Posted by: tommecrow | May 14, 2012

Could learning how to swim really increase your risk of drowning?

Swimming is a skill that most people – particularly those in high resource societies – are taught from an early age. To many it is considered a ‘life skill’, or even a ‘life saving’ skill that can protect you from drowning.

Globally, drowning is a leading cause of childhood death. In some low-resource countries it is the leading cause of childhood death in children over the age of one year.

Yet in most low-resource countries a high proportion of children do not learn how to swim, and those that do learn through an often dangerous informal process of copying friends or family.

A number of organisations are currently working to introduce formal swimming lessons rural communities. The International Drowning Research Centre in Bangladesh (who have trained approximately 200,000 children how to swim as part of their research) have noted a huge (over 95%) decrease in drowning rates among their swimming cohort compared with their control groups.

Yet despite the growing evidence from low-income countries that learning how to swim does provide protection against drowning, there remain a number of academics skeptical of the link. Their main argument stems from the moral hazard conundrum often associated with car-insurance; if you learn how to swim you become more risk averse when it comes to water-safety, and therefore could put yourself at higher risk of drowning.

This argument keeps popping up in public health debates about drowning prevention and may be hampering the roll-out of large scale swimming projects. However, the argument lacks an understanding of the context in which drowning deaths happen in low resource environments (where the World Health Organisation estimate over 96% of drowning deaths occur).

In high-resource countries water is predominantly used for recreation. Drowning deaths usually occur while the victim is undertaking water based recreational activities, for example boating or swimming. In low-resource environments water is used for basic ‘essential’ tasks, such a washing, cleaning clothes, cooking, drinking, fishing…. they are activities which people must undertake, regardless of their swimming ability. People generally don’t swim for recreational purposes like in high-resource countries.

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Evidence from South East Asia has shown that the majority of drowning victims can’t swim. The victim accidentally steps into an area too deep to stand while cleaning their clothes, or gets pulled away by the current of a river while trying to fill a water container. In such situations a knowledge of swimming would certainly increase their chances of survival.

It’s true that after learning how to swim a small number of children may undertake more recreation swimming. However such speculation must be seen in the context of the environment and the scale of the drowning problem (18,000 children drowning every year in Bangladesh alone). Those children will still have collect water for drinking and cooking, still have to wash, and still have to fish… but they will be much safer when doing so.


Responses

  1. Superb blog post Tom. I was at the RoSPA conference a few weeks ago, and there was some brilliant analysis presented there – of the 2010 UK drowning statistics, broken down by activity… and in fact, swimming appears to be one of the safest activities to do – almost as safe as walking beside the water. This is the case when controlled for numbers of people participating in the activity, but also when controlled for number of hours the activity was done for. It would seem that SCUBA and sailing are up there as being the most dangerous water-based recreational activities.

  2. Thanks Dan! Yes I saw the RoSPA figures, they are fascinating!

    It seems that however and wherever you look at the figures learning how to swim is a great vaccination against drowning, and the additional risk is minimal.

  3. Great work Tom. This was echoed by the reluctance of the American Academy of Pediatrics to allowing swim lessons below age 4. Their concern was that if we taught kids to swim, then the parents would stop watching them. they have since softened up a bit and they don’t recommend swimming lesson age 1-4, but they no longer oppose it. The more that we can empower children, the safer they will be.

    • Justin – if we follow that logic, then we should encourage parents NOT to use seatbelts to fasten their children into a car… then they wouldn’t drive so fast. In fact, let’s go further – put six inch spikes on the back of the front seats – so the kids are skewered…. they would slow down then!
      Where is the evidence base for their concern? #Frustrating

  4. Great comment Dan – unfortunately it often comes down to practitioners to bring academics back down to earth! When sitting behind a desk it’s so easy to distance yourself from the reality of what’s really happening on the ground! Evidence suggests that wearing a cycle helmet increases your risk of having a cycle accident….. perhaps, but at least your wearing a cycle helmet….

  5. When they say 200,000 children learned to swim, does it mean 200,000 children took swimming lessons for a few days, or that 200,000 children learned how to be reliable for their safety in deep water?

    • “Learned to swim” = completed the SwimSafe programme. This includes being able to swim 25m unaided and back float for 90 seconds. It’s a 21 session intensive programme. More information can be found at http://www.swimsafe.org Hope that helps!

  6. […] decrease their risk of drowning. Counter intuitively, some public health researchers worried that teaching swimming could increase a populations’ risk of drowning as more people entered the water and took greater risks, or drowned whilst learning to […]


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