Explained: Why do the French love thermal spa cures so much?

Thermal spa treatments in France are incredibly popular and can even be prescribed by doctors for conditions ranging from heart disease to digestive problems.

A women receives a thermal bath treatment in France.
A women receives a thermal bath treatment in France. Such procedures can reimbursed by the French state if carried out for medical reasons. (Photo by GEORGES GOBET / AFP)

How big is the thermal spa sector in France? 

326,000 people visited thermal spas for treatments in 2021 according to the head of the Conseil national des établissements thermaux (National Council of Thermal Establishments). Those who visit these places are known as curistes

There more than 100 stations thermales in France – establishments that provide medical care with heated mineral water and mud. 

France has more than 770 thermal springs which provide the key ingredient for such treatments.

In 2019, there were 850 doctors specialising in delivering thermal treatments in France. That same year, 0.15 percent of reimbursement payments made by the Assurance Maladie (the French public health system) went to people who had undergone thermal spa treatments 

Those representing the sector say that it employs more than 100,000 people directly and indirectly. 

How does it work? 

We’re not just talking a spa day here.

A cure thermale is different from thalassothérapie – the former is used to treat medical conditions and must be proscribed by a doctor while the latter is used simply to relax. If you go with a few friends to a spa for a day of relaxing and gossip with a massage, a sauna and perhaps a facial that is not a cure thermale

You can receive treatment in a cure thermale for problems linked to rheumatology (conditions like arthritis), gynaecology, phlebology (veins), neurology, cardiology, urology, dermatology, child development, digestion, metabolic issues, psychosomatic illness, respiratory problems and buccolingual health. 

Power showers form an integral part of spa therapy treatments in France

Power showers form an integral part of spa therapy treatments in France. (Photo by GEORGES GOBET / AFP)

The standard duration of a cure thermale treatment is 18 days, which are divided into periods of treatment, physical activity and rest. 

The treatment generally begins in the morning and last between 2-3 hours. Patients will undergo 4-6 treatments per day. They can be delivered individually or as part of a group depending on the prescription given by a doctor. 

The exact treatment you will receive is determined by a doctor once you arrive at a station thermale depending on your illness and overall state of health. Common features are massages, steam room sessions, mud baths and power showers. 

Is there any science to support the idea that these treatments are useful?  

Representatives of the cure thermale sector point to studies written by thermal medicine researchers which, surprise surprise, show thermal spa treatments to be effective in treating a whole range of conditions. 

But other research has also pointed towards benefits. A paper published in the British Medical Journal found that thermal spa therapy was an effective treatment for the management of knee osteoarthritis; and other peer-reviewed studies found that the mineral water used has health benefits. 

READ MORE Are the French falling out of love with spa cures?

But there are sceptics however.

“Medical benefits of thermal treatment have been observed in patients with rheumatic conditions, psoriasis, venous insufficiency, ENT conditions, gynecolgical disorders, and anxiety. Unfortunately, many publications in this area suffer from methodological flaws,” notes the French National Academy of Medicine

A lack of control groups and financial interests behind many of the studies into the efficiency of thermal medicine means that the jury is still out on thermal spa treatments. 

How can I get my spa treatment reimbursed? 

You can pay for treatments yourself, but depending on your state of health the government might pay some of the costs, as the French social security system has been reimbursing cure thermale treatments since 1947. 

You can get your treatment partially reimbursed by the French state if you have obtained a prescription from a doctor. You can get one stint in a thermal spa reimbursed per year, for 18 days. Reimbursement typically amounts to 65-70 percent of the cost of the treatment and is transferred into your bank account after you have paid for the treatment itself. You need a French carte vitale to benefit. 

READ MORE How to get a carte vitale in France and why you need one

Thalassothérapie – the relaxing spa day – is not reimbursed. 

Your doctor is the one who decides which thermal spa you should attend – each one is specialised in treating certain illnesses. 

Before receiving treatment, your doctor will have to sign and provide you with this form, which must then be submitted to the Assurance Maladie (French public health system). You must also fill out a déclaration de ressources, providing evidence of your salary or any other earnings. This must also be sent to the Assurance Maladie – you can find the postal address where you must send your documents in the démarches à accomplir section of this website

If you earn more than €14,664.38 annually, your transport costs to the treatment centre or stay at a hotel will not be reimbursed by the French state. If you earn less than this, you should submit evidence and can have 65 percent of transport (the price of a second-class SNCF ticket to the treatment centre) and hotel fees paid (up to €97.50 per day) back to you. 

How has the Covid-19 pandemic affected the sector? 

Covid-19 has hit the thermal spa sector hard. 

The National Council of Thermal Establishments says that the number of clients receiving treatment was 43.3 percent lower in 2021 than in 2019, before the pandemic began. 

Thermal spas in France have been forcibly closed for months at a time during the pandemic.

Thermal spas in France have been forcibly closed for months at a time during the pandemic. (Photo by GEORGES GOBET / AFP)

Access to thermal treatment centres is contingent on being fully vaccinated (for now, not all centres require you to have had a booster); a negative PCR test taken 72 hours before entering the centre if you are unvaccinated followed by bi-weekly tests during your treatment; or proof of recovery of Covid (a positive test between 11 days and 6 months old). Mask wearing is required in communal areas of treatment centres. 

Dozens of thermal spas in France have begun treating patients with symptoms of long Covid, such as loss of taste and smell, chronic fatigue and brain fog. These treatments are not currently reimbursed by French social security, but the sector is trying to negotiate a deal with the Health Ministry to make this happen. 

