Swimming is Public Health - Drowning Prevention

Drowning deaths are preventable.

-o-
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Transcript

SPEAKER_02 0:05

Welcome back to Everything's Public Health, a show about how everything is public health. And public health is for everyone. I'm I'm MJ. Almost messed up my own name. I'm MJ.

SPEAKER_00 0:13

And I'm Cass. You need to keep that.

SPEAKER_02 0:15

I will.

SPEAKER_00 0:16

Cass. Yes.

SPEAKER_02 0:17

On a scale of one to ten, how good of a swimmer are you?

SPEAKER_00 0:20

Um currently I would probably say eight out of ten.

SPEAKER_02 0:24

Okay.

SPEAKER_00 0:25

But I swam in college and not speed, but just like how far I could go and how long I could swim and how much I swam, I would probably say ten out of ten.

SPEAKER_02 0:34

Wow, very good swimmer. Do you remember when you first learned how to swim?

SPEAKER_00 0:37

Yes, I was a teeny tiny baby. I don't actually remember learning to swim. I just always was able to swim and float. So I'm assuming my dad did a good job and got me in the water as a wheel ass.

SPEAKER_02 0:49

Well, eventually when you start swimming as a sport, I'm sure someone taught you how to swim.

SPEAKER_00 0:53

Yeah, I mean, I like I knew how to swim, but in high school and then as a freshman in college, I got much more into swimming because they needed more girls on the team so that they could have more boys on the team.

SPEAKER_02 1:06

Parity.

SPEAKER_00 1:07

Which then became a club because they cut funding for the swim team and it became a club instead of a team sad face, but big sad. It was good exercise.

SPEAKER_02 1:15

Yeah, we did an episode about school sports. They are cutting a lot of stuff, and that's not really good. Cass is a good swimmer, so I will rely on you for the swimming stuff for the rest of this episode. Okay. I am not a good swimmer in a sense that I'm severely out of shape and can't do any physical activities, but I am a good swimmer in a sense that I know how to swim. And I have swam when I was young, not competitively, but you know, we took a lot of swim lessons. Used to be in shape, not so anymore. Like, I won't immediately start drowning, I guess. That's where I am. I do think swimming is one of those fundamental skills that everyone needs to know. Hot take, maybe.

SPEAKER_00 1:47

Okay, hang on. We need to go back to my response. So I am in very good shape. Yesterday I ran six and a half miles before work. This morning I ran three and a half miles before like I run a lot. I am in good shape. I am not in swimming good shape. Those are different.

SPEAKER_02 2:03

That's true. Swimming is tougher.

SPEAKER_00 2:05

Because swimming is not like when I'm running, I get to breathe in and out whenever I would like to. And when you're swimming, you cannot breathe in whenever you would like, or you the drowned. So just wanted to clarify. I said eight out of ten because I know how to swim. And like I'm in good shape. Like I could swim for a while before I got tired, but I'm not like out winning races or anything. I just wanted to clarify.

SPEAKER_02 2:28

It is a very different skill, swimming for survival and swimming for speed. Those are two very different disciplines.

SPEAKER_00 2:33

Fair. I could swim for a very long time if I was swimming to survive.

SPEAKER_02 2:37

Yeah, for sure. I think I could last four minutes before my cardio gives out. Anyway, today is not about how weak I am.

SPEAKER_00 2:44

Okay, you need to get out of. I know you don't like being outside.

SPEAKER_02 2:47

I need to go outside.

SPEAKER_00 2:48

You gotta find some way to get a treadmill or something. You need to get work on your cardio. Wait, you used to ride your bike everywhere.

SPEAKER_02 2:54

I do, but now I work from home, so I don't even go to the office anymore.

SPEAKER_00 2:58

Oh, goodness gracious, MJ. We gotta fix that.

