Scotland might be better known as the "sick man of Europe", but for a few days this week it will be at the epicentre of the world's multi-trillion dollar wellness economy as hundreds of delegates flock to St Andrews for the industry's biggest annual conference.

The sold-out Global Wellness Summit will take place over five days at the iconic Old Course hotel, featuring everything from a Q&A with Dutch 'Iceman' Wim Hof - famed for popularising the health benefits of exposure to extreme cold and breathing techniques - to the latest developments in longevity science, the newest and fastest growing area of wellness.

Now in its 18th year and billed as a "watershed moment for wellness", the summit comes at a time of huge growth in the sector spurred by the Covid pandemic.

READ MORE: 

Globally, its value has gone from an estimated $4.9trillion in 2019 to $5.6trn in 2022 and is now forecast to reach $8.5trn in 2027.

The UK is home to the fifth largest wellness market in the world after the United States, China, Germany, and Japan, but no other country recovered faster post-Covid in terms of its wellness economy than the UK. 

It has more than doubled compared to pre-pandemic levels and is now worth $224 billion (£173bn) annually. 

Susie Ellis, CEO and chair of the Miami-based Global Wellness Institute - the think tank which organises the summit - says there has been a shift not only in the size of the sector, but in its potential impact as governments, medics and healthcare providers worldwide turn their attention increasingly towards prevention.

Speaking to the Herald ahead of the summit, she said: "There's always been growth, but all of a sudden after Covid we had a lot of momentum.

"When we started 18 years ago we were the 'spa summit' - we didn't use the term 'wellness', that wasn't a popular term at the time.

"So that's changed, and now because of Covid many more people and companies, governments, have become interested in wellness and prevention.

"The medical community is very much noticing us and wanting to work together.

"There was a sense, very much after the pandemic, where people recognised that healthcare was important, the medical community was important, but not enough.

"What needed to happen was not just healthcare, but self-care."

Delegates taking part in activities during the 2023 Global Wellness Summit in Miami, Florida  (Image: GlobalWellnessInstitute) Wellness is typically defined as the pursuit of activities and lifestyles designed to optimise health and wellbeing, but the breadth of topics due to be covered at the summit show it is rapidly expanding beyond traditional areas such as nutrition and beauty therapy into hospitality, healthcare, technology and even architectural design.

Wellness tourism is projected to grow by 16.6% annually, to $1.4trn by 2027.

And far from being the preserve of celebrities such as Gwyneth Paltrow - whose Goop site has been criticised for peddling pseudoscience - the summit has the backing of serious medical and scientific minds, including former US Surgeon General, Richard Carmona.

Carmona, a former Green Beret in Vietnam and vascular surgeon who pioneered Arizona's first trauma care system, was appointed by President George W Bush in 2002.

During his four-year tenure, he warned that obesity was saddling the US with a "disease burden we can’t afford" and published a landmark report on second-hand smoke in 2006 which cemented the case for indoor smoking bans.

Former US Surgeon General Richard Carmona is on the board of advisors for the Global Wellness Institute, which organises the summit. He will attend the conference in St Andrews, which runs from November 4-8 (Image: Getty) His interest in public health and prevention led him to become involved with the Global Wellness Institute, where he sits on the board of advisors, and with Canyon Ranch in Arizona - a spa resort whose research offshoot has taken wellness approaches into unhealthy, deprived communities with proven, peer-reviewed results.

"Any time we went into a community we would measure blood pressure, lipids, haemoglobin A1C [a blood sugar test], depression index," said Carmona.

"And in every one of those communities over time - a year or two - we were able to show a change in all of those parameters.

"They improved. People saw the results."

The idea that small changes over time can add up to better health is at the heart of the summit's "Wellness Moonshot" - the vision of a "world free of preventable disease".

This was Carmona's brainchild and it now underpins the work of the Global Wellness Institute's members worldwide.

"It really is the framework of wellness because what's we're trying to do is to have everybody live their best lives by eliminating those things that take away from it," said Carmona.

The Global Wellness Summit is being held at the Old Course hotel in St Andrews, Fife (Image: GWI) The key is not to "try to boil the ocean", he says - solving the entirety of population health dilemmas single-handed - but to identify a few "simple things" that can make a tangible difference in a given community.

