Swimming Upstream - Drowning Prevention as a Public Health Issue

In this episode, host Mighty Fine talks with Tony Gomez, Manager of Violence and Injury  Prevention at the Public Health - Seattle and King County Health Department in the first segment. Following that, Mighty speaks with Morag McKay, Director of Research and Network at Safe Kids Worldwide and also the chair of the steering committee overseeing the development of a US National Water Safety Action Plan along with Rebekah Thomas, who is a public health practitioner with expertise in water safety. In their conversations they discuss why drowning is a public health issue, recommendations for drowning prevention and misconceptions associated with it as well as what everyone should keep in mind to stay safe in and around water, be it community pools, lakes and oceans.

Transcript

Mighty Fine: 0:00

Welcome to the Injury and Violence Prevention INdepth podcast. My name is Mighty Fine, and I'm the host of the Safe States Alliance production. In this space, we'll engage in dialogue with IVP professionals on a variety of issues to help you, our listeners learn about the latest trends and hot topics in injury and violence. This episode is focused on drowning prevention and water safety, and it's sponsored by Safe Kids Worldwide, their nonprofit organization working to help families and communities keep kids safe from injuries, be short and learn more about them by checking out their website safe kids.org. The format for today we'll operate in two segments. I'll start off by talking with Tony Gomez, who is the manager of Violence and Injury Prevention at public health Seattle and King County. Then I'll flow into my conversation with Morag McKay, who's the Director of Research and network at Safe Kids Worldwide, and also the chair of the steering committee overseeing the development of a US National Water Safety Action Plan. Rounding off the conversation will be Bekah Thomas, who is a public health practitioner with expertise in water safety. So Tony, we're gonna go ahead and get started. And after working with you for so many years, I'm super excited that you are a guest on the podcast today. Again, reminding folks we're talking about drowning and drowning prevention. And, Tony, from your experience sort of perspective, why is drowning a public health issue and recognizing we have tons of issues in public health and specifically in injury and violence prevention, but why does it seem like drowning is not discussed as much as some of the other topics in this space.

Tony Gomez: 1:39

Um, I mean, first of all, thank you for conducting this interview. I appreciate Safe States addressing this topic, it is really important that water recreation, water safety, drowning prevention, be considered one of our important public health issues. You know, kind of above the 4000 folks that lose their lives annually around the country to drowning. There's a huge equity component to water safety, water recreation, promotion, for some of the various states, some geographies, some age groups, some race ethnicities, it is, you know, the leading cause of death, I think in about one to four year olds, and certainly for native folks up in Alaska, it's an important daily consideration in their survival. So we have a lot of water to cover this topic, you know, from the oceans and estuaries and rivers and lakes, to water parks, hot tubs, swimming pools, backyard pools, bathtubs, and so, you know, given the ubiquity of just water as a resource, and in our everyday lives, you know, it's one of the more important kind of underappreciated public health issues. There is. And I think, you know, to get to your question about why is it not regarded up there with some of our other topics, and, you know, in addition to the, like, numbers of fatalities compared to say, overdosing, or some of the other, you know, really important public health issues that we have a lot of resources dedicated to, you know, water recreation, and water safety is often seen as kind of a luxury, if you will, that, you know, for elected officials, decision makers, sometimes if budgets get tight, they see cutting the budget for a swimming pool, or for lifeguards as a way they can balance that budget. And it's, you know, not going to affect people. And in fact, it really has a profound effect on on the community.

Mighty Fine: 4:08

Absolutely. Thanks for that context thing. You talked about sort of our access to water, right? We have it in so many variations, whether we're talking about natural bodies of water or swimming pools or bathtubs, and there's certainly considerations there for each of those bodies of water. So sort of building on that a little bit more, what are some of the major factors that contribute to drowning? Or what are some things that we really, really need to pay attention to when we're thinking about water safety?

Tony Gomez: 4:38

And this is where I think we're seeing some exciting work occur. You know, first, I have to think of Safe States, working with the US Coast Guard and National Association of State boating laws, administrators to just get a handle on the burden of starting with boating related cases. And much of that was Um, you know, the, the the data gathering, there wasn't all that it could be in all that it is in some of our other injury programs. For instance, Coast Guard, the the, the data gathering wouldn't include, for instance, somebody that drowned swimming from a boat, they had to be some way attached to the boat or ejected from the boat or water ski. And so if they, you know, were were anchored up somewhere, and they were swimming into shore, and they drowned. They weren't considered part of the official Coast Guard's statistics, we'd capture them and some of our other databases. And so then when they're presenting to Congress, the burden of voting related injury, it's such an undersell, you know, it was like in the 10s of millions of dollars, when it really is probably in the hundreds of millions, if not billions of dollars of problems. So I think the work that they're doing to improve that, along with now, CDC has a bit of resource 1 million versus 5 million that was asked for it, but at least something to start to help them and help us all understand that, that that total burden of both the drowning fatalities as well as drowning survivors. So that gives us a better picture of the of the, just the total burden, and then we can start to look at individual causes for, for what contributes to it. And, you know, in some cases, it's kind of a institutional racism aspect to it, we have entire communities that have never had the opportunity to learn to swim, to learn to use water recreation, as a chronic disease prevention tool, you know, for some folks, they're not going to be able to walk and bicycle and getting in the pool can be their only form of exercise and, and fitness for health. There's some other work that needs to happen with climate change, as we're seeing here year after year. Studies have shown that when each you know, temperature goes up a degree or five degrees that people flocked to the, to the waters more whether it's a pool or beaches. And if we

Mighty Fine: 7:24

don't have a little bit, yeah, to get cool and

Tony Gomez: 7:28

was trying to escape escape that evening. Sure, still have a little bit of fun. And we've seen this happen. It's a national problem where the lifeguard shortage now throughout the country, means we've got lots of beaches that are unprotected now that were previously protected. And so you combine that lack of swim ability, lack of appreciation for how dangerous water could be without now without lifeguards. You know, that creates that burden that we've seen increase at least locally here and expect it's also occurring nationally as we roll it up, where we almost had a doubling of drowning in 2020, compared to the previous three years, kind of once the pandemic hit, beaches were closed, and people aren't wearing life jackets like they need to