SPEAKER_02 3:00

Anyway, so today we're talking about the opposite of swimming, which is drowning. A bummer event, but a preventable one. The inspiration for this episode was last year in 2025, the current regime's gutting spree decided to completely end CDC's drowning prevention program. Yes, the CDC used to have a program aimed specifically at preventing drowning, especially for kids. It cost just $2 million a year. I can't emphasize enough how little that budget is. Like $2 million a year for a federal program, but they decided to gut it. So, like a good public health podcast, we will try to carry on this work in our own tiny way now that that program is gone. Today we're gonna talk about drowning prevention. And now for everyone's favorite segment, Cass makes an educated guest with our one and only contestant. Cass, are you ready?

SPEAKER_01 3:46

Yay!

SPEAKER_02 3:47

Okay. Question number one. On average, how many unintentional drowning deaths occur each year in the US?

SPEAKER_00 3:54

Are we talking all ages?

SPEAKER_02 3:56

Correct.

SPEAKER_00 3:57

I am going to say 600.

SPEAKER_02 4:01

Very optimistic. 4000.

SPEAKER_00 4:03

Oh, jeez.

SPEAKER_02 4:04

4000.

SPEAKER_00 4:04

See, I'm thinking of kids. This is the problem.

SPEAKER_02 4:07

Question number two. For people between these two ages, drowning is the leading cause of death.

SPEAKER_00 4:12

One to nine.

SPEAKER_02 4:13

One to four.

SPEAKER_00 4:14

Uh I knew it was little kids.

SPEAKER_02 4:16

It was little kids, but after a certain age, injury becomes the leading cause of death after a certain age.

SPEAKER_00 4:21

Drowning is a form of injury.

SPEAKER_02 4:23

It is a form of injury, which is a very good point. Question number three. For every fatal drowning, there is on average this many non-fatal drownings. Two.

SPEAKER_01 4:31

Correct! Yeah, I finally got one right.

SPEAKER_02 4:34

For every fatal drowning, there is on average two non-fatal drowning. Now, this is probably an undercount because non-fatal drowning only captures those that end up in emergency rooms. And if you just was drowning but you were okay, obviously you won't go to an emergency room. So this number is probably a lot higher. Question number four, last question. True or false? Most drowning occurs during swimming or water activities. False. Correct. Most drowning occurs when swimming was not on the mind of the person who is drowning. Actually, that kind of makes sense now I think about it. So yes.

SPEAKER_00 5:03

Often when people are not prepared to swim, they are then not prepared to swim.

SPEAKER_02 5:07

Congratulations. That is a two out of four, a passing grade.

SPEAKER_00 5:10

Oh man, that was I think that's my worst ever Casmix and educated guests. Gosh, that's embarrassing.

SPEAKER_02 5:15

That's okay. We have ups and downs. Okay, well, so drowning $4,000 a year, which it isn't a lot, but it's also not a little. It's like a decent amount of drowning deaths every year. So first let's answer the obligatory question. Why is this a public health concern?

SPEAKER_00 5:29

As you said, not that many drowning deaths, but any death from drowning is one too many because the majority of drowning deaths are completely preventable. And from a public health perspective and an injury prevention perspective, we don't use the word accident. We don't like to think about accidents because that implies that there's nothing that could be done. We had no idea that this could have happened and nothing we could do to prevent it. But we know that everything occurs in the context of physical environments, social environments, and simply knowing how to swim is a major way to prevent drowning. As we were talking about, you may get to a point where you are swimming to survive and you become fatigued, but at least you, you know, survived long enough to have a chance to be rescued as opposed to drowning immediately.

SPEAKER_02 6:17

Definitely. And we'll get to this in a bit. Public health is in the interest of preventing major causes of deaths. And since drowning is a major cause of death for children one through four, this is a public health concern. But where to start this conversation? I think a good place to start is just discussing the mechanism of drowning for a little bit. So go ahead.

