Above Water: Rethinking Drowning Prevention at All Levels

By Kyra Hamilton, Griffith University, Australia and Amy Peden, University of New South Wales, Australia

Drowning is a leading, yet largely preventable, cause of death and injury that remains underrecognized. One common myth: drowning isn’t always fatal. The definition of drowning was revised to clarify that drowning is a process, not an outcome. The outcomes of the drowning process can be death (fatal drowning) or survival with or without persisting injury such as cerebral palsy and other neurological disorders caused by a lack of oxygen to the brain (non-fatal drowning). Terms like “dry drowning”, “secondary drowning”, or “near-drowning” are often used in the media, but they’re outdated and medically inaccurate, so it’s time to stop using them. 

Who drowns, and where do they drown?

Globally, the World Health Organization (WHO) estimated that 300,000 people died from drowning in 2021—that’s more than 30 people every hour. However, this figure excludes, among others, drowning deaths from flood and water transport incidents, such as boat capsize and ferry sinkings. In high income countries like Australia, including these events raises drowning rates by 40%; in low- and middle-income countries, the increase is likely even higher.

The WHO’s first Global Status Report on Drowning Prevention identifies children under five account for 24% of the global drowning, with an additional 19% occurring in children aged 5-14. Drowning rates are three times higher in low- and middle-income countries, which represent 92% of all drowning deaths. Fatal drowning rates among males are twice those of females. For young children, the highest risk areas are swimming pools and water bodies around the home, while adults face greater risk in natural waters such as rivers, lakes, dams, beaches, and oceans. 

What drives risk and what works to prevent drowning? 

Beyond age, sex, and location, several other factors increase drowning risk. These include, for example, individual skills and behaviours—such as swimming competence, entering floodwaters, alcohol consumption—and underlying medical conditions that may increase vulnerability.  

Other factors relate to the body of water itself: whether children are supervised and barriers are in place to prevent unintended access; assessments of and confidence in handling the inherent hazards of natural waters; awareness of rip currents, strong flows, and underwater hazards like snags in rivers; and whether people choose to swim at supervised locations such as lifeguarded public pools or patrolled beaches. 

Many other factors influence drowning risk, but fortunately, evidence-based prevention strategies exist. For example, in Australia pool fencing legislation, combined with education and enforcement regimes, has reduced child drowning fatalities in swimming pools by over 50%. Similarly, survival swimming programs for school-aged children in Bangladesh have proven cost effective, dramatically lowering child drowning death rates. 

Laws that require safe practices on boats and ships—like wearing lifejackets—help lower the risk of drowning during water travel. At the same time, ongoing research into drowning, including maintaining and interrogating drowning registries, helps us learn more about the problem and find better ways to prevent it.

System-level (“s-frame”) strategies, like laws and regulations mentioned above, can help shape safer behaviours across entire populations. However, when these are combined with individual-level (“i-frame”) interventions—such as education, social approval, skills training—the overall impact on preventing drowning can be even greater. 

Research shows that how people think and feel plays a big role in their health actions, including for staying safe around water. For example, things like past experience; beliefs about the advantages and disadvantages of safety behaviours and confidence in ability to act; planning ahead; and perceptions of risk, social pressures, and roles people see themselves in all influence whether someone takes steps to prevent drowning. 

Just knowing about water safety isn’t enough to change behaviour for the long term. That’s why drowning prevention programs should use proven psychological strategies to really make a difference. Instead of only warning about dangers, they need to focus on the positive benefits of staying safe—like having fun safely. They also should show that water safety is a normal part of life by involving friends and family. Building confidence, limiting access to risky places, and encouraging people to make plans and keep track of their safety habits all support lasting change.

What can we do to reduce drowning risk moving forward?

Globally, fatal drowning rates have fallen by 38% since 2000—a major achievement. But progress hasn’t been equal everywhere. Some regions, especially those with fewer resources, still face big challenges, including rising risks from climate change and sea migration. To keep moving forward, we need practical solutions that combine both individual (like shifting attitudes about water safety) and broader system changes (like better infrastructure and policies). This effort could involve a range of stakeholders—such as governments, communities, NGOs, and individuals—who can make meaningful contributions to preventing drownings at both the individual and system levels.

Practical Recommendations

• Advocating for stronger laws, education, and enforcement to prevent drowning. This includes measures like pool fencing legislation, safety standards and labels for portable pools, and alcohol-free zones at high-risk locations like beaches and rivers. It also means pushing for water safety to be part of a larger system, such as swimming lessons in schools and flood safety in graduated driver licensing schemes.
• Promoting water safety by focusing on how people think and feel about it. This includes encouraging positive attitudes, like understanding the benefits of wearing lifejackets or watching children around water. It also means helping people feel confident in their ability to stay safe, such as avoiding driving through floodwaters, wearing lifejackets when boating, and limiting alcohol around water. 
• Planning ahead for water activities. This means getting people to think through safety steps—like packing lifejackets or choosing a safe route home during floods—before heading out. Being prepared helps prevent drowning and keeps everyone safer.
• Making water safety a normal part of everyday life—like wearing lifejackets, watching children closely, and avoiding alcohol around water. When these behaviours are common and supported by friends and family, more people follow them, keeping everyone safe.
• Acknowledge World Drowning Prevention Day on July 25th.  Pause to remember lives lost to preventable drowning and reflect on how we can make water activities safer. Commit to encouraging someone to learn to swim, take swimming lessons yourself, raise awareness about drowning prevention, or simply enjoy the water while modelling safe behaviours for others.