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Every year, drowning claims the lives of more than 96 000 children and adolescents globally within the first two decades of their life, equivalent to 263 fatal drownings each day, or 11 deaths every hour.
There needs to be a concerted effort to ensure that the changing drowning risks that children and adolescents face as they grow up are addressed by evidence-based interventions that reach all children, along with the policies, investment and research needed to underpin that.
Combining good practice, and mainstreaming evidence-based solutions across diverse sectors, including health, child protection, education, infrastructure, transport and occupational safety, is critical to providing a system strengthening approach to drowning prevention.
Commitment is needed from governments, financial investors and key service providers, to support wide-spread implementation, sustainability and scale-up of what has been proven to work—including linkages to action for health, climate and environment.
Introduction
Children have the right to a safe and healthy environment in which to live, learn and play. Every year, drowning claims the lives of more than 96 000 children and adolescents globally within the first two decades of their life, equivalent to 263 fatal drownings each day, or 11 deaths every hour.1 More than 90% of drowning deaths occur in low- and middle-income countries (LMICs), with rates that are over three times higher than in high-income countries.2 In the UNICEF East Asia and Pacific Region, children aged 5–14 years die more frequently from drowning than any other cause. In Bangladesh, annually drowning accounts for 43% of deaths among children aged 1–4 years.2
The world has made remarkable progress in child survival in the past 3 decades, and millions of children have better survival chances than in 1990. In 2021, 1 in 26 children died before the age of 5, compared with 1 in 11 in 1990.3 Investments to ensure under 5’s survival (Sustainable Development Goal (SDG) 3.2) have been remarkably effective. Success must not be allowed to be undermined by injury deaths for those under or over the age of 5, and reducing child injury, including drowning deaths, is vital for all ages. The economic costs of lives lost due to drowning is high, with national estimates for Australia, Canada and the USA ranging from US$85 million to US$4.1 billion per year.4 While global drowning deaths have reduced over the last 2 decades, the rate of this decrease (8%), has been much lower in low-income countries than high-income nations (46%).1
Commitment to invest and act now is needed, across sectors, to implement combined drowning prevention interventions as part of the broader public health agenda. This must build on strong global political commitments for action secured through United Nation (UN) processes such as the United Nations General Assembly (UNGA) and the World Health Assembly (WHA).
Political commitment supports action
Over the last 10–15 years several LMICs, especially in the high-burden Southeast Asia region have started to address drowning in their nations using evidence-based prevention interventions. Bangladesh, Thailand, Vietnam and Sri Lanka have all adopted proven child supervision approaches through adult-based day care, and survival swim skills training, as noted in the recent WHO investment case for drowning prevention.5 At government level, Bangladesh is making strong political commitments and taking bold practical action to address child drowning. However, more countries need to implement these interventions, especially where the burden is high. Action must be grounded in strong problem analysis and research, and the application of evidence-based and tested interventions must be implemented across and by diverse sectors, including but not limited to health, women and children’s affairs, early childhood development, transport, and occupational safety.
Emerging research in Africa, particularly in Tanzania, Uganda and Ghana, has identified that child drowning also occurs alongside a significant drowning problem among fishers, many of whom start working as young as 16 years.6–8 Promising work is ongoing to address this, through understanding underlying risk, identifying potential response interventions and developing cohesive drowning prevention strategies.
At the political level, using UN governance mechanisms linking the SDGs and health, the governments of Ireland and Bangladesh have championed and secured two drowning prevention resolutions at the UNGA and WHA9 10 that provide a platform for future improvement, underpinned by a core set of voluntary actions to accelerate progress. These include coordinated global awareness raising, action and advocacy for the issue through a UN designated World Drowning Prevention Day, observed annually on 25 July. Both these resolutions highlight drowning as an issue of public health concern, and the importance of health sector’ engagement and leadership in efforts to advance drowning prevention.
Recognition of the impact of climate change on drowning risks are starting to be identified,11 but policy dialogue, multisector cohesion and collaboration is needed to advance this. The first-ever climate and health day on 3 December 2023 at the CoP28 in Dubai presents an opportunity to ensure that injury is recognised as a climate-impacted aspect of health. Collaboration between the injury prevention, disaster risk reduction and climate change adaptation and mitigation sectors are crucial. Together they can prevent climate change from stalling progress on global drowning reduction, and advocate for climate change mitigation as a long-term drowning risk reduction mechanism.
Following CoP28 climate and health day, the World Conference on Drowning Prevention (WCDP; 4–7 December 2023) in Perth, Australia, provides a more focused opportunity to call for committed action on drowning prevention throughout childhood and adolescence. Being held at a time of great momentum for the issue, WCDP 2023 will gather drowning prevention, lifesaving and water safety experts to share latest issue research and policy insights, outcomes and opportunities; and work towards shaping global strategy and mobilising for action.
This international gathering will contribute to the work of the newly formed multisectoral Global Alliance for Drowning Prevention. This was established in July 2023 by WHO, in response to recommended actions set out in the most recent drowning prevention resolution, passed in May 2023 at the WHA. The Alliance currently comprises five multisector UN agencies and five global non-governmental organisations working together to develop a global drowning prevention strategy to advance collaborative action and accelerate uptake of evidence-based interventions in global drowning prevention.
Conclusion
All children have the right to healthy and safe environments—For Every Child Everywhere. Child drownings can and should be reduced with a view to their eventual elimination. Tested solutions exist and are proven to save lives. Global recognition and political commitment through UN governance processes are in place.
Already great strides have been made in recognising drowning risks implementing interventions for children under 5 years of age. Nevertheless, drowning risk does not disappear on a child’s fifth birthday. There needs to be a concerted effort to ensure that the changing drowning risks that children and adolescents face as they grow up are addressed by evidence-based interventions that reach all children, along with the policies, investment and research needed to underpin that. It is time to attain scaled commitment and investment to act.
Investing in child drowning prevention measures is an investment for our future. It locks in and secures investments already made to ensure child survival, such as vaccination programmes to reduce child mortality. It is senseless to vaccinate children against preventable illnesses, if we then allow them to die from a preventable injury when they drown in a local pond, ditch, uncovered bucket or well. Country case examples demonstrate that adopting and adapting good practices for drowning prevention can have significant impacts and co-benefits in LMICs. Barriers around ponds not only reduce drowning risk but can prevent contamination from animals accessing the water. Replacing open water sources with water pumps and pipes with taps reduces drowning risk, as well as improving access to cleaner, safer water.
Combining good practice, and mainstreaming evidence-based solutions across diverse sectors, including health, child protection, education, infrastructure, transport and occupational safety, is critical to providing a system strengthening approach to drowning prevention. Commitment is needed from governments, financial investors and key service providers, to support wide-spread implementation, sustainability and scale-up of what has been proven to work—including linkages to action for health, climate and environment. The United Nations General Assembly Resolution on Global Drowning Prevention provides a framework for global action, through recommended and tested good practice that countries, regions and communities can implement. Now, we all need to commit to act—For Every Child Everywhere.
Data availability statement
Data are available in a public, open access repository.
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Footnotes
Contributors All authors have contributed to this commentary. There are no competing interests for any author.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.