Mighty Fine: 8:20

know. Just to double back to the lifeguards, is there any understanding as why there's a reduction in the number of lifeguards we have

Tony Gomez: 8:31

or that's yeah, that's been part of the problem was the pools were closed, you know, because of the concern or risk of COVID exposures. And so disrupted you know, we've talked about supply chain and so many other areas have disrupted the supply chain, the pipeline of youth learning to swim learning to be Junior lifeguards, and then filling that role as they turned 15 1617 as swim instructors and lifeguards, and there are just so few of them now. And then the wages went up in other areas of work for for the youth. And so, you know, to have to require CPR and lifeguard training and all that kind of those barriers or requirements. Means for a youth it's easier to get a job elsewhere should they choose than it is to be a lifeguard and you know, what I would argue is that it's a system that needs investment. Now because you know 17 year old lifeguarding us at a beach or a pool is the least expensive part of the whole health care system. You know at$17 an hour it prevents that EMS run that emergency department trying to save somebody the neurological the rehab everything else that goes with sometimes a neurologic Typically devastated, drowning survivor and if they'd have been at a lifeguard facility or just wearing a lifejacket, we've been in the habit for many years of putting on a lifejacket where we're swimming where there isn't a lifeguard. And that notion is caught on among, you know, especially some of the younger community, with parents kind of just becoming second nature, like bike helmets and car seats and all the rest of those. Yeah, prevention devices.

Mighty Fine: 10:31

I actually used to be a lifeguard years and years ago, at a local swimming pool. Lots of fun. So maybe I need to dust my skills off and, and tap in a little bit. But I wanted to pick up and you started to pick back up on the the life jackets, and you said that people aren't wearing them as often. And I will just anecdotally, I know when I've been on vacation in the Caribbean, and they give the spiel about the life jackets. And I noticed that some people just sort of take it for granted. But I don't know if it's my being in the field. I'm like, Okay, where are the jacket? You know, I'm taking stock of it all. But I find that the majority of the folks on the boat are sort of like yeah, whatever, nothing will ever happen. So just want you to unpack sort of the lifejacket issue a little bit more. And then just get your thoughts on sort of the sort of our collective education and understanding around drying, drowning and water safety. And if you think that plays a part in folks maybe not having a higher take up of using life jackets, or is it or is it an availability thing?

Tony Gomez: 11:35

Yes, that's it's all of those. And those are really good questions of kind of profound insight because it is, with life jackets, I mean, we're down to like $15 for a Coast Guard approved life jacket. That's kind of pretty good looking. I mean, we're distributing hundreds of them in our community. This summer, we have an event tomorrow with a group organization called Mother Africa. So they're serving African refugees and immigrants from multiple countries in Africa. And part of why they're motivated to do the lifejacket distribution work is in the areas of the county that they're living. They we have seen the lifeguard cuts there. And it meant that a year ago, one of their beloved youth had neuro and they family has been very public about this, had a very had a near drowning. So the high school youth is just essentially a home for the rest of his life, unable to feed himself, unable to talk and, and so the organization, one of the workers in their leaders contacted us. And as we did a blog with them recently, our University of Washington student interviewed him. She was reporting like, everybody has a story in our community, whether it was in Africa of nearly drowning in a river or lake and now I think about them, and they've come to the United States, surviving war, famine, infectious disease, all the challenges of what they're where they're leaving, to, to drown, to have a near drowning experience in our waters is just devastating and should be to us all. And so we're trying to get community and we've been doing this for a lot of years that you know, the lifejacket we hear of swim with a buddy. So everybody's kind of familiar with that term. What we've said as your buddy needs to be a lifejacket has, unless he's a trained lifeguard like you were mighty fine. They're likely not going to be able to rescue you, they're gonna be able to tell the marine patrol where to recover your body where he went down, but your buddy needs to be your lifejacket. So that, you know you live to swim another day, you can still do your stroke, she can cool off, you can have fun, you know, you can't go underwater. But you know, that's that's the one limitation but you can do everything else you would because they provide mobility. So I think that we'd love to see. And we are seeing this whether it's our state parks, boating, our Seattle Children's Hospital, Harbor View, our organization, the parks industries, we're distributing 1000s of life jackets to community and there's also now lifejacket loaner board so people when they go to the beach, they forgotten their lifejacket or they don't have they can borrow one for the day. Well, they're they're either in the presence of a lifeguard or an over lifeguard. And so kind of got to get over the, you know, the, it's uncool. The Nerd factor with that, just like we do with so many of our other injury prevention devices and you know, it's it's, it's easily achievable if you kind of grow up Um, you know, just having that as a second nature. And then, you know, part of what we'll see in the northern states, and probably even in some of the other states, the colder water. So if one unexpectedly ends up in the water, they get pushed off a dock, they fall off a boat, the cold water causes of the Gasp reflex. And so it can cause people to be in trouble immediately with the panic and everything else. And then in so many of our state's rivers, you know, we have a, we have a problem every year, as do many states is cold, the snowpack starts to melt, and we get an 8085 degree days people will flock to the river. And these things are cold, swift and deadly. And, you know, you wouldn't think of going out there without a professional and yet, we'll have people in inner tubes and air mattresses and other things sort of hanging out and hanging out. And it's very rare for us to, you know, they occur, but it's really rare for marine patrol to be rescuing. Somebody that was wearing a life, you know, to recover somebody's wearing a life jacket, it's really is the vast difference in surviving versus not surviving. But still having fun.

Mighty Fine: 16:18

Sure, sure. Yeah, like, just really tapping into the safe safety aspect of it. I do want to come back and talk a little bit more about any thoughts you have on preventing drowning or, or increasing water safety. But I also wanted to create space for you to talk a little bit more to about, you mentioned, equity and equity issues surrounding drowning and drowning prevention. Can you talk a little bit more about who is most at risk? Or what are some of the risk factors more broadly, and tie that into any sort of disparities or equity issues that you'd like to raise?