He said: "If you are in Nigeria or New York City, the approach may be different but the goal is the same.

"I say to our members: look at where the preventable disease is coming from in your communities - is it heart disease, mental health problems? - and identify a couple of things that you as leaders can start to do to address it.

"Whether it's by better food, reducing stress, creating purpose in life for seniors - incrementally, all of these things move us towards a world free of preventable disease."

Now 74, Carmona grew up in the Bronx and knew what it was like to go to bed hungry.

It is an experience that has informed his work in public health and wellness.

He said: "We did a program on the South Bronx with poor immigrants where one of the problems was access to healthy food, including fruit and vegetables.

"It was an area where I grew up so I went to the clinic [that provides healthcare for poor people without insurance].

"I knew some of [the doctors] because they had looked after me and my family when I was a poor kid, and I said 'look, we get a lot of sunshine - why don't we, on the roof of your building, put a garden?. And in the cold weather, we put hydroponic gardens and lights in, and you can start growing your own fruit and vegetables?'

"They did it, and it worked.

"And then we took mothers to the supermarket and we taught them how to read a food label. These are mostly low education, single mothers with kids who are newly immigrants.

"So they might not be able to buy the best things, but they can start to be a little more knowledgeable in selecting things that are healthier.

"It doesn't sound like a big thing, but when we start to look at all these incremental changes over time, cumulatively you start to see a healthier profile."

Wim Hof will take part in a Q&A session on Tuesday (Image: GWI) At the opposite end of the wellness spectrum, the summit will also showcase the latest innovations in personalised longevity treatment - something that, for now, is limited to the more affluent.

One area which has exploded in interest over the past five years is the role of the molecule NAD+ (Nicotinamide adenine dinucleotide) in healthy ageing.

Although naturally present throughout the body, and used for decades in addiction treatment, curiosity about its potential to the wellness industry was turbocharged in 2019 with the publication of 'Lifespan: Why we age and why we don't have to' by Harvard University genetics professor, David Sinclair, who argued that boosting NAD+ levels - which decline over time - could be key to preventing age-related disease.

At the time, Iain de Havilland, a former banker, had just created NADclinic - a wellness business promoting the use of NAD+ in the form of supplements, injectables, and IV infusions to aid human performance.

The timing could not have been better.

"I was trying to raise awareness of NAD+, then suddenly it went bonkers," he said.

Gleneagles hotel in Perthshire looks set to become the first location in Scotland as NADclinic expands its partnerships (Image: TripAdvisor) In addition to its own clinics in London's Harley Street and Cape Town, NADclinic now supplies more than 500 premises in Europe and has partnerships in more than 40 countries worldwide.

Demand is "growing exponentially", says de Havilland, most recently from the spa and hospitality sectors as major hotel groups battle to cash in on the wellness boom.

NADclinic is currently working with Gleneagles owner, Ennismore, and expects that the luxury Perthshire hotel will be the first in Scotland to offer its NAD+ therapies "in the near future".

READ MORE: 

Commercially it makes sense; a typical IV infusion protocol costs £500 and upwards, so spa hotels with wealthy guests willing to pay can generate a much bigger return on investment than they do from manicures, pedicures, and massages.

De Havilland said: "Most of the big top brands are introducing these things: longevity suites, human performance suites, well-tech. It's happening now - it's not five years away.

"NAD+ is in every cell of your body - it feeds your mitochondria, it's critical for a number of physiological reactions. Without NAD+ you'd be dead in 40 seconds.

"It decreases inflammation, it decreases oxidative stress, it helps you sleep better, it's involved in circadian rhythms, in neurotransmitter production, but it's become synonymous now with preventative health and human performance.

"Our business growth now is being driven by us working with spas, hospitality, corporate wellness.

"The hospitality industry is poised to embrace a new era of wellness.

"Pre-Covid, our typical client would have been late 40s, early 50s and older; now we've got an extra generation of people coming in because they don't want to get sick.

"People will do anything to stay healthy.

"Even the doctors we work with - four or five years ago when I started this, doctors were very traditional, not into functional health.

"Now there's been this massive sea change in terms of the appetite for preventative health. It's crazy."