impact of tourism on
health and biodiversity in Costa Rica.
Felipe Mejía Medina
Academic Supervisor: Valérie R. Louis, PhD
RUPRECHT-KARLS UNIVERSITÄT HEIDELBERG
Department of Tropical Hygiene and Public Health
Master of Science in International Health

9. is this what you think when you think of TOURISM?

10. Maybe, this is what you do not think when you think of TOURISM.

11. Maybe, this is what you do not think when you think of TOURISM.

12. Maybe, this is what you do not think when you think of TOURISM.

13. Maybe, this is what you do not think when you think of TOURISM.

14. Maybe, this is what you do not think when you think of TOURISM.

15. Maybe, this is what you do not think when you think of TOURISM.

16. Maybe, this is what you do not think when you think of TOURISM.

17. Maybe, this is what you do not think when you think of TOURISM.

18. Maybe, this is what you do not think when you think of TOURISM.

19. Maybe, this is what you do not think when you think of TOURISM.

20. Maybe, this is what you do not think when you think of TOURISM.

21. Maybe, this is what you do not think when you think of TOURISM.

24. Costa Rica

25. Costa Rica

26. Costa Rica

27. Costa Rica

28. Costa Rica

30. Travel is a Public Health issue.

31. Travel is a Public Health issue.
Tourism is one of the most important world’s economic
activities especially for developing countries.

32. Travel is a Public Health issue.
Tourism is one of the most important world’s economic
activities especially for developing countries.
Costa Rica is a developing country.

33. Travel is a Public Health issue.
Tourism is one of the most important world’s economic
activities especially for developing countries.
Costa Rica is a developing country.
Costa Rica is positioned as one of the leading eco-touristic
destinations.

34. Travel is a Public Health issue.
Tourism is one of the most important world’s economic
activities especially for developing countries.
Costa Rica is a developing country.
Costa Rica is positioned as one of the leading eco-touristic
destinations.
The number of tourists since 1999 has increased by 92%.

35. Travel is a Public Health issue.
Tourism is one of the most important world’s economic
activities especially for developing countries.
Costa Rica is a developing country.
Costa Rica is positioned as one of the leading eco-touristic
destinations.
The number of tourists since 1999 has increased by 92%.
22% of the working population belong to the tourism
industry.

36. Travel is a Public Health issue.
Tourism is one of the most important world’s economic
activities especially for developing countries.
Costa Rica is a developing country.
Costa Rica is positioned as one of the leading eco-touristic
destinations.
The number of tourists since 1999 has increased by 92%.
22% of the working population belong to the tourism
industry.
There is no further analysis about the impact on health and
its relations to biodiversity and water, energy, waste and
infrastructure utilization.

39. •To identify common tendencies in stakeholders’ perceptions
about the touristic industry impacts.

40. •To identify common tendencies in stakeholders’ perceptions
about the touristic industry impacts.
•To identify specific tendencies in stakeholders’ perceptions
about touristic industry impacts.

41. •To identify common tendencies in stakeholders’ perceptions
about the touristic industry impacts.
•To identify specific tendencies in stakeholders’ perceptions
about touristic industry impacts.
•To assess the relevance on the stakeholders’ perceptions of
the certification in sustainable tourism.

43. Closed In-depth Unstructured
Stakeholder Number* Number* Number*
questionnaire Interview interviews
People in Poas
Yes - P 91 No 0 Yes 5
Volcano
People In Alajuela Yes - P 36 No 0 No 0
People in Hotels Yes - P 16 Yes - P 4 No 0
People in Tour
Yes - P 25 Yes - P 4 No 0
operators
Related people Yes 10 No 0 Yes 10
Total 178 -- 8 -- 15
Yes-P, includes a pilot testing. * Does not include the pilot testing.
Related, refers to shops, communication companies, travel agencies, NGOs and associations.

