Regional and Income-Based Disparities in Health and Hygiene: Evidence from the Travel & Tourism Development Index

Health and hygiene are critical components of sustainable travel and tourism development, particularly in the post-emergency phase of the COVID-19 pandemic when traveler confidence is closely tied to the resilience of the destination. This paper examines global health and hygiene conditions using data from the Travel & Tourism Development Index (TTDI) 2024, with a focus on disparities across regions and income groups. Five key indicators—physician density, basic sanitation, basic drinking water, hospital bed density, and communicable disease incidence—are analyzed to assess healthcare infrastructure, accessibility, and public health resilience. By comparing data from 2021 and 2024, the study evaluates changes during and after the peak period of the COVID-19 crisis, highlighting progress and persistent inequalities relevant to sustainable travel and tourism development. Using descriptive statistics and Spearman’s rank correlation analysis, the study also investigates the associations between key health and hygiene indicators, specifically (i) basic sanitation and basic drinking water coverage and (ii) physician density and hospital bed density, at the global, regional, and income group levels. The results reveal pronounced regional and income-related disparities. Europe and Eurasia consistently outperform other regions, with high healthcare capacity and near-universal sanitation and water access, while Sub-Saharan Africa continues to face systemic deficits in all indicators. High-income countries have well-developed healthcare systems, whereas low-income countries struggle with limited physician availability, poor sanitation coverage, and high communicable disease incidence. Associations between key indicators are also evident: countries with strong sanitation infrastructure almost always achieve high drinking water coverage, and those with higher physician density typically maintain higher hospital bed capacity. These findings highlight the uneven pace of global recovery and emphasize that health and hygiene are not only public health priorities but also fundamental drivers of tourism competitiveness.