Drowning

Overview

Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. Outcomes are classified as death, morbidity and no morbidity.

Scope of the problem

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.

The global burden and death from drowning are found in all economies and regions, however:

• low- and middle-income countries account for over 90% of unintentional drowning deaths;
• over half of the world's drowning occurs in the WHO Western Pacific Region and WHO South-East Asia Region; and
• drowning death rates are highest in the WHO Western Pacific Region and are 27–32 times higher than those seen in the United Kingdom or Germany, respectively.

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.

Risk factors

Age

The Global report on drowning (2014) shows that age is one of the major risk factors for drowning. This relationship is often associated with a lapse in supervision. Globally, the highest drowning rates are among children 1–4 years, followed by children 5–9 years. In the WHO Western Pacific Region children aged 5–14 years die more frequently from drowning than any other cause.

Child drowning statistics from a number of countries presented in the Global report on drowning are particularly revealing:

• Drowning is one of the top 5 causes of death for people aged 1–14 years for 48 of 85 countries with data meeting inclusion criteria (1).
• Australia: drowning is the leading cause of unintentional injury death in children aged 1–3 years.
• Bangladesh: drowning accounts for 43% of all deaths in children aged 1–4 years.
• China: drowning is the leading cause of injury death in children aged 1–14 years.
• United States of America: drowning is the second leading cause of unintentional injury death in children aged 1–14 years.

Gender

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.

Access to water

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.

Flood disasters

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.

Travelling on water

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.

Other risk factors

There are other factors that are associated with an increased risk of drowning, such as:

• lower socioeconomic status, being a member of an ethnic minority, lack of higher education, and rural populations all tend to be associated, although this association can vary across countries;
• infants left unsupervised or alone with another child around water;
• alcohol use, near or in the water;
• medical conditions, such as epilepsy; and
• tourists unfamiliar with local water risks and features.

Prevention

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.

• Preventing drowning: Practical guidance for the provision of day-care, basic swimming and water safety skills, and safe rescue and resuscitation training (2022)

Through investing in day-care programmes for pre-school children and teaching children basic swim skills, 774 000 children can be saved from drowning between now and 2050. Further, through upscaling these two simple interventions, 178 000 children will avoid sustaining severe, life-limiting injuries due to drowning over the same period. Each dollar invested into drowning prevention can return up to 9 times the original value – protecting societal health and well-being, while benefiting the economy. By investing in prevention, more than US$ 400 billion in potential economic losses due to drowning can be avoided.

• Hidden depths: the global investment case for drowning prevention

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.

Developing a national water safety strategy can provide strategic direction and a framework to guide multisectoral action and allow for monitoring and evaluation of efforts.

WHO response

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.  

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.

References

1. Mortality data for countries were considered if they met the following criteria: estimated coverage of national deaths of 70% or more; ill-defined causes of death less than 20%; 10 or more deaths in the 1–14-year-old age group; and data available from 2007 or later.