Tony Gomez: 16:55

Yeah, I think for me, it starts with children, you know, the youngest of our community for for starters. And I'd often say that, you know, there, there is not the advocacy level for the young child as there should be compared to some of the other things and that, you know, given that for one to four year olds, it's for many parts of the country, it's a leading cause of death. That we need to be the advocates for swim lessons, good supervision not being distracted. And all communities communities of color, where there has traditionally been less availability for pools and swim lessons. And that, and that equation has been changing in many areas where they have been prioritizing hope and opening the pools in communities of color. If they're having to make a decision, like we can guard five of our 10 pools, and I have appreciated what I've seen with many parks departments around the country with trying to prioritize where those communities can benefit from from those services. One of the things and this is an example of why public health needs to have a complete set of tools and systems is our Child Fatality Review process. We were seeing a lot of Asian youth drown over a couple of year period, immigrants, immigrant families, and as we got into the Child Fatality Review data very clearly, it was a lot of them were Vietnamese children, and they and they some of the families had grown up in warm water in Vietnam, there was lots of drowning, actually, in a lot of our countries, where our immigrant communities have come from. And it probably is like a leading cause of death in those countries, except for when they drown. They simply bury them. They're on site versus infectious diseases sorts of things where they get to a hospital, and they get treatment and they get part of the official count. So there's a lot of international experts that talk about countries where drowning is really truly the leading cause of death. So as they've we worked with that we identified the these Vietnamese youth that were drowning, and and kind of coincidentally, some of the youth themselves that approached the mayor and said, You know, I've lost so many friends, we're just so sad, can you do something? And so, in doing some focus groups with them, we learn that part of the what was happening is that as they went to a beach and there was some destination, a buoy or dock or something, they were going to swim to that even if they didn't have swim skills, they needed to save face, and so they magically hoped they could swim from A to B, even though they knew they had no swim skills, and it was sort of a fatalistic approach. If it's my time to go, it's my time to go And so we had to kind of change that dialogue around working with the parents and the elders and the elders had a very superstitious thing that we was kind of unknown before were the ghosts of those that have drowned in order to be released need to pull somebody else down. And so, you know, they would actually tell the kids do not swim in that lake do not swim at that beach because of the superstitious nature. So we so we really worked hard with the Vietnamese community, the churches, especially at Seattle Children's Hospital, did a lot of this work, we held a life jacket fashion show to kind of promote the life jacket, use the context for getting them like

Mighty Fine: 20:44

a fashion for life to make them really important.

Tony Gomez: 20:50

It really was, yeah, we had all kids of color there and showing you could you know paddleboard canoe kayaks, when with your life jacket on, it was very hip and very cool. And, and, you know, the mayor was not the head of the show the kids were,

Mighty Fine: 21:04

I mean, I would go to a life jacket fashion show.

Tony Gomez: 21:09

It's cool. We did another one kind of Riverside to show that I think I'd like to do it again, because they are just the kids do youth do a great job with running the thing in the MC, putting the Hit Music and doing the messaging,

Mighty Fine: 21:25

but I don't want to so there's a GET LOST sorry, Tony's the idea of just introducing a life jacket fashion show, just again, to put it on the top of our minds and just introduce it to folks who maybe not as aware of their the benefit of using them in water. And then also you talked about addressing sort of the superstitions that they had. So it just also speaks to, as we're engaging in community, we have to be culturally competent, so we can talk about the work and in ways that will resonate with them.

Tony Gomez: 21:58

Absolutely. And it just kind of finished the life jacket fashion show piece with the Vietnamese youth and the other kids of color. You know, we we kind of have them model, different, you know, there's life jackets, for kayaking, there's the $15 life jackets, that kind of all purpose Coast Guard approved. And we also show that it's a little crazy in the industry, because they sell non Coast Guard approved life jackets that have less buoyancy. And you gotta be careful when you're, you know, they sell them next to the Coast Guard approved life jackets. And so I, you know, for some of us, it's like, yeah, there's a regulatory issue that somebody needs to address here because they shouldn't be selling on Coast Guard approved life jackets, next to the Coast Guard approve life jackets is easy that Oh, it's $5 it's gonna

Mighty Fine: 22:47

say, especially if it's a price differential, because folks may be more than likely to go with the cheaper version, you know, and not knowing the, the impact that they that that's making that decision, you know. So as always, we talked about making the healthy choice, the easy choice, and that's not making it easy for

Tony Gomez: 23:07

you. Yeah, thankfully the price of Coast Guard approve life jackets has just come down and wholesalers and vendors are working with us and glad to work with anybody on some of those deep discounts in order for some of these giveaways. And then, you know, having the youth kind of do the catwalk with various, you know, cool colors and styles and life jackets. And then I think for me, the highlight was actually putting them in the water showing, you know, he could swim butterfly, he can swim all four competitive strokes. You know, and we've had our hydro plane race drivers talk about I always wear a lifejacket when I go out on the water or Olympic medalists. Talk about when they're out on the water. Whether it's kayaking or swimming, they wear a lifejacket if there isn't a lifeguard there because you never know. You know, even good swimmers, can can drown it's it's less likely but even they can drown. And then the other story I have is kind of about a high school I helped volunteer at for coaching baseball. Very diverse school, mostly black youth on the team, and one of my outfielders broke as broke his leg. And you know, baseball up here in the Northwest is kinda usually rainy season, February, March, April. And so, you know, I'm hitting some fly balls to the other outfielders and he comes hobbling out with his glove and his crutches and he goes coach, will you play some catch with me? Like, we need you to like go back in under a shelter there and you know, kind of do your core work and other stuff and I'm just sorry, but yeah, I got to hit you know, work with these other kids and we'll come come chat with you. I said, but as your doctor said, it's okay to get in the pool so we could start doing some exercises in there too. I have to get you back in shape. Because I already know how to swim because now I don't know how to swim. And so by that time the other kids have gathered up around us, you know, because everybody's gotta be in on the conversation, right? It's baseball, of course. So one of the kids goes, yeah, the stereotype of black people not being able to swim is true. I don't think any of us can, can swim. And then one of the other kids says, That's racist to say those sorts of things to even talk about stereotypes like that. And then, you know, one of the other kids goes, Hey, I'm black, I can swim, and I'm proud of it. Like, okay, timeout here, timeout, let's, let's kind of unpack. Certainly, if you find out when the doctor is okay with you getting in the water, because, you know, we have a pool across the street, that's one of the best pools in the region, and he lives a block away. And so it's just criminal, that very tragic that, you know, they haven't had the opportunity to get lessons and know how to swim there. So anyway, we, you know, we get in that water once he's able to and, and, and start doing some water exercise, putting them in a lifejacket and doing a little bit of swim lessons with the kids. And then, you know, dress the other kids about the it's racist to even bring it up? I said, No, no, no, it's important that we talk about this and talk about the reasons that we're in this spot, you know, going back to institutional racism and public health legacy of slavery that's still being addressed here. And, and, you know, black elders that are fearful of their children learning to swim for fear that that's going to increase their risk of drowning. And that there's been, you know, generally less opportunity to learn to swim to be on swim teams, and all those sorts of things. And that we need to, you know, we need to prioritize that. Because, you know, for us, when we had this shift in drowning numbers, again, one of the things we found for the first time here was that blacks were drowning at a rate four times their population. So that to me screams of an equity issue that we all need to address. And for some states, that's not that's not been a new item, it's been historical. And so it's areas that the government community needs to work together on and elected officials and decision makers need to prioritize that need to to improve opportunities for you kind of goes back to that lifelong exercise option for chronic disease prevention, for we're the least in our area, least air conditioned community in the country. So when we get a 90 degree day, it's going to get people to the beaches, and if, you know, some of our beaches are not lifeguard it puts them puts our communities at higher risk. And so there's, there's all this intertwining of really important public health issues that have a lot, a lot of overlap with our injury, violence prevention work, and the drowning prevention work we need to do.