SPEAKER_00 6:36

So the obvious ultimate hazard of drowning is oxygen deprivation. You have to hold your breath when you're underwater. Just a few minutes of anoxia can cause irreparable damage to the brain. It does not take long for anoxia to kill, as low as six minutes, depending on the temperature of the water. But before that, even just a small amount of aspiration of water, sort of breathing in a little bit of water, can cause serious problems. Upon water entering the airway, the body will attempt to close it via laryngeospasm. Sometimes this reflex is strong enough that cardiac arrest actually happens before hypoxia, which means you know you don't have enough oxygen. So before hypoxia releases the larynx, which means then no water enters the lungs. So your heart stops and you're no longer breathing, you're not breathing in water. And this is a phenomenon referred to as dry drowning. But the majority of cases, water does enter the lungs, which is called wet drowning. A little bit of water in the lungs can cause the lungs to fail because water destroys the pulmonary surfactant, the things that allows the alveoli to expand properly. Even if the individual is dragged out of the water before they go unconscious, they still have a risk of death because their lungs can't have that oxygen exchange happening anymore. Even if they're breathing in air, their body might not be able to take it in. And let's say they do make it to the emergency department. The clinical management of drowning victims isn't just pumping water out of the lungs. The damage to that pulmonary surfactant is already done. So the rescue process is complicated and intense. Like we're not physicians, we're not going to get into this too much, but there's a really high chance for complications after the initial crisis, permanent issues, including brain damage. Also, I will add water that you are breathing into your lungs could be dirty AF. And so you also have risk of infection and other issues.

SPEAKER_02 8:26

That was actually another thing I didn't include. Like the inflammation response could be something that kills you. Like even if your initial rescue was successful. Seawater, you know, forget about it. There's a lot of stuff in seawater. So what this means is that drowning prevention is so critical because if any water gets into the lungs, the outcome is often quite bad. So how does drowning happen? Let's take a deeper dive into the stats for children, because this is the main group that we're worried about. For zero to one year old, what are some common causes of drowning, you think?

SPEAKER_00 8:55

I would imagine bathtubs are highly problematic. Yes. Any kind of unsupervised time around water, um, even if it's not a swimming pool, kids can fall into buckets of water, puddles, those sorts of things. And so thinking about any place a kid might be exposed to water for those very young kids could be an opportunity for drowning.

SPEAKER_02 9:16

Yeah, bathtub is actually one of the major causes for infants between zero and one year old. And this is something that I think it's a common misconception that people have that I think it's good to dispel. A lot of people think you need enough water to submerge the baby. You absolutely do not. You can drown a baby in with two inches of water, and that's why buckets, this is actually something I didn't because who has buckets lying around? But I guess I don't know, mop buckets. Some people have buckets lying around, but buckets can drown kids as young as zero to one. A big part of it is making sure that the child has supervision at all times. It can happen very quickly and it's often very silent. Now, for the one to four year old where drowning is the leading cause of death in the United States, what do you think are the common causes for drowning for this age group?

SPEAKER_00 9:56

I would guess many of the same things that we were just talking about bathtubs, buckets, standing water in general, where kids may fall in and either be unable to get themselves out.

SPEAKER_02 10:08

Yeah. So as we shift from zero to one to one to four, the bathtub uh sort of goes away. And the most common cause that I could find is backyard pools, which is a very large body of water. Um, one to four, they have arms now. I mean, babies have arms, but you know what I mean?

SPEAKER_01 10:22

They have no arms when they were infants. They have arms, but they can move them.

SPEAKER_02 10:27

They just couldn't pull themselves out of the bathtub when they're that young. But when you're one to four, the highest risk is now backyard pools. Oh wow, you you fully losing it.

SPEAKER_01 10:36

I turned that made me laugh so hard.

SPEAKER_02 10:38

That babies don't have arms now.

SPEAKER_01 10:39

They have arms now.

SPEAKER_02 10:41

They have arm strength now, so they can like get out of a bathtub if they want to. Still, yeah, backyard pool is very dangerous, more dangerous than people think. Hundreds of kids drown in backyard pools uh every year. So, what are some ways to prevent drowning?

