Currently, tourism represents a fundamental reality for the generation of wealth and job creation in Portugal [1,2]. Between 2010 and 2019, the country registered an average annual growth rate of 7.2% in overnight stays. This scenario translates into an increase from 37 million overnight stays in the beginning of the period to 70 million in 2019, the highest value registered so far. The growth in generated revenue followed the same trend. It grew at an average annual rate of 10.3% in the same period, which translated to an increase from EUR 7.6 to 8.4 billion [3].

In 2020, in the face of the unprecedented global health, social and economic crisis caused by the COVID-19 pandemic, Portuguese tourism followed the global trend and suffered unrecorded losses. The country received 73.7% fewer international tourists, 60.4% fewer guests in tourist accommodation establishments and 61.1% fewer overnight stays [3]. During much of 2020 and 2021, major restrictions on international travel and social distancing counseling were introduced. This scenario was based on the outcome of a significant decline in demand and production in a context of disruption to distribution chains, which implies an abrupt reduction in jobs, at least temporarily, due to the imposition of sanitary lockdowns [4]. This pandemic context caused Portuguese tourists to prefer the domestic market and to value outdoor spaces and contact with nature, to the detriment of large urban centers and mass tourism destinations.

At the same time, demand for nature-based activities started increasing [5,6,7], as well as demand for smaller tourist resorts with good accessibility and in low-density areas [8], as the need to escape the stress and anxiety caused by confinement became more prominent, along with social distancing. Tourist products associated with these practices, including health and wellness tourism, also started seeing an expansion in demand. In this context, a greater general awareness about sustainability of tourism practices started emerging. Some of the main concerns included how tourism could contribute to the recovery of local economies and promote more sustainable community development for the territories, thereby fostering the achievement of “decent work and economic growth” (SDG 8), “responsible consumption and production” (SDG 12) and “life under water” (SDG 14) [9].

Health and wellness tourism represents a tourist product that has emerged as a global reality and has undergone exponential growth in recent decades [10,11,12,13]. This trend was essentially driven by changes in demographic structure and lifestyles, the need to reduce stress among the working population, the change in the medical paradigm towards prevention and alternative practices and the changes from mass tourism to personalized travel [14]. This approach can enhance the appeal of local areas and seasonal demand in a more sustainable manner, specifically by incorporating activities that have a positive effect on the health of older people. Additionally, certain forms of health tourism infrastructure can aid in expanding the healthcare network of residents, thereby increasing their access to preventive and health-promoting practices [15]. Other motivations can include a growing enjoyment of leisure time and practices, the search for low-density spaces and closer contact with nature [16,17,18] and a growing appreciation for the body and its care [19].

Health tourism can be defined as that which “covers the types of tourism whose primary motivation is the contribution to physical, mental and/or spiritual health through medical and wellness-based activities that are able to increase the ability of individuals to meet their own needs and function better in their environment and society” [13,20]. This, in turn, extends to two fundamental segments of the tourist demand: those who travel primarily for medical reasons and whose main motivation is a cure for and/or recovery from illness—medical tourism—and those who travel for reasons of prevention, well-being, relaxation or fitness recovery—wellness tourism [21,22,23]. These are distinguished not only by the type of treatments and healthcare that make up the offer, but also by the types of infrastructure and facilities with which they are associated [24].

In Portugal, thermal tourism continues to be the product with the greatest projection within the concept of health and wellness tourism, resulting from a historical past of great relevance [10,27,28]. Throughout their more recent history, the frequency of Portuguese thermal establishments has always been marked by the segmentation of their users into two major groups, which are distinguished not only by the nature of their practices and motivations (predominantly therapeutic use and predominantly recreational use), but also by their social composition [29,30]. In Portugal, “regular visits have declined in recent years, while the number of visitors seeking wellness and comfort activities has been steadily increasing, especially in recent times” [25] (p. 221). However, these motivations have also alternately defined the demand, in aggregate form, according to the phases that characterize thermalism in Portugal.

In recent decades, several strategic documents have been formulated and approved to promote the competitiveness and sustainability of tourism, not only because of their relevance to the current situation, but also because of their diagnostic capacity and their character as a basis for strategic sectoral intervention in the medium to long term [31]. Among these are the pioneering National Tourism Plan 1986–1989 [32] and, more recently, the National Strategic Plan for Tourism—PENT, both in its initial formulation for the 2007–2015 time horizon and in the revision carried out in 2013 [33]—to adapt to the evolution of the national and international contexts. Other documents include the Tourism Strategy 2027 [34], the Regional Tourism Development Plan of Turismo Centro de Portugal [35] and the Marketing Plan of Turismo Centro de Portugal 2020–2030 [36]. All the documents presented mention health and/or wellness as strategic products/assets with relevance for regional and national tourism development.

At the same time, health and wellness tourism finds several opportunities for expansion and recognition, either per se or in conjunction with other strategic tourism products. The thermal establishments are development poles at the local and regional scale, since they generate an overflow effect in the economic and social fabric. They contribute to the enrichment of the quality of life of local communities, contributing to an endurable and economically executable form of tourism, socially and ethically fair in relation to the host community [37]. These locations also contribute to the mitigation of regional asymmetries and their position in the face of an emerging paradigm: the affirmation of destinations in the interior of the country [14,38], more specifically the northern and center regions of Portugal, where most of the national thermal springs are located.

Moreover, scholars have stressed the significance of recognizing the value of intangible factors in this form of tourism [39]. During their stay in such establishments, travelers can engage with the local community, gain insights into their distinct language and culture and consequently enhance their appreciation of the community. In this particular context, a cost-benefit analysis may have to deviate from the customary approach and acknowledge the financial worth of the ecological and societal contributions that stem from tourism in this locality. At the same time, in a context of permanent change and, more recently, due to the great economic impact caused by the COVID-19 pandemic, new challenges arise that require the development of strategies, products and services that meet the specific needs of the market [40]. COVID-19 was seen by thermalism as an opportunity to claim its health-promoting character in society. As an example, in the Spanish tourism scene, the value and importance of the spa was promoted during the pandemic, essentially due to its curative aspect. This is a dimension that gave spas uniqueness and allowed them to differentiate themselves from the centers and destinations of mass tourism, by ensuring the quality and safety of the facilities and services when reopening the tourist resorts [41].

According to the literature [42], tourists with extensive international experience engage in more robust and long-lasting travel arrangements, even in difficult circumstances. In contrast, senior citizens generally avoid tourist destinations with perceived high risks, whereas younger generations are less concerned about physical hazards associated with tourism and, therefore, exhibit greater travel intentions. Thus, young travelers tend to prioritize immediate gains and show greater interest in destinations that have faced disasters. This phenomenon may clarify why, within the context of wellness tourism, this urge in demand after the lockdown has been propelled by younger and wealthier individuals. In addition, Qi’s 2009 study [43] highlights that well-educated tourists demonstrate more favorable attitudes towards travelling, even if there are potential perils associated with it.

Even in the post-COVID-19 era [44], it remains advantageous to showcase the distinctiveness of the resources associated with health tourism. This advantage stems from the exceptional thermal water, unique experiences and local community context of such locations. Such an approach will continue to differentiate this form of tourism and allow it to compete effectively.