Prevention of drowning — a leading cause of childhood deaths — could get a boost in federal budget

Black Americans are 1.5 times more likely than white Americans to drown

By: Christine Vestal - July 26, 2021 7:00 am

Pool at Como Regional Park in St. Paul. Photo courtesy St. Paul Parks and Recreation.

As temperatures soar in much of the country, more Americans are cooling off in swimming pools, lakes, rivers and oceans. Yet, when people flock to the water, drowning deaths spike — particularly in the month of July.

Nearly 4,000 people die from drowning in the United States every year, according to the Centers for Disease Control and Prevention, and another estimated 8,000 are treated for nonfatal drowning injuries. For children, drowning is the second leading cause of death after birth defects, with three dying every day, and it’s the second leading cause of accidental death after vehicle crashes for those ages 1 to 14.

Although the CDC reports that drowning death rates have declined by 32% over the past decade, water safety experts say that’s not enough.

A June CDC report noted that longstanding racial disparities in drowning deaths have not improved since 1999. According to the report, Black Americans are 1.5 times more likely to die from drowning than white Americans, a legacy of Jim Crow laws barring Black people from public swimming pools and beaches, preventing many of them from learning how to swim and engaging in competitive aquatic sports.

Although the number of annual drowning deaths is relatively low in a country of 330 million — there are 10 times as many annual traffic deaths, for example — public health experts say water safety is worth focusing on because nearly all drowning deaths are preventable.

“These deaths do not have to occur. It really is something we should be ashamed of and be energized to address when we see that thousands of us are dying every year from drowning,” said Shannon Frattaroli, director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School of Public Health. State public health agencies aren’t doing enough to develop and enforce proven water safety policies, she said, primarily because they receive no federal funding.

Some advocates say this is the year that may start to change.

With greater awareness of deficits in the nation’s public health infrastructure since the pandemic and the Biden administration’s willingness to spend billions to improve the health and welfare of Americans, drowning prevention may finally get the attention and investment it deserves, said Richard Hamburg, executive director of Safe States Alliance.

The CDC, he said, may for the first time receive funding for drowning prevention that can be allocated to state public health agencies to save lives.

A subcommittee of the U.S. House is slated to vote July 15 on a bill that would appropriate $2 million for drowning prevention.

Prioritizing Drowning

Most state and local health departments are chronically underfunded for accident prevention in general and many have no expertise in drowning prevention, Hamburg said.

But a handful of states, including Colorado, Florida, Nebraska, New York, North Carolina and Washington state, have robust drowning prevention programs primarily funded by state revenues, he said.

In Florida, which has the fourth highest drowning death rate in the country, lawmakers considered a bill this year that would have required public schools to give parents information on water safety education courses. But the bill never reached the floor for a vote.

New York lawmakers proposed a bill that would make swimming and water safety education a mandatory part of the state’s K-12 curriculum. The bill never reached the floor for a vote but it is expected to be refiled next year.

A lot of decisionmakers see lifeguarded beaches and pools as a luxury. But access to swimming is a public health benefit that should be available to everyone.

– Tony Gomez, manager of King County Injury and Violence Prevention Program

Washington state lawmakers considered a proposal that would require paddle boarders, kayakers and even tubers to pass a water safety class and carry a certificate with them. But the measure was roundly opposed by consumers and the recreation industry and did not pass the legislature.

In Massachusetts, Republican Gov. Charlie Baker responded to a spate of drownings this year by filing legislation that would hike fines to $500 for swimming outside of designated areas in the state’s waterfronts. The bill is still under consideration.

Water safety laws vary widely from state to state, and most states lack the statutes and regulations water safety experts say are needed to effectively prevent drowning. “It’s not rocket science,” Frattaroli said. “This is a field that is chronically under-resourced and under-recognized.”

Part of the problem, she and other safety experts said, is that drowning historically has taken a back seat to other pressing accident prevention issues, such as drug overdose deaths, automobile accidents and gun violence, which has made garnering support for new state water safety laws and investments difficult.

In a March letter to Congress, more than 200 national and local organizations and state agencies, including the American Red Cross, the YMCA and California Highway Patrol, called drownings a “silent crisis” that requires federal leadership and money.

