REPORT #4: DROWNING PREVENTION MIGHT NEED A BETTER BRAND
By Doug Forbes
RESISTANCE
Drowning does not discriminate. It affects children of celebrities, including Bode Miller and Granger Smith, just as it affects thousands of lesser known children from all walks of life.
Drowning continues to be a leading cause of death for our young, with numbers on the rise yet again, according to the Consumer Product Safety Commission. The question is whether it’s time to follow a different path toward prevention.
The CPSC is “charged with protecting the public from unreasonable risks of injury or death associated with the use of the thousands of types of consumer products under the agency's jurisdiction.” These products include pools and spas.
The CPSC issued a 2020 report that revealed a steady rise in drowning fatalities for children under 15, more than 70% of which were in residential pools. An average of nearly 20 children per day wind up in hospitals due to nonfatal submersions.
CPSC Press Secretary Patty Davis denied access to any interviews with officials or researchers, including the report’s author, Ted Yang, who serves as director of epidemiology.
Davis said, “The procedure followed by CPSC’s Office of Communications is to gather questions from these types of requests and have our agency’s experts consider and address the questions as they are able in writing.”
Davis did not defer to epidemiological experts. She answered the questions herself.
The 80-year-old nonprofit known as Ad Council assembles “the brightest minds in media, tech, advertising, entertainment and marketing to develop campaigns that inspire action – and change lives.” Some of the Council’s youth-facing initiatives include child car safety, fatherhood involvement, empowering girls in STEM and anti-vaping.
Throughout its storied history, however, Ad Council campaign initiatives have not included child drowning prevention, the leading injury-related killer of children ages 1-4 and second for children 5-9.
Colleen Thompson-Kuhn is Ad Council Manager, New Business and External Affairs, “We recognize the importance of the [childhood drowning] issue,” she said. “We have done a lot of safety campaigns, so after we get through the pandemic, our list of priorities is different, with considerations being given to a range of social justice topics.”
Thompson-Kuhn said campaigns are $1.2-$1.6 million and must be funded by the NGO itself, hardly affordable for prevention foundations operating on shoestring budgets.
According to the World Health Organization, “Global estimates may significantly underestimate the actual public health problem related to drowning.” The WHO also cited a “wide range of uncertainty” surrounding this worldwide safety issue.
Dr. David Meddings is an epidemiologist and injury prevention specialist at the WHO. Meddings said he was concerned about insufficient reporting,
“We don’t even get the nonfatal [drowning] data. It’s a far cry from what is needed at local, national or sub-national levels to go about meaningfully setting up drowning prevention programs.”
Nearly 30,000 pediatricians practice in the U.S. Not nearly enough of them proactively address drowning prevention, according to Dr. Ben Hoffman, chair of the American Academy of Pediatrics Council on Injury, Violence and Poison Prevention.
Hoffman said that pediatricians must prioritize such discussions with new parents.
“It’s a no-brainer. Bode Miller and his wife Morgan looked me in the eye and said they don’t remember their pediatrician talking to them about drowning.”
The fact is, however, the AAP surveyed more than 1,100 pediatricians in 1994 about drowning prevention counseling. According to that report, 83% of the pediatricians said they discussed water safety/drowning prevention with parents of toddlers 1-4 years. Nearly 70% said they discussed the topic with parents of children under one year.
The question remains as to whether those conversations have abated over the past 25 years, and if so, who discusses drowning with caregivers as victim numbers worsen.
According to 2018 data from WISQARS, the CDC’s injury database, 311 children died from drowning in just three states: Texas, where Granger Smith’s child died, California where the Millers’ child died, and Florida, with the most childhood drowning victims.
Totals from these three states alone equate to a child dying every 1.2 days from a preventable outcome.
And according to WISQARS, hospitalizations related to nonfatal submersions from 2010-12 totaled 16,870 compared to 21,083 from 2016-18, a 25% increase.
One role of federal government is to provide these health and safety statistics, as limited in scope and detail as they may be. The other role is to consider legislation that might otherwise impact the rise and fall of such statistics.
REGULATION
The Pool Safely division of the Consumer Products Safety Commission launched in 2010. Watch their public safety announcement.
Click HERE for the full Resource Pack.