SPEAKER_00 10:53

So, education is really key here. So, teaching parents the common risks and dangers. And as we've been alluding to both sort of tangentially and very specifically, supervision is key. Don't leave your kids, babies, or toddlers alone with standing water. Make sure if your kids are in the bathtub, they are supervised until they can support themselves and get themselves up. Swim lessons for toddlers. I mean, I know they start swim lessons quite young these days, so that parents are there, and then eventually the parents get out of the pool and it's just the toddlers. This dramatically decreases the risk of drowning. I will say when my kids were in school, they had to take a course called drownproofing, where they had to they learned all of the skills that they needed to do, and then they basically were thrown into the pool fully clothed, like normal clothes, not bathing suit, and had to float for five minutes in order to pass and be certified as drownproofed. That's another strategy to make sure that everybody has some kind of water education. Also importantly, folks need to recognize the signs of drowning. Drowning can be quiet. We see things on TV where people are thrashing around and calling for help. That's not necessarily what happens. A lot of movements are underwater and there might not be any splashing, particularly if the person cannot come back up to the surface. They're often too busy gasping for air to yell. So watch for gasping air and coughing fits. Their heads may be tilted back as they're trying to keep their nose above water. It may look like they're attempting to tread water or swim, but their head is not staying above water. Sinking bodies, right? Not all bodies float. So if you see a body sinking and sinking and not floating back up to the top, that's a concern. No movement is obviously a concern. Drowning happens so fast. So it is imperative that we're supervising kids in particular at all times until we know for sure that they can swim safely.

SPEAKER_02 12:50

Yeah, a lot of these very sad testimonies from parents with kids that died of drowning, is oftentimes they'll say, I just turned around for a minute. I was like getting something, but that was enough. That that was enough. And you don't hear anything because if there's water in your lungs, you cannot make a sound. And I blame Hollywood for every time someone's struggling in the water, there's always like loud music and a lot of splashing, which is not what drowning looks like. And a lot of people sort of have that misconception. Now, regarding the one to four-year-old group, the backyard pools, the importance of keeping backyard pools safe. Many states require all pools to have a pool barrier. Have you seen a pool barrier?

SPEAKER_00 13:26

Uh, depends on what you mean, but every pool that I have seen personally has a fence around it and it has a pool cover on it when it's not in use.

SPEAKER_02 13:37

Yeah, so a lot of community pools will have that. But the thing is, with backyard pools, a lot of backyard pools.

SPEAKER_00 13:42

I'm talking about backyard pools.

SPEAKER_02 13:44

You have seen those fences.

SPEAKER_00 13:45

Yeah. Like my dad's best friend when I was growing up, they had a fenced backyard, a very high fenced backyard. And then they would put a pool cover on when it wasn't being used. And our neighbors around the corner, even though we have a community pool right across the street from my house, our neighbors are on the corner. They have a fenced yard. I don't know that they put their pool cover on like every night, but when the weather is because their kids are older now, but when it's sort of not being used for long periods, they always put the cover on.

SPEAKER_02 14:12

Okay, maybe this is just me. I have not seen a backyard pool with a pool fence.

SPEAKER_00 14:16

So maybe that's just a Oh, I know of people who see those kinds of I just have never experienced a an unsafely secured Wow, you know good people. I know, I know good people. And I always use pools as an analogy when we're talking about safe storage of guns.

SPEAKER_02 14:31

Good one.

SPEAKER_00 14:31

Like if you have a pool, you should have a fence around it and don't let your kids swim unsupervised. If you have guns, you should store them unloaded and locked up and make sure kids can't get access.

SPEAKER_02 14:40

Yeah. Hundreds of kids every year wandered into the pool fall and they couldn't get up and they drown in backyard pools. There is a rule about all pools requiring a pool barrier. However, as we've discussed several times on this podcast, a rule without enforcement is not a rule, folks. Correct. So very few people actually buy the pool barriers to put around their pools. Another policy intervention is lifeguards near water, be that pool or open water. These laws are unsurprisingly regulated at the local level. So a classic MJ mistake, I cannot go through them all.