Mighty Fine: 28:13

And I think you just also just touched on, it's really shifting that narrative. As you mentioned, helping folks understand the intention behind learning to swim, because it's safe and debunking these myths that black people can't have a black guy and I swim very well. Like that. I like that guy, you talk to us, I'm glad you were able to create that space for them to dialogue and work through some of those things so that they all can be safer as a, you know, engage in water in various ways. So I don't know if there's anything else you wanted to mention about prevention. And if not, it just curious from you, as we're having this conversation, what's something that you think most people don't know about drowning, that you want to use this opportunity to share?

Tony Gomez: 29:00

You know, one of the important things that we we've worked on and seen that has implications for listeners here and for state health departments and for injury prevention advocates is that the public health system has generally a pretty good handle on drowning prevention and what we term maybe Health Department regulated facilities. So these are the water parks pools spa, you know, apartment hotel motels. Most states through environmental health have strong inspection programs. So they're getting out there looking at fences looking at lifeguard certifications, we've got entire states I think, last I'd heard Texas was still one of them were there. And there are others where there's really no public health oversight, and so they have drowned higher drowning rates and some of those which should be public health inspected, regulated facilities, public health, working with industry, on the Open water side, the beaches side, we did a we did a paper, we did a study that showed a strong association between states that have good open water beach regulations, again, largely through environmental health, but some of them had overlap with the injury prevention community. And that the states like New York, New Jersey, Illinois, that had very strong swim beach rules and regulations requiring, you know, certain amount of lifeguards requiring a water clarity, so rescues could occur, surveillance plans, data get, those states have less drowning, and we're not one of those states, you know, we started this field nearly 40 years ago, we're supposed to have had a swim beach program go on. And it just still doesn't exist in our state most states. And it needs to be a partnership with the private beaches, as well as the public beaches. So the parks departments, federal, state and local level, to fund and do a better job around these areas. Because in addition to be in an injury prevention issue, it's a climate change. It's a chronic disease issue. And so I think that's one thing we need to, you know, keep in mind is that we need some push, you know, through ash doe, through environmental health directors through our injury prevention folks to advance this. And part of that goes to we need to fully fund the request amount for CDC to have some drowning prevention, both surveillance and programming. Dr. Tessa Clemens who's working there on some of this is just outstanding, she helped develop Canada's national plan. We're close to having a national plan. And that is really great news. But we're one of the few developed countries without a National Drowning Prevention Plan. And so it's been great to see that but we need Congress to fully fund the 5 million that's been requested. And I understand from our congressional folks that, you know, it was a real battle even keep the 1 million in there. And, you know, that's it, like so many other public health injury issues, money needs to flow to the Feds and enough amounts to flow to the states to flow to the locals, with the bigger populations to do some important work on this issue.

Mighty Fine: 32:28

Yeah, absolutely. Thank you sort of laid some great groundwork for the way forward, and you certainly have elevated what we're currently doing that's effective, and we being in public health. And again, what what else we can be doing? I don't know if there's anything else you want to add there. Or before we close out, if there's some other message you'd like to communicate to our listeners about water safety or drowning prevention, if now the proverbial floor is yours.