The Motorboat Act of 1940, Sec. 6, required maritime operators to equip vessels with “one life preserver for each person on board.” The act did not require any passenger to actually wear the preserver.
Regardless, this is the government’s first legislative gesture directly related to drowning prevention. It remains one of only a few in effect today.
Almost 70 years later, Congress passed the Virginia Graeme Baker Pool and Spa Safety Act to reduce fatal pool drain entrapments and raise awareness about additional layers of pool protection, as noted in Report #3 of this series.
The CPSC launched its Pool Safely campaign in 2010 to reinforce VGB and “raise awareness about pool and spa safety.”
The federal government also adopted a law regarding safe swimming pool slides and a few others related to pool plumbing and electrical codes.
This is where federal drowning prevention legislation essentially begins and ends, despite numerous efforts to transition state laws into national mandates.
For example, California requires firefighters and public beach and pool lifeguards to be certified in CPR every three years. Massachusetts requires at-risk swimmers who attend municipal and recreational programs at bathing beaches to wear U.S. Coast Guard-approved life jackets.
Neither one of those state requirements emerged as federal bills.
Drowning is the fifth leading cause of child and adolescent death, according to a CDC study. Drug overdose or poisoning is the sixth.
From the White House and the National Institutes of Health to NGO’s such as D.A.R.E. and Drug Policy Alliance, a host of entities have urged schools to embrace substance abuse curriculum. And, for decades, schools have obliged.
By contrast, childhood swim lessons ostensibly remain the primary proxy for noticeably absent drowning prevention curriculum in public and private schools.
The CDC’s National Action Plan for Child Injury Prevention urged stakeholders to “improve training on injury prevention in schools of education” and to push for laws and regulations that enable safer environments.
The reality, however, is vastly different.
The CDC ranks Texas first in fatal child drownings. In 2019, Texas legislators declared May 7-14 as Drowning Prevention Awareness Week during which affected families spoke at the state capitol.
However, Texas has not passed a bill related to water safety curriculum in schools.
Florida ranks second in fatal child drownings. As a response, Florida Sen. Jason Pizzo introduced Senate Bill 608 in 2019 to mandate water safety education in K-12 schools.
The measure immediately died in the chamber’s education committee.
California ranks third in fatal child drownings. Naima Ford is legislative director for state assemblyman, Chris Holden. During a recent phone call, Ford said that any attempt to introduce a new curriculum mandate, such as water safety education, would likely result in overwhelming resistance from the state’s department of education and teachers association.
New York introduced a school water safety curriculum bill in March of 2020. That bill was also referred to its senate education committee where it remains stalled.
In 2017 and 2018, New Jersey Assemblyman Sean Kean introduced bills to require water safety instruction as part of health and physical education standards.
Both bills died in the assembly’s education committee.
Hawaii introduced SB 2941 which requires “ocean safety and stewardship education” for fourth graders. That bill remains stalled in its senate education committee. Even if passed, the legislation would not be enforceable until 2050. According to data from Hawaii’s department of health, 150-200 children will drown to death while 500 will require medical attention.
England, however, requires every 11-year-old to exit school with vital drowning prevention skills.
The country’s National Water Safety Forum reported 12 child drowning deaths in 2019 spanning the ages of 5-9 and 15-19. In the U.S., approximately 357 children in those same age groups drowned in 2018, the last available reporting year.
Australia’s Queensland state schools are required to offer water safety education through grade six. The Department of Education itself is responsible for the development of such curriculum. According to the Child Accident Prevention Foundation of Australia, 27 children under 14 drowned from 2017-2018.
CHANGE AGENTS
A variety of drowning prevention resources from public and private entities.
Despite this stark legislative reality and nominal public resources invested in U.S. anti-drowning campaigns, safety advocates continue to extend whatever prevention services they can muster.
The American Academy of Pediatrics offers a Drowning Prevention Toolkit.
The Consumer Products Safety Commission’s Pool Safely program provides research and educational material.
The World Health Organization hosts its World Congress On Drowning.
The American Red Cross affords a virtual water safety hub.
The National Drowning Prevention Alliance avails a robust resource center.
The NDPA was launched in 2004 “to become the top destination for drowning prevention in the United States.”
