09. BARRIERS TO IMPROVEMENT AND RECOMMENDATIONS

Although unintentional drowning fatalities in the United States have gradually declined in the past twenty years, it is important to remember that they still represent a significant number of preventable deaths and injuries, mental and physical disabilities and their related costs. Whether at home, work or play, human behavior is often the "usual suspect" in the chain of events leading to drowning, which often confounds prevention measures. Community action groups (e.g., enlisting the aid of businesses and institutions in improving and maintaining recreational water venues), governmental programs (e.g., funding water safety and swimming education programs for children), law enforcement efforts (e.g., boating while intoxicated laws) and safety campaigns (e.g., courtesy boating safety inspections and PFD use) have all made some progress in warning and educating people about the need to adopt safety-compliant behaviors, but obviously more must be done.

It remains for the individual to take preventive messages to heart and practice them. For example, four males die from drowning for every female in the United States. Globally, that ratio is similar. Since males do not appear to be programmed genetically for self-destruction and since warnings and educational efforts have been available to both genders, what will it take to change male behaviors? Ambivalence about or acceptance of inebriation from consuming alcoholic beverages, abuse of prescription and illicit drugs, and violations of societal norms play a significant role in behaviors associated with drowning. Parental responsibility and accountability for safely raising very young children who are at high risk for drowning requires more scrutiny, especially since some drowning injuries have been attributed to child abuse and neglect, postpartum depression and Munchausen Syndrome by Proxy (factitious disorder). Social, economic and ethnic factors and cultural beliefs also present barriers to the behavioral changes needed to prevent drowning. Such barriers limit access to water safety and swimming education, recreational water facilities, beaches and natural waters, and the ignorance of and inexperience with potential water hazards contributes to drowning.

As with many public health programs that promote early intervention and primary prevention programs and policies, public support and governmental priorities and funding are paramount to their effectiveness and realization. The telltale stimulus for action is tragedy, and it has been said that the prospects for public health improve as the number of dead bodies pile up because horrific catastrophes and their ensuing publicity stimulate public concern and action. To change this tack requires that public health actively educate, engage and secure the commitment of entire communities and their governance. It is essential to ensure more complete and accurate tracking of all drowning fatalities and non-fatalities, to obtain better estimates of the exposed populations (i.e., participants), and stimulate more epidemiologic research of drowning incidents for the development of intervention and prevention strategies.