Tony Gomez: 32:55

Yeah there's two two, kind of things that I'd like to talk about. And depending on where you decide or if, you know, maybe with Morag, it'll end up, you know, as part of that conversation, what is through Child Fatality Review, I you know, as talking about the Vietnamese youth and how we were able to develop a prevention program, and part of that included, eventually, by looking at our Child Fatality Review cases, and just start data and prevention. We went a three year period where no child at all drowned in King County. Now, given all our water, that's pretty dramatic improvement. Because when I first started, we were in, you know, 12 to 20, youth, and kids a year drowning. So zeroed out for three years was really big, and part of what we identified and Child Fatality Review and other states and localities would have an opportunity as well, is that we found one of our Lake Washington ship canal system. So it's a canal that allows water to flow from freshwater to saltwater. And it's not a swim. It's not a safe swim area. It's a voting area, and we were losing 234 kids a year swimming in this body of water on lifeguard and, you know, I put up rope swings. And so we just simply prohibited swimming there, you know, and, and there were warnings and the boating patrol kind of, you know, it became known we had a lot of publicity and so we had for 20 some years now, no child has drowned in that body of water. So are there are certain places, you know, you just prohibit swimming because it's just such a dangerous body of water. And you try to get them And so that was what he was thinking, as he knows, and he's to go to the lifeguarded beaches, which are, you know, not that far away. So that's been one of the challenges. One of the things we were doing is investigating all cases in our through environmental health folks in our pools, spas and water parks to make recommendations for improvement so There's many states that conduct that. And some of that work needs to be done in partnership with injury prevention folks. And, and so we also had expanded that because we have authority to be notified about all drownings out in public settings. And so we had set up a system with the docks to like, let me know when there's a drowning, that presents at your emergency department or in your office, because we'd like to talk with those folks if they're willing. And so like many areas, we have a river that will get a hot day and hundreds of people will go out there, and inner tube and jump off the cliffs and you know, pack beer in, you know, in beer and alcohol is an important factor, or alcohol and drugs are an important factor in drowning. Some cases, some years, we see as half of our cases are alcohol or drug involved and, and it adds a whole nother dimension to both decision making, and then even resuscitation because, you know, the docks can't do much once you've reached the emergency department. It's not like so many other injury issues where they can reverse it, you know, the damage is done. And the prevention is the key that preventing that three to five minutes of submersion, where brain cells are dying, and things are irreversible, in many ways, at that point, so that's the importance of you know, the prevention. So anyway, this we have the system set up where Doc's will notify us and so I got a call from a doc, he goes, Hey, I got an interesting case here. This probably 1819 year old had jumped off the cliff at this Green River Gorge is our is our area. And, and he nearly drowned. And waiting showed up in my office was a week later he was you know, practically dying of pneumonia, it set in, and he's gonna be fine. And he's willing to talk with you. So anyway, we met out there and we hiked into the area, and it is just beautiful and fun. And, you know, in our youth, we might have joined in on some of that, sort of, you know, be competent swimmers that you were going to be okay, but I do know, folks that got in trouble in those spots. But anyway, and he described how he jumped off the cliff, and his body just went numb instantly. So he was fighting when paralyzed and he couldn't move. And all he could think about was needing to get his hands in his pocket to get his car keys out. So he could try to somehow get his arm out of the water to throw his keys to shore. So his his friend could drive his girlfriend to work. gonna, he's gonna probably die. And then And then his friend grabbed him by the hair pulled him up and pulled him out. And they had to revive him. So they got him breathing again, and he refused medic transport. So that's where the trouble kind of said, No, he just went to, you know, take his girlfriend to work and go to work himself. And then the pneumonia nearly said, and it's, you know, this dry Drowning is a pretty rare situation where you survived the incident, and then pneumonia or something comes along, you know, in a in a few days, or in this case a week later, where he must have been really sick when he has finally shown up at the doctor's office. And so, you know, it's hard to kind of address some of that high risk behavior, but we need to help inform parents and others, to have those conversations with their youth avoid jumping off of the railroad bridges, and some of that, and, and I've seen this work now where if they're wearing a life jacket, you still do the jump and hold on to the life jacket that's going to help pull you back up and, you know,

Mighty Fine: 38:54

buddy with you, you know, your life jacket? For sure. So

Tony Gomez: 38:59

it's just an interesting story is kind of at the local level. Yeah. See some of these?

Mighty Fine: 39:04

No, that's fascinating. And even him sort of sort of thinking about what his steps were to get his car key. You know, it's just amazing what, you know, I guess, when you're confronted with a literal life and death situation, who knows what you'll be thinking at that at that point, but thankfully, he came out on the other end of that. And I think what you raise is that while there are things we can be doing nationally, when we think about water safety and drowning, prevention, there's a lot of nuances that we need to account for, for what happens on the local level, when there's a lake or a river or something that folks tend to go and hang out and certain messaging and safety issues around around there. But it sounds like a lot of great work is happening. And with a lot of other public health issues, there's there's some improvement opportunities for enhancement or improvement in what we're currently doing.

Tony Gomez: 39:54

And again, it kind of comes around to your first question about you know, this is important for us to be You know, the core functions of Public Health to at least serve that assurance role, that if we're not able to do it as injury prevention leads that environmental health is addressing it, or the parks system, the parks Association in that state or the Children's Hospital. And we can be an important part of that assurance role to make sure both the surveillance is occurring as well as the prevention activity.

Mighty Fine: 40:25

Absolutely. Awesome. Well, I think that's a great way to punctuate our conversation in this portion of the podcast. Tony, always a pleasure. Thank you again for joining us today. And I look forward to seeing you again soon. It's been way too long or interacting again in some other manner. But again, thank you so much for your time today.

Unknown: 40:44

Thank you, Mighty. Thank you, Christa.

Mighty Fine: 40:48

Bekah, Morag I'm so glad to have you both here to chat with me to follow up on this first segment where I had a chance to talk with Tony about his thoughts on drowning prevention and water safety. I'll ask you both some of the same question that asked him to just help give us a broader perspective on those questions. And so I'll dive right in and ask you both to just share with me from your perspective. Why is drowning a public health issue? And again, as I asked Tony, sometimes I feel like in the realm of injury, violence prevention, it doesn't seem to get sort of its share fair share of the spotlight. So if you could just talk to us about those two things, why it's a public health issue. And am I wrong? Or is it just a misperception of me having that it's not spoken about as much as I think it should be?

Morag McKay: 41:38

Well, from Safe Kids perspective, mighty it is definitely a public health issue. It's a leading cause of death in children. In fact, it's the leading cause outside of unintentional injury out of all deaths, it's the leading cause for children between the ages of one and four, and we lose somewhere between 900 Or Well, around 900 kids a year to drowning. It's sort of up and down the last couple of years, but it probably averages out to about that. But anybody can drown. And all together in the US, we lose about 4000 people a year to drowning. So from my perspective, maybe one of the reasons it doesn't get the attention is that when you look at some of the other unintentional injuries, like motor vehicle crashes, or of course the opioid epidemic, the numbers are just so much larger. But again, for us, it's Safe Kids, it's second only to motor vehicle crashes in terms of cause of death. And when you're losing children that young to me, I mean, that's the future of the society. Right. So from my perspective, it's it's definitely a major issue for that reason.

Mighty Fine: 42:52

Thanks so much, Bekah, for you.