45. Group of tourists did not always perceive tourism as
a positive activity, neither for tourists nor for locals.

46. Group of tourists did not always perceive tourism as
a positive activity, neither for tourists nor for locals.
Locals perceived tourism as a convenient and positive
activity with no truly important negative impacts.

47. Group of tourists did not always perceive tourism as
a positive activity, neither for tourists nor for locals.
Locals perceived tourism as a convenient and positive
activity with no truly important negative impacts.
Healthy or ecologically conscious behaviors are also
perceived as an influence on the locals.

48. Group of tourists did not always perceive tourism as
a positive activity, neither for tourists nor for locals.
Locals perceived tourism as a convenient and positive
activity with no truly important negative impacts.
Healthy or ecologically conscious behaviors are also
perceived as an influence on the locals.
The concept of health impact may be misunderstood because the word health
is related to health system and hospitals. It was often associated with the
concept of medical tourism.

49. Group of tourists did not always perceive tourism as
a positive activity, neither for tourists nor for locals.
Locals perceived tourism as a convenient and positive
activity with no truly important negative impacts.
Healthy or ecologically conscious behaviors are also
perceived as an influence on the locals.
The concept of health impact may be misunderstood because the word health
is related to health system and hospitals. It was often associated with the
concept of medical tourism.
Influence on local’s behavior seems to be neglected or misunderstood.

50. Group of tourists did not always perceive tourism as
a positive activity, neither for tourists nor for locals.
Locals perceived tourism as a convenient and positive
activity with no truly important negative impacts.
Healthy or ecologically conscious behaviors are also
perceived as an influence on the locals.
The concept of health impact may be misunderstood because the word health
is related to health system and hospitals. It was often associated with the
concept of medical tourism.
Influence on local’s behavior seems to be neglected or misunderstood.
Bias about sexual tourism in relation to sexual behavior was identified. In
general, people related topics such as “sexual transmitted diseases”, “unwanted
pregnancies” or “use of condom” with sex tourism.

52. The perception of the negative impact is not always the
same for all stakeholders, especially regarding a new topic
such as health impact.

53. The perception of the negative impact is not always the
same for all stakeholders, especially regarding a new topic
such as health impact.
There is confusion among the groups about the health
consequences on the locals because of the presence of
tourists in the region.

54. The perception of the negative impact is not always the
same for all stakeholders, especially regarding a new topic
such as health impact.
There is confusion among the groups about the health
consequences on the locals because of the presence of
tourists in the region.
Health impact do not seem to be an issue to the
stakeholders, maybe because of the lack of proper
information.

55. The perception of the negative impact is not always the
same for all stakeholders, especially regarding a new topic
such as health impact.
There is confusion among the groups about the health
consequences on the locals because of the presence of
tourists in the region.
Health impact do not seem to be an issue to the
stakeholders, maybe because of the lack of proper
information.
There are no major concerns about negative health impacts or impacts not
related to ecological consciousness.

56. The perception of the negative impact is not always the
same for all stakeholders, especially regarding a new topic
such as health impact.
There is confusion among the groups about the health
consequences on the locals because of the presence of
tourists in the region.
Health impact do not seem to be an issue to the
stakeholders, maybe because of the lack of proper
information.
There are no major concerns about negative health impacts or impacts not
related to ecological consciousness.
There may be an increase in the risk of any touristic activity or action boosted by
the tourism, if there is the perception that negative impacts are unlikely.