NDPA Executive Director Adam Katchmarchi said that government agencies and NGOs might want to place more emphasis on improving behavior change and less on education. He said people have been repeatedly educated about the fact that driving while intoxicated is wrong, but that does not prevent them from heading down the road.
“The reason why I think that nobody wants to address [behavior change] in drowning prevention – although I bring it up to everyone – is because there’s no answer to it right now. But we can’t ignore that it’s the root issue.”
AAP’s Hoffman said, “Drowning does not receive the attention it needs. Some of it is that it’s just not sexy and a lot of it is a matter of risk perception. In order to go about our activities of daily living – to navigate in this world – we accept a lot of risk.”
Hoffman said we don’t consider common fixtures such as bathtubs to be a threat, in addition to the idea that our swimming pools are symbols of recreation and joy, not potential catastrophe.
Julie Lopiccolo knows about pool catastrophes. Her 2-year-old son, Jasper, drowned in 2014. Lopiccolo said the babysitter took Jasper, without permission, to her own family’s backyard pool, which was not properly gated. The babysitter failed to pay attention long enough for Jasper to make his way into the pool unnoticed.
Lopiccolo and her husband launched the Jasper Ray Foundation soon thereafter in order “to touch people emotionally and become a catalyst for change.”
“After I left the hospital, I spent hundreds of hours researching, trying to get my hands on everything I could,” she said.
She discovered a nearby drowning prevention foundation but was deeply disturbed that she never heard about it before Jasper’s death.
“What is the disconnect here? We agonize over organic food, but nobody’s discussing drowning prevention, even though drowning is the leading cause of death for Jasper’s age. This has a lot to do with psychology and how complex and overwhelming this issue really is. We must legislate the same way we legislate for seat belts for children to stop dying.”
Lopiccolo not only runs her foundation with her husband, Jonathan, she actively participates in the Orange County Drowning Prevention Task Force and the National Water Safety Action Plan.
Like Lopiccolo, Chezik Tsunoda said she felt she had no other choice but to engage the advocacy arena. After her 3-year-old son, Yori, drowned in a friend’s backyard pool, Tsunoda began feverishly working to bring about change in her greater Seattle community.
Tsunoda’s primary vehicle to drive that change is an upcoming documentary which she alone has financed, produced and directed. The film, No More Under, follows parents who find purpose in their pain and seek to end the deadly epidemic of childhood drowning after their own children suffered fatal and nonfatal drownings.
Tsunoda said she sincerely believes we can change behavior and habits to arrive at “near elimination.” But she cautioned that we must “scare them enough” to make an impact.
“It's really such a shame that someone needs to connect with a real life person who has lost a child to drowning to take it seriously,” Tsunoda said. “It's not something that only happens to this or that kind of parent you see in the news.”
Reduction in drowning not only requires a shift in behavior but also a shift in access.
Former Penn State athletes, Shaun Anderson and Jayson Jackson, founded Diversity in Aquatics in 2006. Miriam Lynch is now CEO.
The foundation’s mission is to “reduce drowning disparities for all minorities, expand the efforts and policies around drowning prevention and water safety, while promoting the benefits of aquatics activities.”
Since drowning adversely affects minority children far more than white children, DIA aims to create “new paradigms in diversity and inclusion” that will improve statistics and perceptions.
In a MIT Media Lab presentation, Lynch said, “There’s a fragmented approach between what has been done in the aquatics industry and what’s been done in STEM. It’s what we call a cradle-to-career concept.”
She said a culture of exclusivity has created what we see today in these huge racial and ethnic gaps in aquatics. Lynch said she would like to see culturally competent and trauma-informed training offerings to transform existing paradigms in aquatics leadership.
BRAND ASSESSMENT
FCB Health and Colin’s Hope produced this multimedia campaign in 2016
Drowning is a methodical, torturous breakdown of body and mind, exponentially amplified when the victim is a child in a futile fight for a life just begun.
Nobody wants to discuss such an event, detail by detail, let alone witness it. This is ostensibly why the vast majority of drowning prevention content features sprightly children learning how to become water-safe within controlled if not contrived environments.
Olympian Michael Phelps recently participated in a video with popular cartoon characters in this very vein.
One might argue that advocates continue to embrace an overarching prevention brand that has, statistically, failed to move the needle toward the desired outcome. The question is whether alternative means are worth exploration.
