Turning the tides on child drowning
Rebecca Wear Robinson
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WCDP2017 – The Big Picture

by Rebecca Wear Robinson on November 1, 2017

Canadian flag and balloons in front of view of False Creek and the Burrard street bridge in Vancouver, Canada for Canada's 150 Birthday celebration.

Canadian flag and balloons in front of view of False Creek and the Burrard street bridge in Vancouver, Canada for Canada’s 150 Birthday celebration.

The World Conference on Drowning Prevention (#WCDP2017) in Vancouver, Canada was attended by over 800 people from 60 countries. There were over 200 presenters and 109 poster presentations in the three days of breakout sessions, and numerous side meetings. Old friends reconnected and new friendships were formed. The sense of shared commitment to ending drowning permeated the conference, activated through the sharing of ideas and forming strategic alliances.

We heard from Canadian dignitaries and an eloquent 13-year old reminding us of our responsibility to the youth of the world. Representatives from Bloomberg Philanthropies, the Princess Charlene of Monaco Foundation and the World Health Organization confirmed their support and outlined their commitment. Tima Kurdi, aunt to Aylan Kurdi, spoke eloquently about the link between refugees and drowning. The photos of two-year old Aylan, a Syrian refugee who washed up on a Greek beach in his red shirt, shocked the world and showed us the real toll of war. Dr. Windy Lai from Médecins Sans Frontiers encouraged us to look at the upstream causes of drowning, including refugees. Dr. Aminur Rahman gave us hope, looking at how efforts in Bangladesh are making a difference, while Dr. Olive Kobusingye reminded us that with 57% of the Ugandan population being under age 18, the effective programs for which we have quantifiable data in Bangladesh will need to be adapted to local demographic and cultural realities.

The conference encompasses a range of issues related to drowning prevention, including: Data, Medical, Prevention, Rescue, Research, and Swimming. The key concepts and conclusions from each stream were summarized by the leaders of each stream and are found at the end of this report.

I approached the conference from a different perspective, looking for commonalities across sectors or countries, or themes which represent a new stage in the evolution of drowning prevention. My observations:

Local engagement is key.

  • Qualitative Data – Programs in countries as diverse as Sudan, the U.S. (Seattle, Washington), and Ireland stressed the importance of using qualitative data to engage and understand local concerns. The focus has been on collecting quantitative data, which is key for targeting where programs are needed, but successful local implementation requires a deeper understanding and follow-up, achieved through surveys, interviews, and observation. One innovative technique used in Sudan had local people draw their village, and then identify the dangers, so that you see their life through their eyes.
  • Local Support – Programs are most successful when village leaders, local influencers, and families are engaged; culturally sensitive programs are developed; and local employment is created, all with the goal of creating a locally-run sustainable program.
  • Use Local Culture – Engage the target audience using their mediums. Ireland engaged through their cinema culture. Tanzania used local drama and film groups, and offered inter-village competitions to foster relationships. Norway integrates their Viking culture in programs teaching children about cold water.
  • Demand Exceeds Supply – In many countries, people want to learn to swim and basic water safety, which provides greater impetus for programs to expand. However, don’t assume this is always the case, as qualitative data in Ireland showed that 50% of people did not want to learn to swim, which means that education about the benefits needs to precede the programs. Push the benefits, not the programs.
  • Health and Safety Standards – The people in communities must be protected. Programs should integrate Core Humanitarian Standards. UNICEF has Risk Managers Guidelines, it is my opinion that all drowning prevention programs globally should commit to adopting international standards for the protection of participants, volunteers, and staff.

Government involvement fosters success.

  • Identify which branches of government to engage – Successful programs repeatedly emphasized that engaging local and national governments was key to their success. This was particularly important in the education sector, bringing water safety education into the schools. It is important to identify which sectors of government to approach. In countries like Brazil, rescue services are part of the military. The form of government should also be taken into account. It was noted that it was easier to get programs implemented in Communist countries with their centralized governments, while data efforts vary widely by state in the U.S.
  • Sustainable Development Goals – Countries are being judged on their ability to meet the Sustainable Development Goals (SDGs). Monies are also being directed to programs which target SDGs. Forming multi-sectoral partnerships to address SDGs may facilitate government involvement and attract funding from external sources. SDGs 1.5, 11.5, and 13.1 were identified as being connected with drowning.
  • Global advocacy is needed – RNLI noted that there are no UN Resolutions related to drowning, though a survey indicated over 100 member countries would support such a resolution.
  • Use financial arguments – Drowning costs money. Childhood drowning is a loss of early child health investments. Adult drowning eliminates wage-earners, driving families into poverty or requiring social services. Embed drowning prevention through resiliency and preparedness into national risk reduction policies – for each $1 spent, it is the same as spending $15 on relief efforts. Need cyclone warning systems and evacuation plans as well to minimize storm-related costs.

