Child Drowning

2.5 PREVENTION CHALLENGES IN LMICS
HICs became rich before they became safe. They had already developed, which provided the capacity to
become safe with regard to water safety and drowning prevention. When they began to focus on safety,
they had already achieved:
Low fertility rates and thus small family sizes.
High primary and secondary school graduation rates with literate populations.
Well-developed civil governance structures.
Enforced building codes and zoning ordinances.
Large civil services and well-staffed public safety institutions.
Predominantly urban populations.
Access to day-care facilities for working parents
Water exposure primarily limited to recreational settings.
These already developed countries built a culture of water safety on those foundations, using the
wealth of financial and social capital they possessed. Introducing drowning prevention and the creation
of a culture of water safety was a natural progression in the process of developing strong public health
and public safety institutions connected to effective civil governance and enforcement structures.
Sweden serves as an example: the factors noted above have been identified as being associated with
Sweden achieving the distinction of having the lowest child injury mortality rate, including drowning, in
Europe. 35
However, compare this with Asian LMICs. They are predominantly rural. Water and other environmental
hazards are ubiquitous around the home and throughout the community. Building codes and zoning
ordinances are lacking or unenforced. Universal primary education is a goal, not a reality resulting in
high levels of illiteracy across large segments of the population. Parents often have 4 or 5 children and
must rely on older children to supervise younger ones. There are few, if any, social services, such as
emergency medical and rescue services that extend life-saving services outside the hospital, or any
other safety infrastructure.
These countries lack an abundance of financial and social capital. Without these resources they are
unable to develop environmental, social and governmental structures that promote a culture of water
safety. In such countries, interventions cannot rely on the passage of laws and regulations, as the
governance structures for implementation and the financial and human resources required are
inadequate to ensure effectiveness. In fact, laws and regulations are often already on the books but are
widely ignored and are rarely, if ever, enforced.
This presents a challenge to drowning prevention efforts. It is a reality that will guide the development
of effective interventions. It is useful to note that in LMICs, the same challenges were experienced in the
development of the effective child health interventions that underpinned the child survival revolution
over the past thirty years. Many of the key lessons from that experience can be applied to accomplish a
similar revolution in child drowning prevention.
35 Jansson B., et al. (July 2006). ‘Why does Sweden have the Lowest Childhood Injury Mortality in the World? The roles of architecture and public
pre-school services’. Journal of Public Health Policy. 27(2): 146–165.
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