The most common category of references explores the relationship between backpackers and health, often framing backpackers as a population at risk. This question appears in many studies on the incidence of diseases affecting tourists. The word cloud shown here (Figure 1) reflects the frequency of references related to various diseases. The most frequently mentioned (13 times) is traveller’s diarrhoea (turista), but there are also numerous studies on parasitic infections (6), malaria (5), sexually transmitted infections (STIs) (4), rabies, and hepatitis (3).

Some of these studies are empirical [18,19], while others involve literature reviews [20], but in the vast majority of cases, backpackers are just one category among many. And more often than not, they are described as a population at greater risk because of the way they travel: they stay in less hygienic hotels, are less careful about their diet and hygiene, and often engage in riskier activities and behaviours such as extreme sports, unprotected sexual encounters, or the use of psychotropic substances. A significant body of research also exists in the field of accident analysis [21].

The problem is that the assumption that backpackers are a category at risk is generally based on citations from few empirical studies [22]. Yet this assertion is seldom verified or challenged. For instance, one study [23] found that backpackers tend to take more precautions in terms of vaccinations when they travel to high-risk areas.

In terms of geography, the majority of the studies considering health issues for backpackers are located in the Global South.

The second category of research is made up of articles that look at backpackers by nationality and/or destination. Unsurprisingly, the destinations correspond to popular backpacking hotspots, i.e., Southeast Asia, Latin America, the USA, India, Australia (and to a lesser extent New Zealand) are the primary destinations, and Africa is less popular (Adam, op.cit.).

In terms of nationalities, Australian backpackers are by far the most extensively studied population [18,24], which may introduce bias, as the studies are calibrated according to the characteristics of this population and in particular their understanding of the healthcare system and health insurance. However, these points are not discussed in the articles.

A third category of references includes those that approach the subject by analysing behaviours, attitudes, and perceptions [25]. Within this category, like the references on disease risk, there is a recurring notion that backpackers tend to engage in riskier behaviours, whether consciously or unconsciously. For example, some may opt for unsafe modes of transportation due to budget constraints, thus increasing their risk of accidents. Backpackers are also often associated with a proclivity for outdoor adventures and extreme sports, entailing additional hazards [26].

Some studies suggest that backpackers may be poorly informed or negligent about health concerns and preventive measures. For example, studies report a high rate of unprotected sex among backpackers [27]. As a rule, the subject of behaviours associated with sexual health and the risks of sexually transmitted infections is frequently addressed [28]. However, other studies show that backpackers are attentive to their health and fully aware of the risks [29] or do not perceive themselves as an at-risk group [30]. The same contradictory opinions can be found on the subject of vaccinations prior to travel [31]. It would appear that backpackers’ behaviour toward health issues is a multidimensional phenomenon, and the perception of risk during a backpacking experience varies depending on the individual’s characteristics, such as age, gender, and past experiences [32].

Regardless of the specific subject, these studies typically rely on a very small number of empirical studies, and more often than not, they are literature reviews that reuse the same data without further analysis.

The next category pertains to healthcare systems, in peculiar the healthcare systems in the travellers’ home countries.

In a first point related to healthcare systems, one key issue is pre-travel medical visits and prevention recommendations [5,33,34]. Once again, the vast majority of studies are literature reviews. However, some of them are highly focused and targeted on a specific issue, such as HIV and post-exposure prophylaxis, with clear operational guidelines [35]. Other publications in this area deal with travel medicine in general [36], and only a few provide specific information on backpackers. Despite this, and with the usual precautions associated with the scarcity of sources, these studies seem to contradict the idea that backpackers do not adequately prepare for their trips. The majority of them seek advice and take out insurance before leaving.

For a second point regarding healthcare systems and the management of diseases or injuries at the travel destinations, researchers had to search for a specific combination of terms to bring up a few references, but none of them addressed the question as a whole: do backpackers have difficulty accessing healthcare? The few references that were found touched upon this issue only through examples pertaining to specific pathologies, such as the management of diarrhoea [37] and treatment of chlamydia [38]. There is very little research specifically on access to care. A summary text does exist [5], but it is not fully satisfactory, as it is not based on a case study but rather on a series of considerations by doctors, drawn from their experience, without any explanation of the methodology used.

This category of references perhaps contains the most empirical research, with case studies from various countries (Peru, Thailand, and India). The number of references is small, but they are almost exclusively case studies that describe a population more prone to risky behaviour and substance consumption associated with health risks: diarrhoea stemming from sharing bottles at parties, sexual risk during unprotected intercourse under the influence of alcohol, sexual abuse facilitated by drunkenness, etc.