“Thermal medicine can contribute to the management of certain after-effects of Covid-19 by a support to more efficient ventilatory mechanics and motor functions and by a relief of the stress following a prolonged stay in an intensive care unit,” said the National Academy of Medicine. 

Other information 

You can read more about the process of getting thermal spa treatments reimbursed here

The National Council of Thermal Establishments has an interactive map where you can search for treatment centres by geographical area and speciality. 

If you are interested about the alleged benefits of thermal spa treatments, an exhibition is currently being held at the Carousel du Louvre in Paris, until January 23rd. Tickets are free but you must subscribe to the event here

Lyon will also hold an event bringing together thermal spa practitioners from January 28th to January 30th at the Eurexpo centre. You can get more information about that event here.  

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Burkini: Why is the French interior minister getting involved in women’s swimwear?

Bikini, topless, swimsuit, wetsuit, burkini - what women wear to go swimming in France is apparently the business of the Interior Minister. Here's why.

Burkini: Why is the French interior minister getting involved in women's swimwear?

It’s a row that erupts regularly in France – the use of the ‘burkini’ swimsuit for women – but this year there is an added wrinkle thanks to the country’s new anti-separatism law.

What has happened?

Local authorities in Grenoble, eastern France, have updated the rules on swimwear in municipal pools.

French pools typically have strict rules on what you can wear, which are set by the local authority.

For women the rule is generally a one-piece swimsuit or bikini, but not a monokini – the term in France for wearing bikini bottoms only, or going topless. For men it’s Speedos and not baggy swim-shorts and many areas also stipulate a swimming cap for both sexes.

These rules typically apply only to local-authority run pools, if you’re in a privately-owned pool such as one attached to a hotel, spa or campsite then it’s up to the owners to decide the rules and if you’re lucky enough to have a private pool then obviously you can wear (or not wear) what you want.

READ ALSO Why are the French so obsessed with Speedos?

Now authorities in Grenoble have decided to relax their rules and allow baggy swim shorts for men while women can go topless (monokini) or wear the full-cover swimsuit known as the ‘burkini’. This is essentially a swimsuit that has arms and legs, similar in shape to a wetsuit but made of lighter fabric, while some types also have a head covering.

Is this a problem?

No-one seems to have had an issue with the swim shorts or the topless rule, but the addition of the ‘burkini’ to the list of accepted swimwear has caused a major stir, with many lining up to condemn the move.

Those against it insist that it’s not about comfy swimwear, it’s about laïcité – that is, the French secularism rules that also outlaw the wearing of religious clothing such as the Muslim headscarf and the Jewish kippah in State spaces such as schools and government offices.

READ ALSO Laïcité: How does France’s secularism law work?

The burkini is predominantly worn by Muslim women, although some non-Muslim women also prefer it because it’s more modest and – for outdoor pools – provides better sun protection. 

Grenoble’s mayor Eric Piolle, one of the country’s highest profile Green politicians who leads a broad left-wing coalition locally, has championed the city’s move as a victory.

“All we want is for women and men to be able to dress how they want,” Piolle told broadcaster RMC.

Is this France’s first burkini row?

Definitely not, the modest swimsuit has been causing a stir for some years now.

In 2016 several towns in the south of France attempted to ban the burkini on their beaches. This went all the way to the Constitutional Court, which ruled that such a ban was unconstitutional, and the State cannot dictate what people wear on the beach.

The situation in municipal pools is slightly different in that local authorities can make their own rules under local bylaws. Most pools don’t explicitly ban the burkini, but instead list what is acceptable – and that’s usually either a one-piece swimsuit or a bikini. These decisions are taken on hygiene, not religious, grounds.

The northwestern city of Rennes quietly updated its pool code in 2019 to allow burkinis and other types of swimwear, which seems to have passed unnoticed until the Grenoble row erupted.

Why is the Interior Minister getting involved?

What’s different about the latest row is the direct involvement of the Interior Minister Gérald Darmanin. He appears to have no objection to topless swimming in Grenoble, but he is very upset about women covering up when going for a dip.

No, he’s not some kind of creepy beauty pageant judge from the 1970s – he’s upset about laïcité.

Darmanin called the decision “an unacceptable provocation” that is “contrary to our values”.

He has ordered the local Préfet to open a review of the decision, and later announced that prosecutors had opened an inquiry into Alliance Citoyenne, a group that supports the wearing of burkinis in pools.

And the reason that he gets to intervene directly on the issue of local swimming pools rules is France’s ‘anti-separatism’ law that was passed in 2020.

This wide-ranging law covers all sorts of issues from radical preaching in mosques to home-schooling, but it also bans local councils from agreeing to ‘religious demands’ and among its provisions it allows the Interior Minister to intervene directly on certain issues.

So far this power has been used mostly to deal with extremism in mosques, several of which have been closed down for short periods while extremist preachers were removed.

Darmanin’s foray into women’s swimwear seems to represent an extension of the use of these powers. 

Is this all because there is an election coming up?

Parliamentary elections are coming up in June and the political temperature is rising. It’s certainly noticeable that in Darmanin’s initial tweet about the matter he referred to Grenoble mayor Eric Piolle as a “supporter of Mélenchon”, although Piolle is actually a member of the Green party.

Mélenchon and his alliance of leftist parties are currently the main rival for Macron’s LREM at the parliamentary elections.