58. I Indicator CR Chile USA Year Source
1 Population under 15 years (%) 26 23 36 2008 WHO
2 Population 16-49 years (%) 27 31 20 2008 WHO
3 Physician density (per 10 000 population) 13 11 27 2009 WHO
4 Nurse and midwifes density (per 10 000 population) 9 6 98 2009 WHO
5 Life expectancy at birth both sexes (years) 78 78 78 2008 WHO
6 Total expenditure on health as % of 8.1 6.2 15.7 2007 WHO
7 Malaria Number of reported cases 732 -- -- 2008 WHO
8 HIV Prevalence among adults aged 15–49 years (%) 0,4 0.3 0.6 2009 WHO
9 Mortality diarrhea Number of reported cases 45 -- -- 2008 MOH
10 Mortality Respiratory diseases. (per 1000 population) 0,3 -- -- 2009 MOH
11 Dengue Number of reported cases 8277 25 -- 2007 PAHO
12 Yellow fever Number of reported cases 0 0 -- 2008 WHO
Alcohol consumption among adults aged ≥15 years
13 4.2 6.8 5.2 2005 WHO
(litres of pure alcohol per person per year)
Prevalence of smoking any tobacco product among 25.7/ 42.0/ 23.8/
14 2006 WHO
adults aged ≥15 years (%) male/female 7.3 33.8 4.0
15 Population with improved drinking-water sources (%) 97 96 99 2008 WHO
16 Population using improved sanitation (%) 95 96 100 2008 WHO

59. Selection of method according to the stakeholder.
Closed In-depth Informal
Stakeholder Number* Number* Number*
questionnaire Interview conversation
People in Poas Volcano Yes - P 91 No 0 Yes 5
People In Alajuela Yes - P 36 No 0 No 0
People in Hotels Yes - P 16 Yes - P 4 No 0
People in Tour operators Yes - P 25 Yes - P 4 No 0
Related people Yes 10 No 0 Yes 10
Total 178 -- 8 -- 15
Yes-P, includes a pilot testing. * Does not include the pilot testing.
Related, refers to shops, communication companies, travel agencies, NGOs and
associations.

60. Sample of calculation for question 7
Question Q7
Group G1 G2 G3
Frecuency 54 64 54
Standard deviation 0.910 1.005 1.022
Individual mean 3.037 2.578 2.556
Total mean 2.715
Coeficiente variación 30.0% 39.0% 40.0%
F 4.240
F crítico 3.049
Probability 0.016
ANOVA -
Scheffé
Scheffé (when
Groups F Probability
it requires)
Test G1-G2 -0.458912 0.043
G1-G3 -0.481481 0.041
G2-G3 -0.022569 0.992

61. ANOVA results for all questions without demographics, Q17 and Q19.
F Scheffé
Question F P value Scheffé Test Question F F critic P value
critic Test
1 0.009 3.049 0.991 No 22 6.942 3.049 <0.001 Scheffé
2 1.076 3.049 0.343 No 23 2.031 3.049 0.134 No
3 0.716 3.050 0.490 No 24 0.236 3.049 0.790 No
4 0.551 3.049 0.578 No 25 1.251 3.049 0.289 No
5 0.560 3.050 0.572 No 26 0.203 3.049 0.817 No
6 1.262 3.049 0.286 No 27 0.027 3.050 0.973 No
7 4.240 3.049 0.016 Scheffé 28 0.394 3.049 0.675 No
8 10.807 3.050 <0.001 Scheffé 29 2.161 3.049 0.118 No
9 3.408 3.049 0.035 Scheffé 30 2.876 3.049 0.059 No
10 2.826 3.049 0.062 No 31 2.443 3.050 0.090 No
11 1.654 3.049 0.194 No 32 5.739 3.050 0.004 Scheffé
12 4.273 3.049 0.015 Scheffé 33 2.880 3.049 0.059 No
13 9.901 3.049 <0.001 Scheffé 34 2.371 3.049 0.097 No
14 5.449 3.049 0.005 Scheffé 35 2.209 3.049 0.113 No
15 0.249 3.049 0.780 No 36 3.465 3.049 0.034 Scheffé
16 4.443 3.049 0.013 Scheffé 37 1.730 3.050 0.180 No
18 4.322 3.051 0.015 Scheffé 38 6.304 3.050 0.002 Scheffé
20 14.665 3.049 <0.001 Scheffé 39 4.114 3.049 0.018 Scheffé
21 9.841 3.049 <0.001 Scheffé 40 0.430 3.049 0.652 No