Without funding, most states are unable to adequately enforce the water safety regulations they have, such as required fencing around pools, hiring lifeguards to supervise public pools and beaches, and requiring people to wear life jackets in boats and unsupervised open waters.

Even more difficult for states to accomplish without federal funding is expanding access to swimming lessons and water safety education. According to the Red Cross, more than half of all Americans don’t know how to swim well enough to save themselves in the water.

The nonprofit and government groups, which included Safe States Alliance, asked for $5 million in funding for the CDC to finance better surveillance and research on the specific causes of drowning deaths to better inform prevention measures.

In addition, Hamburg said, if the Biden administration’s proposal to fund public health infrastructure becomes a reality, it would go a long way to helping states develop effective drowning prevention programs.

In the meantime, a group of more than 100 researchers backed by Water Safety USA — an alliance of nonprofits and government agencies, including the CDC, the National Park Service, the Consumer Product Safety Commission, the Coast Guard and the Army Corps of Engineers — is slated to publish a first-ever national water safety plan for drowning prevention.

The study, which is intended for state and local health agencies, as well as the federal government, will focus on successful drowning prevention policies, including greater use of lifeguards, expansion of life vest requirements, promotion of CPR training, enforcing swimming pool fencing requirements, improving drowning surveillance and expanding swimming and water safety education.

“Drowning prevention doesn’t have a federal government agency that oversees it,” said Tina Dessart, a member of the action plan committee and a program director at USA Swimming, which governs U.S. swimming competitions, including Olympic trials. “That’s a big part of what we’re trying to address in the national action plan.”

The World Health Organization published a global report on drowning in 2014 that called on all countries to develop a national water safety plan. Australia, Canada, Ireland, New Zealand and the United Kingdom already have such plans.

In April, the U.N. General Assembly echoed that recommendation and established July 25 as “World Drowning Prevention Day.” According to the WHO, drowning is the third leading cause of unintentional injury death worldwide, accounting for an estimated 236,000 deaths each year.

Swimming Lessons

The last time the United States made significant progress in reducing drowning fatalities was in 1914, when the American Red Cross added water safety to its mission and offered free swimming lessons for millions of people of all ages.

In 2014, the nonprofit celebrated the centennial of its “waterproofing of America” campaign and has continued to promote water safety and provide swimming lessons for thousands of people every summer since.

By increasing access to pools and training people in swimming competency and water safety, the Red Cross claims it has helped reduce accidental drownings by nearly 90% over the past century.

Connie Harvey, director of the nonprofit’s Centennial Initiatives and a member of the action plan steering committee, said a national water safety plan is an essential first step to substantially slashing the nation’s stubbornly high number of drowning deaths.

A big part of the national plan, she said, will be to expand access to swimming and water safety lessons. But public pools are limited in many low-income neighborhoods and rural towns. And building new pools is an expensive proposition.

Harvey said a proven strategy is to encourage swimming classes at a young age by working with schools that have pools and arranging for schools without pools to collaborate with nearby hotels, condominiums, public parks, recreation centers and community groups to help more kids learn how to swim.

“Drowning is a 100% preventable tragedy,” said Tony Gomez, program manager for injury and violence prevention in King County, Washington. His agency has analyzed every drowning case in the county, he said, and found that if one or more safety precautions had been followed, the deaths would not have occurred.

“A lot of decisionmakers see lifeguarded beaches and pools as a luxury,” he said. “But access to swimming is a public health benefit that should be available to everyone. It provides valuable exercise that helps prevent chronic disease, and if you pay lifeguards $20 an hour, you can save millions in EMS and hospital costs by preventing drownings.”

For public health officials, Gomez said, water safety is straightforward. “We need to make sure that all communities offer everyone the ability to learn to swim and ensure that people only swim where there are lifeguards, wear lifejackets as required, obey safety signs and follow boating safety rules. That way, everyone can safely cool off, get some exercise and have fun this summer.”

This story was originally published by Stateline, an initiative of The Pew Charitable Trusts.

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Christine Vestal

Christine Vestal covers mental health and drug addiction for Stateline. Before joining Pew she covered health care, the environment, energy, information technology and telecommunications for a variety of news outlets, including McGraw-Hill, the Financial Times and Post-Newsweek Business Information.