The Double-Edged Impact of Tourism on Public Health in Ghana: A Systematic Review

Background International tourism can facilitate disease spread across borders but also foster health and wellness through economic and social development. Ghana’s expanding tourism sector, supported by government initiatives and rich cultural and natural assets, intersects with public health challenges ranging from endemic infections (malaria, cholera) to emerging threats (COVID-19, dengue). Objective To critically review the evidence on tourism’s dual role in Ghana’s public health, characterising tourism as both a vector of disease and a promoter of health, and to synthesise findings in line with PRISMA 2020 guidelines. Methods A systematic search of PubMed, Scopus, Web of Science, Embase, CINAHL, and grey literature (2018–2025) was conducted for studies addressing tourism and health in Ghana and comparable contexts. Inclusion criteria encompassed quantitative, qualitative, and mixed-methods research on tourism-related mobility, infectious disease transmission, wellness tourism, and health infrastructure. Titles, abstracts, and full texts were screened by two reviewers, and data on study characteristics and outcomes were extracted. Study quality was assessed using established checklists (e.g., JBI, CASP). Findings were synthesised narratively using thematic analysis. Results The review identified 20 studies meeting the inclusion criteria (Fig. 1, PRISMA flow). The literature broadly fell into two thematic domains: (1) Tourism as a vector of disease , evidence that travel (including tourism) to and from Ghana can introduce or amplify infectious diseases (e.g. importation of COVID-19, malaria, and potentially cholera/dengue), especially given gaps in surveillance and health infrastructure; and (2) Tourism as a catalyst for public health promotion – examples of wellness and medical tourism, economic investments in healthcare linked to tourism growth, and increased public health awareness. In Ghana, endemic conditions (high malaria burden, periodic cholera outbreaks) and socio-economic disparities modulate these dynamics. Cross-cutting issues such as health equity, ethical resource allocation in medical tourism, and climate impacts were noted. Conclusions Tourism in Ghana is double-edged : it contributes to economic development and health sector strengthening, yet also poses disease risks via increased mobility. Policymakers and health authorities must balance these aspects by enhancing disease surveillance and travel health measures, while harnessing tourism’s health-promoting potential (e.g. domestic wellness tourism, medical travel). Gaps include a paucity of Ghana-specific epidemiological studies on tourism-related transmission. Future research should quantify travel-associated disease burden and evaluate interventions (e.g. traveller screening, destination health promotion).