Death toll from drowning “intolerable”

Drowning claims the lives of 372 000 people a year worldwide, with over 90% of these deaths occurring in low- and middle-income countries. In the WHO European Region, drowning causes the loss of 37 000 lives every year. It is the second leading cause of death in children aged 5–14 years and the fourth leading cause among young people aged 15–29 years.

A new WHO global report outlines the devastating impact of drowning, and provides a tangible means for stemming its rise.

“Drowning is a highly preventable public health challenge that has never been targeted by a global strategic prevention effort. The report sets out current knowledge about drowning and drowning prevention, and calls for a substantial scaling up of comprehensive efforts and resources to reduce what is an intolerable death toll, particularly among children and adolescents,” said Dr Margaret Chan, Director-General of WHO.

Disparities in drowning rates

In the WHO European Region, death rates from drowning are five times higher in males than in females, and eight times higher in the low- and middle-income countries of the Region, compared to the high-income countries.

Whereas death rates for drowning have improved overall across the European Region in the past decade, alarmingly, in children under 15 years, the gap between the death rates in low- and middle-income countries and high-income countries has widened.

Key drowning risk factors

Wherever there is water, the threat of drowning exists, especially where young children are concerned. For infants and young children, the greatest risk factors for drowning include a lack of barriers to water bodies and inadequate supervision. Poor swimming skills and a low awareness of water dangers also pose threats to children.

Among adolescents and adults, a leading cause of drowning is alcohol consumption while engaging with water.

Generally, water transport, the lack of a safe water supply and flood disasters are all risks factors for drowning. Most drowning incidents happen inland, even in countries with extensive coastlines.

Whether a bucket, a bathtub, well, pool or pond, it poses a drowning risk.

Drowning prevention

The WHO Global Report on Drowning sets out effective  prevention strategies for drowning across all Regions, and separates activities by sector.

Community-based actions include:

• providing safe places with capable child care, such as day-care centres or crèches, away from water for preschool children;
• teaching school-age children basic swimming, water safety and safe rescue skills;
• training bystanders in safe rescue and resuscitation;
• strengthening public awareness of drowning and highlighting the vulnerability of children; and
• installing barriers controlling access to water, such as fencing swimming pools and using playpens to limit access to water.

According to a recent report, 75% of swimming pool drowning deaths among young children could be prevented by using four-sided fencing to completely separate the pool from the house and yard.

Effective policies and legislation include:

• setting and enforcing safe boating, shipping and ferry regulations;
• building resilience and managing flood risks and other hazards locally and nationally;
• coordinating drowning prevention efforts tailored to a country’s circumstances and risk groups with other sectors; and
• developing a national water safety plan.

Further research on effective preventive policies and data on drowning is needed. The establishment of a global partnership for drowning prevention would also support coordinated efforts.

Europe’s unique vulnerabilities to drowning

In Europe, floods are the most common natural disaster, and recent years have produced some of the worst flooding in the European Region’s history. Poor flood disaster protection puts local people at increased risk. The number of people exposed to hazards is rising with the increased frequency and severity of flood disasters and inadequate flood preparation and mitigation plans.

When extreme weather events, such as flooding, occur, WHO/Europe works closely with the local health authorities to coordinate the humanitarian health response in the health cluster/sector. WHO also supports the public health authorities and relevant partners to establish and to test preparedness and response plans.

In times of crisis, Europe is one of the first regions to which refugees, asylum seekers and stateless people turn for protection. This brings its own series of drowning risks, as vulnerable people often use overcrowded and unsafe vessels to reach Europe. According to the United Nations High Commissioner for Refugees, limiting the loss of life of migrants, refugees and asylum seekers who take to the sea in unseaworthy vessels calls for:

• effective national and regional search and rescue capacities;
• strengthened cooperation systems (particularly for international situations);
• policies to remove disincentives for commercial vessels to rescue those in peril;
• a shared understanding of safe places where those rescued can disembark; and
• the possible application of approaches set out in the International Maritime Organization’s International Convention on Maritime Search and Rescue and the International Convention for Safety of Life at Sea.

WHO/Europe’s Public Health Aspects of Migration in Europe (PHAME) project works closely with Member States to strengthen the health sector’s preparedness and public health capacity to better address widespread migration. Created in 2011, the PHAME project has provided technical assistance to Mediterranean countries, including Italy, Portugal, Malta and Spain, among others.

In the Italian region of Sicily, for example, more than 150 000 migrants have arrived since the beginning of 2014. Many of them were rescued by the Italian Mare Nostrum Operation, committed to preventing drowning and saving lives in the Mediterranean, now replaced by the European Union Triton mission. To support Sicily in its response to the health needs of migrants arriving on its shores, the PHAME project assisted Sicily in drafting the first health contingency plan to manage large influxes of migrants in the European Region.

Examples of effective drowning prevention policy in practice

In the Netherlands, the policy environment has a strong focus on flood prevention and control. The Netherlands National Water Management Centre in Lelystad monitors water flow in the Netherlands and coordinates the day-to-day changes necessary to keep water levels within the country at an optimal and safe level. In cases of potential flood crises, the national coordinating centre provides relevant information to decision-makers. In addition, the Netherlands’ Delta Programme aims to protect the country from high water and to ensure the fresh water supply. While its focus is not on drowning prevention, it is a strong example of how important preventing water-related natural hazards is for some countries.

The United Kingdom launched a drowning prevention strategy in 2013. The strategy is implemented by the National Water Safety Forum, which comprises six specialist advisory groups that focus on safety in relation to beaches, inland water, the sea and swimming pools and on water sports safety information and research. A coordinating group provides a direct link to the national Government and the search and rescue sector. The Forum’s secretariat is based at the Royal Society for the Prevention of Accidents and seeks to provide the Government with a strong voice on water safety issues.

Furthermore, in many countries in Western Europe, such as Sweden, Finland and Denmark, swimming and water safety skills are an essential part of the school curriculum, with standards that need to be achieved by the age of 11.