SPEAKER_00 15:09

Classic MJ.

SPEAKER_02 15:10

But I think this is an important thing. Like why participating in your local elections and your local politics is so important because these are the type of rules that affect your daily life. They're not regulated at the state. They're not regulated at the federal level. Vote down the ballot, is I guess another point.

SPEAKER_00 15:24

We talked a lot about risks to kids. Uh, there are adults who have drowning risk as well, and the statistics are pretty different from kids, which makes sense. A lot of it is associated with risk-taking behaviors, primarily among men, alcohol consumption, not wearing life jackets, and it's more common to be in open water than in a pool.

SPEAKER_02 15:43

Yeah. So very different risk profile for adults compared to kids. For kids, it's very much they wandered into a pool or they can't get themselves out of a body of water. Uh so very different.

SPEAKER_00 15:53

Did I ever tell you about the time I almost drowned?

SPEAKER_02 15:55

No. Oh, this is a great time to tell about the time you almost drowned. Do enlighten us.

SPEAKER_00 15:58

I was a kid. I think I was 11. No, I was younger than that because my parents were still married. So I must have been like eight or nine.

SPEAKER_02 16:05

That's how you know when it is.

SPEAKER_00 16:06

That's a marker of my life. My parents got divorced when I was 11. So, but I was a older but young kid anyway. I grew up in the Seattle area, the Puget Sound would have boat races that, and so you would go out to these buoys and you would tie up and you would watch seafare. They would do all these boat races and stuff. Folks are inevitably drinking lots of alcohol, the adults, right? And kids are all swimming around. And you were required to wear life vests if you were kids, and they would actually patrol. And like all of the kids had life jackets on because you would get a ticket if the cops came around and you didn't have a life jacket on. Anyway, all of that is to say, we were in the water, folks were getting out of the water. I was waiting to climb up the ladder to get into the boat, and my mom was climbing up the ladder in front of me. She slipped and fell off onto me, and I was shoved under the boat.

SPEAKER_02 16:58

Oh my gosh.

SPEAKER_00 16:59

But because of my life vest, it pulled me back up the side of the boat. I was only underwater for, I don't know, 10 seconds, maybe 15 seconds at the most. But because I knew how to swim, and then with the life jacket, I don't recall being knocked unconscious or anything, but I do remember like suddenly I was under the boat, and then a few seconds later I was up in the water. But that life jacket, I I guarantee saved my life.

SPEAKER_02 17:24

Huge difference, massive difference how much a life jacket can make. It's kind of like wearing a helmet. It's like, yeah, it might be uncomfortable, it might look dorky, but it could literally save your life. For sure. Now, here's an interesting angle that I thought about when I was doing research for this show. Another public health angle to examine drowning is the disparity of drowning rates. For example, boys and men are much more likely to die by drowning than girls and women. I think that's just like a risk-taking behavior thing. Yeah, not a lot of comments on that. Black children particularly have much higher rates of drowning compared to the average. This, I think, is a great example of the effect that access has on individual risk levels.

SPEAKER_00 18:01

Historically, black Americans were excluded from public and community pools. There's even a Supreme Court case about this. When integration was legally mandated, several white neighborhoods decided to shut down the pool altogether rather than share that space with black people. And the rise of backyard pools happened during that same time. So America used to be full of community pools, and the harmful stereotype that black people can't swim is the result of years of racist policies denying black people and minorities from accessing public goods. Quick tangent: Mr. Rogers, who I love so much for a whole bunch of reasons, he did an episode where he had a little waiting pool in his backyard and the mailman came who was black, and Mr. Rogers was cooling himself off by having his bare feet in the pool, and he invited the mailman to take his shoes and socks off and put his feet in the pool too, which was like symbolic. People lost their minds when this episode came out.

SPEAKER_02 18:55

Yeah, they're racist, yeah.

SPEAKER_00 18:56

Yes, the racist people because of them being in the water together.

SPEAKER_02 19:01

Same body of water.