Bekah Thomas: 42:54

Thanks, Mighty - yeah Morag I couldn't agree more. And I think there's a couple of reasons that it's a it is a public health issue, and some reasons that it doesn't crop up on a lot of people's radars. You know, it's, it's a public health issue, because people are dying from it. Because social determinants of health affect whether or not you experienced drowning or near drowning, or whether or not you have access to prevention strategies for drowning. And I think it gets a little bit of short shrift, if you will, doesn't really get as much attention in the injury and violence prevention world because it can be really context and location specific. And also, a lot of times in our health department's pool regulations are covered under building codes or sanitation codes. So it doesn't necessarily make it into the purview of the injury and violence prevention, people who are doing these important work. And also it goes under the Department of Conservation and recreation a lot of times, which are, they're all wonderful partners in the space and people who need to be at the table for public health to work. But at the same time, it doesn't the regulations and the things that we have control over in public health doesn't necessarily land on our plate, not to mention, public health is really short strip short, staffed right now has a lot of burnout in this historically, in my experience, a lot of the local public health offices focus on what their statutory and regulatory mandates are met doesn't always cover injury and violence prevention, and therefore it doesn't always call covered drowning prevention.

Morag McKay: 44:34

And just to add on to that, I think one of the reasons why we don't see it happening at whether it's the state or the county or local office level with public health as well, also stems from what the priorities are at the national level. And I would say that when you look at issues that get attention, they've got public outcry. They've got media attention to the issue that leads to governments paying attention and to you know, Creating a focal point and creating a mandate for coordinated action to happen. And that results in more funding flowing to it more staff flowing to it. And without that, you know exactly what Rebecca saying, you know, at that local level, they're focusing on what they're being told to focus on.

Mighty Fine: 45:17

Right now that that I get it for sure. And, and I think that's why it's important for us to create spaces like this and others where we really help to sound the alarm of this major public health issue. And, Becca, you alluded to this already thinking about some of the major contributing factors and you talked about access, and obviously, there's education around water safety and skills. Can either you just talk a little bit more about from your perspectives, what are some of the major contributing factors to, to drowning?

Morag McKay: 45:50

Well, we already spoke about age, and kids are a major age group there, but really interesting. Ly, gender, about eight out of 10 of the drownings that occur in this country occur in males. And there's many factors that might contribute to those higher rates there, it could be just their increased exposure to water, it could be increased risk taking. And it could be alcohol use, because alcohol is another huge factor we see in many of the adult drownings.

Bekah Thomas: 46:20

Yeah. And it's the same, what we see in Massachusetts is pretty much the same too. And we have another additional at risk group, which is new immigrants to Massachusetts from other countries, they're way over represented in our data. And one of the things we think is going on there is they're coming to a new place they might have might not have experience with ponds, rivers, lakes, or waterfronts, or ocean beaches, and they might not have experience or haven't had the opportunity to learn to swim. So face with those opportunities to get in the water, they might not know this is not a place that's safe for swimming, they might not know access to life vests and other you know, life saving materials that are out there. But I also want to you know, Morag is completely right about the age group to what we're especially worried about the 15 to 24 year olds, up in the Northeast. And those summer months are so tricky. So there's so much we can do to prepare a little bit more, get the word out, make sure that there's not just swim classes, but swim classes for all ages, since having a parent who knows how to swim is a protective factor for children, and making sure that people have access to water safety or water rescue classes. In addition to standard swimming classes, we've seen a few really tragic cases where people go in after a drowning victim. And they themselves then drown because they don't have the the the skills and resources for conducting that water safety effort. And it's a it's a tragic talking point to have that I would rather have see one fatality then two or three fatalities in one go. But that's what we're faced with right now. And the Northeast.

Mighty Fine: 48:08

Got it? Yeah. Earlier today, I shared that I was a lifeguard and you know, I enjoyed it. But it was for swimming pools, not nothing beyond that. And I recognize that sort of the skill level is different. But I just also it reminded me of I've had a lot of jobs now that I think about it. But I used to work at like a daycare. And I remember it wasn't until I started talking about this today. But I remember like some of my most anxious days were the days when we got the little kiddie pools and have the kids in the water. And given it was only a small amount of water. But I don't know, it was always super anxious. But also, me it made me pay closer attention to make sure things are and not that I think about it. I was trained as a lifeguard, but there wasn't any sort of additional training other than CPR that I got it to be supervising kids around water. Now I'm thinking like, that's probably a misstep on the behalf of the organization that I won't name? None, no. You talked about children being at risk. And then you talked about the immigrant populations. And I had a question I wanted to pose to you both about risk any disparities that we're seeing, but you both alluded to them already. I just want to open it up if there's anything additional that you wanted to share about some of those risks.

Morag McKay: 49:29

So, in terms of other disparities that we see, And you know, more broadly at a national level two groups that are at increased risk are American Indian and Alaskan Natives their risk is like two times higher up to the age 30 of white people. So definitely some of that may be exposure to either hazards or exposure to less exposure to preventive measures, but the other group is actually black African American children. And we see almost similarly in some ways to the immigrant population, often they don't have access to swimming lessons, or they don't have access to community pools. So they're going out to the local, open water, whether that's a river or a lake, or the ocean, and they are swimming in open water, which is even more dangerous than a pool in some ways, because there are unknown conditions, currents, that sort of thing. And often they're doing it, especially the last couple of summers, where we've had these really hot spells, they're not necessarily going to a designated swim area, they're just finding an area along that body of water and going in and swimming. And so you see some of those same tragedies that Rebecca was talking about where a couple of young teenagers are going and cooling off and one gets into trouble, and the others try to rescue them. And before you know it, you've got a lot of them in trouble. So it is more than learning to swim, we talk about survival, swimming, there are some specific skills that we really encourage all children to learn, even if they don't want to go on and learn how to butterfly and, you know, and because there's some very basic skill sets, that make up part of water competency. And that's that they can basically jump or fall in the water, go OUT out of their depth, but find their way back up to the surface, that they are able to float or tread water for at least a minute. And floating is great, because that takes less energy than treading water. And so that's something that they're often taught, we, we want them to learn to be able to turn around those so that they if they, if they really have fallen in, whether it's off the side of a dock or off a boat, or the side of the pool, that they're able to orient themselves to where the exit would be. So they can turn around and figure out where they are and see where that exit is. Swim 25 yards to get to that exit, and then actually exit that water, not so hard, maybe in a beach where it gets shallower. And you can just exit out that way in a pool. You know, we're like, we want them to be able to actually pull themselves out of the pool without a ladder, because sometimes you just have to do that. But of course, the minute you're talking, doing that in a pool is one thing doing that in open water where you have differences in water temperature, you may have currents working against you, you may have differences in visibility within the water, all of those things, increase your risks. So yeah, it's it's it's really surprising. I did work in Europe for a number of years, and a number of countries require that all kids learn to swim, and they actually put in the infrastructure. And they put in, you know, a requirement within their educational programs that all children are taught to swim. And they have to pass certain certain performance standards in order to pass and be said that they're safe. And so it's, for me, it's really interesting, having moved to the US about six and a half years ago, to realize that, that that's not the case. And in fact, you know, again, with with the black African American communities, there was actually systemic changes or lack of access because of systemic racism over the years that that meant it really almost became a white person's recreational activity in the pool sort of setting. And there's some amazing organizations like diversity and aquatics now that are working really hard to ensure that kids get that opportunity to learn to swim, because that is one of one of the main ways that we can keep them safe.

