The  term  spa is commonly thought to  be  derived  from  the  name  of the  town of Spa in Belgium,  where  a natural hot  springs has  been  a site of healing  since before  Roman times.  Evidence of human visitation to hot  and  cold  springs can be traced  to prehistoric times,  and  many  people  worldwide have  believed  in the healing   power   of  certain springs and  of  bathing and  purification in  general. Most  spas  were  established at sites  that  had  been  used  for centuries for health and  well-being, often  built  around natural hot  springs or near  lakes. The  ancient Greeks  and  Romans were  well known for their  medicinal bathing and  the  vast complexes they built  to accommodate this pastime.

Spas and sanitariums in the United States  blossomed in the 1800s  along with a resurgence in  values  associated with  the  Greco-Roman period:  a focus  on physical  exercise, hygiene, disease  prevention, and overall well-being. European and  British  colonialists brought to  the  New  World  an  interest in  the  medicinal  use  of bathing and  hot  and  cold  springs. In addition, many  learned about local hot  and  cold springs from  Native  Americans. Colonial doctors began  recommending water  cures  in the  18th  century, establishing famous spas  such  as Saratoga Springs in New  York,  as well as in Pennsylvania and  Virginia.  Entrepreneurs built  hotels where  visitors  could  lodge,  eat, and  visit the  hot  springs, thus giving  rise  to  the  U.S.  health resort industry. Industrialization gave  rise to a prosperous middle  class in the  United States  that  could  also afford  to use upper-class spas  and  sanitariums, mostly  to treat  ailments under a physician’s recommendation.

Use Statistics

In the United States, the spa industry grew and prospered in the late 20th  century, with  a 24 percent growth rate  between June  2007  and  June  2008  and  $10.9  billion of revenue according to the  International Spa Association (ISPA) (Figure  1).

One  in four  Americans has  been  to a spa, with  138  million  spa  visits estimated in  2007  (Figure  2). In  a 2002  American Massage Therapy Association survey, 28 percent of Americans who said they had received a massage in the previous five years said the reasons were relaxation or stress reduction (23%), other health reasons (53%), and pampering themselves (15%). Twenty-seven percent preferred to receive a massage at a spa compared with 19 percent in the therapist’s office.

Corporate Wellness Culture

Founded in  1991,  ISPA  is the  first  professional organization to  represent the industry. It  represents  3,200   health  and   wellness   facilities   and   providers in 83 countries. Members include resorts, hotels, medical  spas, mineral springs, and cruise  ships,  as well as service  providers such  as physicians, massage therapists, and  product suppliers. Its mission is to  forward  the  industry’s mission to  promote  the spa experience, demonstrating that  the spa is not a luxury but a lifestyle. The  organization offers  directories, a job  bank,  promotions, and  outreach programs  to  promote wellness  to  communities through education, research, and scholarship. ISPA  has  also  conducted ethnographic consumer trends research into spa use, exploring why the spa experience is becoming a sought-after lifestyle focused on wellness  and connection to self.

spas f1Figure 1    U.S. Spa Industry Revenue from 2003 to 2007 (in billions)

spas f2Figure 2    Number of Spa Visits in the United States from 2003 to 2007 (in millions)

Worksite wellness  programs advanced in the 1990s  focused on employee wellness. In particular, corporations often  funded retreats for their  top-level employees at spas with the intent to enhance company performance. This  helped to fuel the  burgeoning spa industry, which  caters  increasingly to corporate culture and high-income clients.  Recent  news  reports suggest  that  executives from  firms receiving bailout money  from U.S. taxpayers spent  hundreds of thousands of dollars on expensive  spa retreat weekends, angering the public.


The  spa industry employs a range  of workers, including massage therapists, nutritionists, physicians, wellness  educators, cosmetologists, and cleaning staff. Most employees in the  spa  industry are  part-time or  contract employees, numbering 160,500 in comparison to 143,200 full-time employees.

Massage therapists have always been part of the spa industry, but were employed in greater  numbers in day spas and  beauty  salons  as the  industry boomed during the  early 20th  century and  again  in the  1990s.  Although most  massage therapists, according to the American Massage Therapy Association (AMTA) practice privately, 22 percent of AMTA members say they are employed in a spa or salon, compared to 43 percent who travel to client locations, 33 percent who have a home office, 16 percent who have an office with other massage therapists, 30 percent who are in private practice with their  own office, and 19 percent who work in a medical  setting.

Most  massage students tend  to train  in regions where  there  is a large potential market for massage services.  Increasing numbers of students, however, are likely to become employees in the  burgeoning spa  industry rather than practicing for themselves. Changing licensing laws  and  increasing educational standards are more  likely to affect the  provision of massage in the  enormous day spa industry. Hotel  spas and large corporate day spas typically pay between 20–30 percent commissions to massage therapists.

Another reason for the  burgeoning spa  industry has  been  a ready  supply  of cheap  labor,  allowing  spa  business to  make  a hefty  profit.  For  many  workers in day spas  and  salons, $10–$12/hour is the  industry maximum, although some contract massage workers make  more.  Being non–English speaking means lower wages,  sometimes $50  a day, well below  minimum wage, and  up  to  20 percent of spa-worker income can  be based  on  commissions. At times,  spa owners may change the  percentage of the  treatment price  they  pay employees or change or stop  paying  the  hourly rate  altogether. In some  spas, there  is no  hourly rate  and employees are not  paid at all for no-shows. Plaintiffs  in a lawsuit  against  two nail salons on  the  Upper West  Side  of New  York  City  were  awarded $250,000 for overtime violations and  wrongful terminations; these  salon  workers were  routinely putting in 10-hour days, often  without a break,  six days a week.

Day Spas

A spa  environment offering  services  to customers on  a day-use basis  is usually built  in a stand-alone facility, without lodging  or restaurants. Most  day spas offer massage services,  and  cosmetology services  such  as facials, waxing, body  treatments, manicures, pedicures, and sometimes hairstyling.

Medical Spas

A medical  spa  operates under the  supervision of a licensed health care  professional  and  integrates complementary and  alternative therapies with  typical  spa services. In addition, many medical  spas offer the latest dermatological skin treatments that  can  be practiced by technicians under the  supervision of a licensed medical  professional, such  as microdermabrasion, a tool  that  exfoliates  the  top layer  of skin  from  the  face,  medical  chemical peels,  and  Restylane and  Botox injections.

Mineral Springs Spas

A mineral springs spa is a spa that  is built  around a natural mineral hot  or cold spring  that  offers hydrotherapy treatments. They  can be day spas or may also include  a hotel  or resort  spa environment with lodging,  restaurants, and a full range of spa services.  Some  of the  most  famous include the  Spring  Resort  and  Spa in Desert Hot Springs, CA; Colorado’s Hot Sulphur Springs Resort and Spa; the Ojo Caliente Mineral Springs Resort  and  Day Spa in Northern New Mexico; and  the Hot  Springs Resort  in North Carolina.

Hotel/Resort Spa

Hotel/resort spas  are  hotels or  resorts that  offer  spa  services  or  a spa  environment  within  the  facility; this  may include fitness  and  wellness  services,  as well as special  meals.  Examples of the  best  known spas  in the  country include Canyon Ranch (Tucson, Arizona), The Spa at the Mandarin Oriental (New York), Mii Amo (Sedona, Arizona)  and Lake Austin Spa Resort  (Austin, Texas).

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