New Year 39;s Day Drowning

[Kensel Whiteman]

Althoughdrowning death rates have decreased overall, racial/ethnic disparities persist. Implementing and evaluating community-based interventions, including those promoting basic swimming and water safety skills among disproportionately affected racial/ethnic groups, could help reduce these disparities.

Multiple factors contribute to increased risk of drowning for all persons, including behavior, skill (e.g., low water competencyꝉ), environment, and underlying medical conditions (5). Racial/ethnic differences in drowning death rates might reflect variation in these or other social or cultural factors among groups. Relying on death certificates to describe drowning disparities limits the ability to explore these factors, because death certificates do not include details on known risk or protective factors (4) or other sociocultural influences. Further research is needed on the determinants that contribute to racial/ethnic disparities in drowning, including the barriers to implementing effective drowning prevention programs in communities at highest risk.

Proven drowning prevention strategies include installing barriers that prevent unintended access to water, teaching basic swimming and water safety skills, using life jackets properly, active supervision, and knowing and performing cardiopulmonary resuscitation (CPR) (4). Racial/ethnic disparities in drowning deaths differed by setting, and the most applicable drowning prevention strategies might also differ by setting; however, having basic swimming and water safety skills can be beneficial in all settings (4). Research suggests that Black persons report more limited swimming ability than members of other groups (6,7). This disparity in swimming ability has persisted over time (8). Racial differences in fear of drowning have been identified as one factor contributing to limited swimming ability in some Black youths (9). A reduction in Black:White drowning disparities occurred in Florida from 1970 to 2015 (10). This progress might be the result of community-level initiatives to promote swimming skills among Black children (10). Swimming skill and other factors contributing to increased drowning risk in AI/AN persons have not been thoroughly explored. Engagement of the populations and communities at highest risk of drowning is critical to developing effective programs and reducing disparities.

Drowning is preventable, and more prevention efforts are needed to reduce the racial/ethnic disparities in drowning death rates that persist in the United States. Identification and evaluation of factors contributing to racial/ethnic disparities are crucial to inform the development and implementation of interventions that could effectively reduce disparities. Developing, implementing, and evaluating community-based interventions to promote drowning prevention strategies (installing barriers, basic swimming and water safety skills, using life jackets properly, active supervision, and knowing/performing CPR) among disproportionately affected racial/ethnic groups could help reduce disparities. Although the practicality of prevention strategies varies by setting, having basic swimming and water safety skills is applicable in all settings. Engaging populations at the highest risk of drowning to understand and address the barriers to accessing basic swimming and water safety skills training is needed.

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In 2019, an estimated 236 000 people died from drowning, making drowning a major public health problem worldwide. In 2019, injuries accounted for almost 8% of total global mortality. Drowning is the third leading cause of unintentional injury death, accounting for 7% of all injury-related deaths.

Despite limited data, several studies reveal information on the cost impact of drowning. In the United States of America, 45% of drowning deaths are among the most economically active segment of the population. Coastal drowning in the United States alone accounts for US$ 273 million each year in direct and indirect costs. In Australia and Canada, the total annual cost of drowning injury is US$ 85.5 million and US$ 173 million, respectively.

There is a wide range of uncertainty around the estimate of global drowning deaths. Official data categorization methods for drowning exclude intentional drowning deaths (suicide or homicide) and drowning deaths caused by flood disasters and water transport incidents.

Data from high-income countries suggest these categorization methods result in significant underrepresentation of the full drowning toll by up to 50% in some high-income countries. Non-fatal drowning statistics in many countries are not readily available or are unreliable.

Males are especially at risk of drowning, with twice the overall mortality rate of females. They are more likely to be hospitalized than females for non-fatal drowning. Studies suggest that the higher drowning rates among males are due to increased exposure to water and riskier behaviour such as swimming alone, drinking alcohol before swimming alone and boating.

Increased access to water is another risk factor for drowning. Individuals with occupations such as commercial fishing or fishing for subsistence, using small boats in low-income countries are more prone to drowning. Children who live near open water sources, such as ditches, ponds, irrigation channels, or pools are especially at risk.

Drowning accounts for 75% of deaths in flood disasters. Flood disasters are becoming both more frequent as well as more severe and this trend is expected to continue as part of climate change. Drowning risks increase with floods particularly in low- and middle-income countries where people live in flood prone areas and the ability to warn, evacuate, or protect communities from floods is weak or only just developing.

Daily commuting and journeys made by migrants or asylum seekers often take place on overcrowded, unsafe vessels lacking safety equipment or are operated by personnel untrained in dealing with transport incidents or navigation. Personnel under the influence of alcohol or drugs are also a risk.

There are many actions to prevent drowning. Covering wells, using doorway barriers and playpens, fencing swimming pools and otherwise controlling access to water hazards greatly reduces water hazard exposure and risk.

Community-based, supervised childcare for pre-school children can reduce drowning risk and has other proven health benefits. Teaching school-age children basic swimming, water safety and safe rescue skills is another approach. But these efforts must be undertaken with an emphasis on safety, and an overall risk management that includes a safety-tested curricula, a safe training area, screening and student selection, and student-instructor ratios established for safety.

Effective policies and legislation are also important for drowning prevention. Setting and enforcing safe boating, shipping and ferry regulations are vital to improving safety on the water and preventing drowning. Building resilience to flooding and managing flood risks through better disaster preparedness planning, land use planning, and early warning systems can prevent drowning during flood disasters.

The Global report on drowning pointed out that drowning has been highly overlooked to date, and that a great deal more should be done by governments and the research and policy communities to prioritize drowning prevention and its integration with other public health agendas.

The global report provides recommendations to governments to tailor and implement effective drowning prevention programmes in their settings, improve data about drowning, and develop national water safety plans. The report also points out the multisectoral nature of drowning and calls for greater coordination and collaboration among UN agencies, governments, NGOs and academic institutions.

In May 2017, WHO released Preventing drowning: an implementation guide. This publication builds on the global report and provides concrete guidance for drowning prevention practitioners on how to implement drowning prevention interventions.

In April 2021, the UN General Assembly adopted the first-ever Resolution on drowning prevention, which highlighted links to sustainable development, social equity, urban health, climate change, disaster risk reduction, and child health and well-being. The Resolution called on WHO to coordinate multisectoral drowning prevention efforts within the UN system and announced 25 July as World Drowning Prevention Day.

In May 2023, the 76th World Health Assembly adopted a Resolution to accelerate further action through 2029. Through the Resolution, WHO committed to establishing a Global Alliance for Drowning Prevention with organizations of the UN system, international development partners and NGOs. Further, WHO will prepare a global status report on drowning prevention for release in 2024.

At country level, WHO is working with Ministries of Health in several low- and middle-income countries, guiding the development of national drowning prevention strategies and supporting delivery of evidence-based drowning prevention interventions. In addition, WHO has also funded research in low-income countries exploring priority questions related to drowning prevention. At regional level, WHO organizes training programmes and convenes workshops to draw together representatives of governments, NGOs and UN agencies working on drowning prevention.

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