The connection between alcohol consumption and risk-taking has also been highlighted, for example, in a study conducted in Cusco, Peru [39].

The last category, containing a significant number of references, features studies that do not necessarily focus primarily on backpackers, but portray them as individuals more exposed to food and hygiene-related risks due to their travel style, particularly when categorized as adventure travellers [41]. In this literature, long-term travel is presented as an additional risk factor for digestive tract diseases (associated with water and food), parasitic infections, dermatitis and parasite-borne infections contracted in unsanitary accommodation (ticks and bedbugs) or during outdoor activities (ticks, bites, and various skin irritations), and for more serious diseases like rabies [42]. Poor compliance with preventive treatments such as malaria chemoprophylaxis is also mentioned as a risk factor that may be more significant amongst backpackers than other tourists [43].

In these studies, which are mainly in the field of travel medicine, backpackers are just one category in a typology of exposure or vulnerability. Long-term travellers like backpackers are also compared with immigrants in the context of imported infectious diseases [44].

Finally, in this category of travel styles, there are two original references, albeit on the periphery of the topic, which offer a biomedical perspective on musculoskeletal disorders associated with backpacking [45,46]. These studies are worth mentioning here because they are among the few empirical studies to use health data on backpackers. They discuss the osteoarticular risks associated with walking while carrying heavy loads and make recommendations. Backpackers are compared with hikers and soldiers on exercise.

Irmgard Bauer, for example, has published a study on “the modern female traveller” [47]. Although it does not focus only on backpackers, it describes situations and needs, particularly in terms of health, encountered by women travelling alone with backpacks. It is a literature review, not an empirical study. Bauer’s work has two main themes: (1) personal hygiene and gynaecology and (2) safety and security. Concerning the first topic, she highlights various issues such as managing menstruation, the challenges of carrying or buying hygiene products while travelling, adjustments to contraception necessitated by travel conditions, and the potential for irregular or interrupted menstrual cycles due to travel. Pregnancy and the precautions it requires when travelling are also discussed. Finally, Bauer reports research linking difficulties in accessing clean sanitary facilities to an increased risk of urogenital tract infections, particularly affecting women backpackers. The use of cosmetics, which can present health risks (e.g., henna), is also discussed.

On the second point of safety and security, Bauer cites various studies and all of them report that women encounter situations of fear and vulnerability more frequently than men while travelling. However, these studies also show that these experiences lead women to adopt more cautious behaviours. This issue of the association between risk and gender among travellers, particularly among backpackers, addressed by Bauer from a travel health perspective, is also discussed in the tourism management literature [48].

During this literature search, the term grey nomads emerged. There are two main references in this field. The first is by M. Yates et al. on senior citizens who travel across Australia in campervans or caravans rather than backpacks [49]. The second reference is another publication by I. Bauer [50] dealing with senior adventure tourism in Peru. Once again, it concerns Australian tourists and is based on a literature review. The first publication is more general and outlines potential angles for studying this population, including a question on pre-travel health-related planning and preparation. The second publication identifies and describes the general travel health considerations that senior travellers may encounter. What is interesting about these two studies is that they set a threshold (50 years old for Yates and 55 for Bauer) beyond which a change of category seems to take place, with backpackers transitioning into grey nomads.

Put in another way, if we look at the issue of backpackers’ health, should we exclude people over a certain age along with their unique challenges because these people form a different category? Doing so might mean overlooking exceptional cases. For instance, there is a story of an 89-year-old backpacker featured on a website (https://www.timetravelturtle.com/worlds-oldest-backpacker/ accessed on 1 January 2024). Or should we merge these categories and study them cumulatively?

The concept of transformative tourism, although not new, has gained prominence recently (Figure 2). It encompasses the idea that travel can be a transformative experience, akin to a rite of passage, where individuals undergo personal changes. There has been a substantial increase in articles on this theme, as well as fresh approaches [51].

Several studies explicitly mention the health benefits of travel [53], and in particular, the therapeutic virtues of the tourist experience in terms of mental health and wellbeing. Travel, particularly long-haul travel undertaken by backpackers, provides a break from daily routines, encourages personal development, increases self-confidence and self-enrichment, and helps manage negative emotions (anxiety, fears, phobias). One of the most positive aspects reported is socialisation through interactions with local communities [54,55], with whom backpackers engage with more frequently than “conventional” tourists. In an empirical study, Pung [56] suggests that transformations after long journeys lead to lasting and permanent personal transformation, without specifically discussing backpacking.