Mighty Fine: 53:34

Absolutely. And just Bekah before you chime in, just harkening back to the earlier conversation we had with Tony. And one of the things that came up was this, this idea of the stereotype that black people can't swim or they don't want to swim. And so to your point, having more programs like that, and just creating or reshoot reshaping the narrative that no actually, there are Blacks that can't swim, swimming, learning how to swim is beneficial. So yeah, absolutely. It's a cultural shift that we certainly need to see here in the States. And it's great to hear that where you've come from, there are provisions put in place to ensure that the environment doesn't conspire against a change that we want to see, but it supports it instead.

Bekah Thomas: 54:16

Wouldn't it be a dream to have that in our school curriculum and requirements here in the United States what a dream, and Morag you started and mighty started to touch on something that I wanted to really bring up about why history matters and how our history of systemic racism and institutional racism affects the drowning rates and a lot of injury and violence prevention rates that we see today. Because, yes, black Americans are way over represented in our drowning data. And if you think about the history of segregation, where black people didn't have access to public pools, and when they weren't finally and eventually granted access to some of our all of those public pools, white people turn to Build pools in their backyards. And that's where you really saw the advent of the inground swimming pool and above ground swimming pool in middle class white people's houses for the most part, which of course increases accessibility for white people to learn how to swim, and deny those same opportunities for people of color. And, you know, I alluded it to it before, but we know if a parent knows how to doesn't know how to swim, their child has something like a 13% likelihood of learning how to swim themselves. So when you have that kind of intergenerational challenge, it's nearly impossible to overcome it without really specific and explicit interventions for the populations that have been marginalized because of those historic policies. So I love hearing about all those organizations, we've got some up in the Northeast that are just doing such great work. But without that systemic change, like that incorporation into regulations, that incorporation into educational curricula, those creating that access, we're just never going to get over this. Just devastating

Morag McKay: 56:06

Inequity. Yeah. Well, and even something that might be referred to earlier being a lifeguard yourself, when when young kids go to the pool, and they look and they see who are the lifeguards, if they see people that look like them, they feel more welcomed and part of the community. And I think that's, you know, another area where we also need to be ensuring that we're building diversity. One, one last really interesting thing about the systemic racism that started this sort of bifurcation of opportunity for some populations is some of that same infrastructure that was eventually built, it was built back in the 50s, and 60s, and maybe 70s. It's all really old now. So what you now sometimes have is you have a community pool, but it's being closed, because there isn't funding to fix it. And then you have situations where you want to have swim lessons for kids, but you just don't have access to a pool to do those swimming lessons in. Or you have small communities in rural areas that just would never be able to have happiness support a community pool sometimes. So you again, you don't have access to locations where kids can swim. And one of the really interesting things is we're we're sort of exploring some of the ideas that are coming from overseas in some of the low and middle income countries where they again, they don't have access to pools, but they found these great ways of bringing in these mobile pools that they bring to a community for a period of time and the kids get lessons over a period of six to eight weeks. And then they move on to the next community. So I think, you know, despite the fact that we're a high income country here, there are some lessons to be learned just to increase access to ensure that all kids get that opportunity to learn to swim.

Mighty Fine: 57:59

That's pretty fantastic. You know, I love that. Yeah, it's I think it behooves us, us being America to open ourselves to the idea that we can learn from other countries, right, if particularly if they're lower middle income countries, there's still a lot of learning that can happen. I'm not saying that we're not I'm just saying we should open ourselves up more to the idea that we can learn from abroad. And you both again, have touched on some prevention strategies and sort of cultural shifts, policy shifts that we need to see here to get these numbers down. But are there any other thoughts you have on? What are some of the most effective ways to preventing drowning?

Morag McKay: 58:41

Oh, let you go first. This time, Rebecca.

Bekah Thomas: 58:44

Oh, thanks, Morag. I was gonna use that time to think, you know, picking up on the conversation, we were just having to thinking about it in terms of free opportunities for swim lessons, I think that that's a really powerful intervention tool. Because again, if you're talking about low socioeconomic status individuals, they're not necessarily going to prioritize a swim lesson over, you know, required, you know, their rent or their food or anything else. It's really a day to day necessity. So like one barrier is just providing free swim lessons, capturing funds and making it a low cost or no cost swim lesson those the swimming lessons, were really the best way to go about it. In the northeast, we have a lot of work to do around messaging for natural bodies of water, especially in multiple languages. So I'm very proud that we have an infographic on the dangers of natural bodies of water geared towards men and boys between the ages of 15 and 24. And we have it in about 13 different languages in Massachusetts. So it's really and more to come because we had a huge influx of Afghan refugees. So we're translating those materials as well. But just talking about, you know, if you don't know how to swim, you can't learn to swim on a whim, you got to go out and get a lesson, even if your friends are splashing around and having a fun, stay ankle deep, don't go in after somebody else if they're drowning. But I think at the the end of the day, what I like to see most are those societal interventions, the requirements for education, the, the access to tools for all people, the free and low cost lessons. And I think at the when we take this at the individual level, there's just still too much room for error or mistake or missing people or not getting it out to the right people. So I really love thinking at the societal level for policies and programs that can improve access, and education.