Broaden our Base.

  • Multi-sectoral partnerships – Greater emphasis on WHO recommendations to create multi-sectoral partnerships is needed, though an increasing number of partnerships within the field was noted. I spoke about how to identify and develop partnerships.   There has been a steady increase in the creation of multi-sectoral partnerships, but there is a long way to go.
  • Climate change is a drowning issue – With rising sea levels, 10% of population lives less than 10m above current sea level, mega cities on coast, warmer water more severe storms and deadlier storm surges, drowning deaths will increase. Flooding can be a political issue with dams opening and closing upstream based on other country’s concerns.
  • Refugees are a drowning issue – 50% of refugees arriving in Greece have secondary education, children are 34% of refugees; 72% fleeing for war/political reasons; human traffickers make estimated $5million per day profit. Currently volunteers are doing a number of rescues. Médecins Sans Frontiers and UNICEF agreed to reduce sea rescues after political pressure.

Data

  • We have enough data to act, but need to work towards communicating the importance of data to governments, what data should be connected, and allowing access of data for program development.
  • Significant issues still exist regarding consistency of data points, issues in collecting data, and problems with accessing data when it exists.
  • – Qualitative data should be more widely used.

Dr. David Meddings, of the World Health Organization, best summed up the challenges facing the drowning prevention field, and outlined the way forward. To paraphrase, “I have never seen a global epidemic remain so insular for so long”.

In the ten years I have been in the field, I have seen enormous progress being made in developing the infrastructure necessary to address drowning, in building relationships, in creating a body of evidence-based research.

It’s time to show the rest of the world.

The official conference summary of the research streams:

Prevention
We have a better understanding then ever before of who as at risk and factors influencing risk.
Need to look at how climate change affects drowning risk and develop prevention strategies.
Challenge is to balance a need for prevention with risk management needs for safety of learners.
There needs to be a greater understanding within the community of the need to ground work in evidence-based research.
Programs are implementing the 10 Preventative Actions outlined in the World Health Organization Drowning Report.
There must be more accessibility of academic research, and ways of translating academic research for the lay person.
There should be greater sharing of evidence-based learning and case studies of implementation of WHO recommended strategies.
Need to build capacity for growth and engage stakeholders and policy makers.
Strategies needed for engaging and convincing governments to implement drowning prevention programs.
Figure out how to scale up programs in low- and middle-income countries (LMICs)

Rescue
Show lifeguards what drowning looks like, otherwise how do they know?
Push lifeguards outside their comfort zone.
Design innovation is great, but sustainability is better.
Time influences survival – fast is better than fancy.
Need usable safety guidelines for swimming pools.
Technology is here, don’t get left behind.
The media loves sharks and drones.
Challenge the traditions and dogma around lifeguard training.
How make lifeguard standards achievable and sustainable for rescue services in LMICs?

Data
Quality of data; more collection of non-fatal drowning data; national and subnational; populations; comparing like with like – definitions; availability; timeliness;
Need for more data – targeted, timely, fills gaps, adds to knowledge; linkages
Challenges – definitions; access; comparisons; LMICs

Medical
ILS has issued 6 statements which are evidence-based and researched.
Conflicting research – but it is helpful to have both positive and negative study results to learn what works and what doesn’t work.

Swimming
Increasingly evidence-based.
Acceptance of water competence concept.
Goodwill and willingness to share among practitioners.
Many groups ‘miss out’ on aquatic education.
Identified need for greater evaluation of programs.
The public has difficulty in realistic understanding of personal competence in the water.

Disaster
Climate change leads to greater impact with more vulnerable populations at risk.
SENDAI, WHO, and SDG are relevant for lifesaving organizations.
Refugees – because the situation is political, the humanitarian efforts are hindered.
The dimension of drowning is inflated by generic and global changes.
Lifesavers can provide a human face to the problem.
Need to identify, invite, and involve problem owners and those outside the common areas of expertise.
Decide where the organizational responsibility of ILS is to prevent and reduce disaster drowning mortality.

Global Drowning Prevention
Partnerships are needed – multi-sectoral engagement
Burden data evidence drives action, but data and estimates are challenging
Culturally based interventions are needed to address key targets
We have enough data for actions
Well-designed research on impact and added value of interventions is needed.

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