SPEAKER_00 19:02

But it was such a landmark thing, like showing children, like, hey, this is okay, and thinking about the generations that he impacted with that short little clip.

SPEAKER_02 19:12

Yeah. The higher-ups try to shut him down before that. And he stood his ground and refused. And thankfully, he denied the higher-ups.

SPEAKER_00 19:19

Gotta love Mr. Rogers.

SPEAKER_02 19:20

Yeah, he's cool. Another interpretation is from a class perspective, swim lessons cost money. Do you want to talk about how much money your kids' swim lesson costs?

SPEAKER_00 19:28

I taught my kids how to swim. I did not pay for swim lessons. I know I know how to swim, so I taught them myself.

SPEAKER_02 19:33

Fair enough. But swim lesson costs money, and access to a pool often costs money. So if you're historically, economically disadvantaged, you probably won't spend your money on swim lessons when you're worried about putting food on the table. So there's that aspect of it as well. And as local politics get more stingy about community resources and community programs, access to public pools and publicly funded swim lessons went away, making swimming more and more associated with like wealth. You talk about your swimming team that got turned into a club because there wasn't enough funding.

SPEAKER_00 20:00

Yeah, there was not a lot of attention on swimming at my undergraduate institution, unfortunately, which I understand. There are limited resources, but it was a real bummer that the team got cut and turned into a club. But I think you make a really great point, which is there are things that should be considered public goods and community pools, public pools is an important way to make sure that people have access to a really important safety skill, which is not drowning, even if you don't exactly learn how to swim. Like the class that my kids took.

SPEAKER_02 20:33

Can you not drown in water?

SPEAKER_00 20:35

Which they knew how to swim already, but the class that they took on drownproofing through the school was like the bare minimum that everybody should get to make sure that we don't have 4,000 people dying from drowning every year.

SPEAKER_02 20:48

So preventable, too. It's one of, honestly, it might be one of the most preventable type of mortality that we've covered on this show, given how easy it is to avoid.

SPEAKER_00 20:56

Yeah, I agree. I think there are some very simple steps that folks can put in. Now, of course, we are minimizing the issue of access. I totally get that. We just talked about how challenging access can be. But in the context of making access more easily available, this is something that drowning doesn't have to happen. This is something that we could prevent.

SPEAKER_02 21:14

Yeah, we can get to near zero if we tried.

SPEAKER_00 21:16

Far more likely with drowning than with motor vehicle crashes or gun violence or anything like that.

SPEAKER_02 21:21

Microgrid time. The first microgrid is obviously you should learn how to swim. Your kids should learn how to swim, or at the very least, be comfortable enough in the water that they don't immediately start to panic when they fall in the water. Yeah, I think that's just a good microgrid to have in your life. Do you have a microgrid today?

SPEAKER_00 21:38

I do. I would say shop local.

SPEAKER_02 21:40

Sure.

SPEAKER_00 21:41

Even though it may be a little bit more expensive or it may be a little less convenient to go to a store to buy something as opposed to getting it shipped or buying from a big box store. Investing in your community by shopping local is really important.

SPEAKER_02 21:55

Yeah, definitely. And I would say invest in your local government as well. They are the ones that decide whether you have a public community pool or public swimming programs, how often it is maintained, etc. Believe that the purpose of government is to provide resources and services to the people. Federal stuff can feel very out of reach right now. So I think a good way for people to feel like they are contributing to a positive future is to focus on the things that you can control, which is oftentimes your local city council. Go vote, people. I think this will come out around voting time. So please go vote. Thank you for listening to Everything's Public Health. New episodes every week. If you like the show, please tell everyone you know about the show. That helps us immensely. Commenting, subscribing, and leaving us a review helps us a bunch as well.

SPEAKER_00 22:35

If you have any questions or think we missed an important perspective, you can reach out to us at everything ispublichealth at gmail.com. Follow our website, everything is publichealth.com, for all show updates and bonus material. And remember, everything is public health.

SPEAKER_02 22:48

Everything is public health.