Gratuitous ad campaigns have long been a matter for debate, especially considering how challenging it is to calibrate where campaigns cozy up to the very edge of inappropriate or, at the very least, questionable content.
Author, researcher and Stanford University professor, Chip Heath, said in an interview “Nobody ever gets married because somebody says let me explain to you why we should be married. We change in our life because of a deep emotional desire to change.”
Heath said that an ad campaign can change behavior if it is “unexpected and emotional, with very concrete, visualizable images.”
In 2014, the CDC ran its first federally funded anti-smoking campaign with those very elements. Commercials featured smokers grappling with the disturbing physical effects of nicotine addiction. According to its research, the CDC said almost 2 million smokers attempted to quit.
The ASPCA launched a battery of animal cruelty commercials in 2007. Visibly battered dogs and cats stared directly at viewers who could hardly stare back. Famed ballad singer, Sara McLachlan, lyrically pleaded for support.
To say it worked is a vast understatement.
The organization raised $30 million in what became its most successful campaign to date. Similar pet adoption campaigns have stormed the airwaves during the pandemic, with shelters coast-to-coast reportedly selling out.
Over the last decade, more drowning prevention advocates have chartered similarly challenging territory.
Abbey Taylor was six when she was entrapped by a public pool drain and drowned. Her parents, Scott and Katey, launched Abbey’s Hope Foundation soon thereafter. The couple decided to showcase two chilling videos on the foundation’s home page.
“We knew it was provocative or pushing the envelope in the water safety space,’ said Katey Taylor. “We had lots of comments regarding the PSAs. Some state we are scaring their children, some thank us for being bold.”
Taylor said her goal is to do whatever she can to keep families intact.
“If that means a child is frightened by a commercial on TV, which hopefully leads to a conversation with an adult about how we can safely be around water, then I am doing my job, and that is what Abbey’s HOPE is all about.”
Beginning in 2018, renowned ad agency FCB Health — Foote Cone & Belding — teamed with drowning prevention foundation Colin’s Hope, Lifeguards Without Borders and other NGOs on the pro bono campaign Not Out of the Water.
FCB Health VP and Associate Creative Director Melissa Ludwig helped drive the creative for the campaign.
“In this day and age, we are inundated by information and how we can cut through the clutter,” Ludwig said. “We tried to tap into something emotional. When I started on this campaign I was not a mother, and now that I am, it’s changing my own son’s life. I already started him in swimming lessons.”
The haunting print and web integration propelled the World Health Organization and popular cruise lines to amend policies and programming.
England’s Royal Life Saving Society shares “expertise and knowledge with as many people as possible, giving everyone the potential to save lives and enjoy water safely.” During their annual Drowning Prevention Week, the Society aired a video with a stark message about how abruptly fun can turn fatal.
Risk prevention can require taking risks. Measurable impact from these provocative drowning campaigns is hard to come by, but advocates like Katey Taylor from Abbey’s HOPE said she has already developed another video which focuses on the potential risks of added distractions during the pandemic.
Time will tell if these relatively rare approaches have long-term payoffs.
The U.S. is not a monolith, and what works in one place might flop in another. This is yet another quandary water safety champions face in their race to prevent avoidable outcomes.
Map courtesy of Total Aquatic Programming
America often feels more like a composite of 50 countries rather than 50 states. Counties, cities and neighborhoods also operate like highly distinct microcosms.
California has 9 million children and 3 million pools. Michigan and Wisconsin have an abundance of recreational lakefront acreage. Florida drips wet everywhere one turns.
Therefore, a universally acceptable childhood drowning prevention effort might not be the most logical solution.
But while fatal and nonfatal submersions increase, state governments continue to deny potentially impactful legislation. Regional NGOs fight for a greater share of an already dwindling pool of funding due to prior economic restraints only exacerbated by COVID-19.
And even as new drowning prevention foundations join the multitude already engaged in the fight, the clock continues to tick and young bodies continue to pile up.
NEXT UP
Read Report #5. The next and final report taps traditional and innovative prevention methods as well as the potential value of acknowledging behavioral sciences. The report also surveys gatekeepers about their top prevention ideas and their greatest challenges and triumphs.