Drowning prevention: A global health promotion imperative, now more than ever

Health promotion and injury prevention have in common the mobilisation of communities and coalitions to develop and implement a range of evidence-informed strategies to prevent disease, protect health and ultimately, reduce mortality and morbidity.¹ Over the past three decades, health promotion and injury prevention have been brought together in the Health Promotion Journal of Australia across articles on many injury prevention areas, including drowning prevention. This has included the publication of two special issues almost 20 years apart—in 1991 and again in 2018.

Since that first special issue on injury prevention so early in the HPJA's inception, the journal has published a growing number of papers on drowning prevention, from those focusing on exploring water safety attitudes and practices² to papers exploring pool fencing compliance.³ In this Editorial, we reflect on developments in drowning prevention from our perspectives as health promotion practitioners, researchers and policymakers, and highlight global and national drowning prevention endeavours over the past 5 years to reduce the impact of fatal and non-fatal drowning. As we head towards the sixth World Conference on Drowning Prevention (WCDP), hosted in 2023 for the first time in Australia, we explore future opportunities and challenges to guide further investment and innovation to address the very important issue of the prevention of fatal and non-fatal drowning.

The evidence is clear that drowning is a leading killer globally, with the greatest mortality burden affecting children, young adults, socially and economically disadvantaged populations and those living in low- and middle-income countries.⁴ Drowning is a complex public health issue,^{5, 6} resulting from a range of dynamic, and interconnected personal, behavioural, social, commercial, economic, ecological and political determinants of health. Since the launch of the Global Report on Drowning by the World Health Organization (WHO) a decade ago, there has been considerable progress in drowning prevention around the world.^{7, 8} Drowning prevention awareness has grown, and there are an increasing number of dedicated educational, environmental, policy and research efforts to prevent drownings and save lives, across the jurisdictions where people live, work and play.⁹ For example, there has been commendable and measurable progress made in drowning prevention over the past 5 years, especially in countries such as Bangladesh, the Philippines, Uganda, the United Republic of Tanzania and Vietnam.^{9, 10}

Despite advancements, drowning remains the third leading cause of unintentional injury death worldwide, accounting for 7% of all injury-related deaths.¹¹ Preventing drowning is a complex, multifaceted issue.^{5, 6} Consequently, it demands a comprehensive, cross-disciplinary response applying evidence-informed measures that address hazards, exposures and vulnerabilities^{12, 13} and, more than ever, climate-related factors.^{13, 14} However, in public health and health promotion domains, drowning has often been overshadowed by other causes of mortality and drowning prevention has focused on burden and risk factors.⁵ Until very recently, vital aspects of public health, such as implementation and knowledge translation, have been mostly overlooked in drowning prevention action.^{6, 12} Accordingly, there is still much work to do.

Several United Nations system resolutions have been adopted over recent years. In 2021, the United Nations General Assembly (UNGA) adopted the Resolution on Global Drowning Prevention (the Resolution).¹² Sponsored by the Governments of Bangladesh and Ireland, and co-sponsored by another 79 countries, including Australia, the UNGA resolution invited the WHO to coordinate action on drowning within the UN system, and called on countries around the world to recognise and take action to prevent hundreds of thousands of drowning deaths each year.¹⁵ The Resolution recognises the association between drowning and sustainable development, as well as the inequities between countries and regions.¹⁰ The Resolution offers a guiding framework for implementation by a range of actors to address the challenge of drowning prevention.^{7, 10, 15}

In 2023, the 76th World Health Assembly (WHA) adopted its first-ever resolution on drowning prevention, requesting governments and their partners, in collaboration with the WHO accelerate action on drowning prevention. The resolution was again sponsored by the Governments of Bangladesh and Ireland and was adopted by Member States to address drowning as a public health concern.⁹ The WHA resolution formally accepted the UNGA resolution and also asked the WHO to establish a global alliance for drowning prevention and undertake a global status report on drowning.

Of interest, the commercial determinants of health (CDoH) are rapidly emerging as an area of focus for drowning prevention efforts across research, practice and policy. Kickbusch²⁰ defines the CDoH as ‘strategies and approaches used by the private sector to promote health harming products and choices that are detrimental to health’. The use of alcohol in aquatic environments is a strong risk factor for injury, including fatal and non-fatal drowning.^21-23 This immediately puts the alcohol industry into the spotlight,^{21, 23} together with the emergence of an aquatic ‘alcogenic’ environment. An ‘alcogenic’ environment has been described as a concentrated area of licensed premises, events that have a primary focus on drinking, intense advertising and promotion by the alcohol industry.^{24, 25} We use the term to describe the very commonplace practice of alcohol consumption and promotion in and around waterways.²³ Recent research highlights the need for increased advocacy and policy efforts to mitigate the effects of the alcohol industry that use stylised imagery featuring alcohol in and around waterways and water activities to promote their products.²³ Commercial actors also use their considerable influence through sponsorship and corporate social responsibility activities²⁶ which, while on the surface can provide tangible community benefits, also serve to give these actors credibility and legitimise practices that can harm health.²⁷ However, many other commercial actors have the power to positively impact on drowning prevention, for example, the tourism and recreational sectors. Careful consideration of these tensions in developing our coalitions and partnerships for drowning prevention is critical. If not monitored, commercial actors have the power to stymy sustained efforts to prevent drowning over the last decade.²² This is going to be a considerable challenge. An overreliance on interpersonal interventions (such as education), while necessary, will not be sufficient to combat the pervasive influence of commercial actors. Tackling this will require greater upstream action to address the products and practices that have increasingly negative impacts on human health and equity.²⁶ As Professor Rob Moodie has argued, such action by public health ‘is not anti-business it is pro-health’.²⁶

By ensuring equitable access to evidence-informed drowning prevention interventions, fostering global coordination and collaboration, and emphasising research that encompasses implementation and knowledge translation, we can work together to make the next decade one marked by even greater success in preventing drowning and saving lives. We look forward to the upcoming WCDP 2023 which will afford researchers, practitioners and policymakers, time to disseminate their findings, re-focus their energy, and illuminate areas for urgent and well-resourced health promotion action to prevent drowning worldwide.

The authors declare no conflicts of interest.