Morag McKay: 1:00:51

Yeah, there's some nice example around that around the issue of life jackets. The Coast Guard requires all children up to the age of I think it's 12 or 16. Gosh, Morag you should know this, to wear a life jacket. But it's like you're required to wear a life jacket. But where do I get the life jacket, particularly if if I'm a family with a low income and but I still want to take advantage of opportunities to go and participate in water recreation. And you know, life jackets aren't just for when you're on a boat, or paddling on your paddleboard or whatever. We also recommend them for weak and non swimmers just anytime that the kids are in on or around the water because it just doesn't take any time at all, for a child to get into trouble and to to begin to drown. But we have communities in a number of locations across the country, often with the support of the Army Corps of Engineers who have put up lifejacket loaner boards in their communities. So they've identified locations within their jurisdiction where people are likely to be coming to either boat or, or just even just beyond the beach. And they have these loaner boards and they work with community partners to ensure they remain stocked and it just provides an opportunity for a piece of equipment that is really important when you're in honor around the water. But you might not use every day. So you know, when you're trying to decide what I'm going to spend money on it might need not might not be something you decide to right away. So I love these programs. And there are more and more occurring all the time.

Mighty Fine: 1:02:31

Sure. And to that point, I think, more education around using them I chatted with Krista and Tony about this offline. But I remember recently I had gone to Jamaica and you know, they have the catamaran you slide down the slide and go into the water. And I consider myself um, you know, I think I'm a pretty great Olympic material. But I'm a pretty good swimmer. But it's like I started to swim out and at first I was like, Wait a minute. This is a lot of water, you know. So I swam back pretty quickly and got the lifejacket on. And it just, even though I'm a good swimmer, it just made me feel even more protected. And we joked on the boat like some folks who are swimmers are like, Oh, I don't need that. You know, why did you put that on? But you know, thankfully, I was secure enough in who I am in my ability to not let that shift my thinking around using it. But I think even sort of those nuances around who needs it? When do you need it? How you know? So thanks for for elevating that. What do you think is one thing or a few things that most people don't know about? Water safety or drowning prevention that you you think? Good for them to know you like to share today?

Morag McKay: 1:03:44

I think the one thing that is there is no way to drown proof anybody, right? That's one of the things that we really teach parents. It's not one protective factor. So learning to swim isn't enough. You need supervision you need if you're, you know, in on around the water, a lifejacket is recommended. You need to not take risks like drinking alcohol. So we talk about layers of protection, particularly with young children. It's really important that you don't just think okay, they've taken swim lessons. They're okay now, or you know what we we built that fence around our backyard pool. We're okay now because we hear of incidences all the time, where that there's a what's the word I want, but one layer that they have in place fails them and then you want to have subsequent layers in place because there is just no way to improve. And I think sometimes that's a false sense of security that gets built and we really want a particularly when we're talking to parents for them to understand that they need multiple layers.

Mighty Fine: 1:04:49

Got it.

Bekah Thomas: 1:04:51

Swiss cheese for drowning, I like that so much. And I a couple other things like just interestingly you know what And we have 86 degree hired degree Fahrenheit days or higher. That's when we see the most drownings. So I think that's a it's an important people to really, for people to really think about, like, oh, it's warm people are headed out, okay, let's be on high risk for drowning and drowning prevention, maybe we can get some messages out when we're sending out messages about heat waves, or other things so that we're, you know, capturing that moment when we know the risk is highest. And also there, you know, it looks like it's kind of emerging evidence, I'm not sure if that how concrete the the evidence is, but water temperature might actually have an impact here as well. So you know, here in the Northeast, the water temperature stays really cold for a long while, and so the air temperature might get up high. But you know, thinking about how your system reacts, when you expose to that cold water right away, it can, it can slow your mobility, and it caused a little bit of shock that can actually put you at increased risk, even if you're a really, really strong swimmer. And both of those things are important as we think about climate change, because we're getting more hot days more frequently, and hotter days more, more regularly. So this is not an issue that is that we think it's going to go away anytime soon, I'm very concerned that this is actually going to get quite worse. And a lot of places where we're seeing the most devastating impacts of climate change, and we have to be on high alert. So and then there's one thing that I want it since we're all injury and violence prevention practitioners here, just wanted to mention that homicide and suicide happen with drowning as well. So we actually, you know, it's not I don't think it's very often talked about in the suicide prevention realm. But we do see a fair number of older adults who die by drowning in their bathtubs. So it's, it's out there, and there's conversations to be had, beyond the unintentional and really with the intentional forms of injury as well.

Mighty Fine: 1:06:56

Great, yeah, great point to to showcase the intersection of even within the field. So as we're educating and as we're talking about, and and communicating about these issues, we can show where those intersections are in, in thinking about prevention from a more comprehensive approach as well. One of the things I just want your quick thoughts on as well. And this is something it wasn't until I was sort of steeped into my public health career that I learned about dry drowning. I'm like, What in the world? You know, so I don't know if there's any sort of quick, quick thoughts that either of you have on that subject?

Morag McKay: 1:07:33

Yeah. Well, our medical experts, experts that support our efforts in drowning prevention, say there are no medically accepted conditions, known as near drowning, dry drowning, or secondary drowning. Very, very rarely, a child develops aspiration pneumonia after, you know, choking down some water. But they are not 100% Fine. And then a week later, they're having difficulties, they are going to be continuing to have difficulties in the interim. So the media response that has happened, I don't know what it feels like it happens every other summer, maybe that there's a big, you know, hype in the media about this. And I think what concerns us about it is that absolutely, if your child has choked on some water, you want to pay attention to their breathing. But parents are far more focused on that than they are on just even understanding. You know, what does drowning look like? And when do I understand that my child's and troubling, you know, one of the surfaces, I guess, that Hollywood is done is everybody thinks that when someone starts to drown, they are splashing out in the water, they're waving their hands, they're yelling for help. And the reality is drowning is pretty silent. By the time a drowning starts, you have sort of between 20 and 60 seconds, they estimate before full submersion will happen. And particularly in little kids, you will see them they're basically upright in the water, their heads are tilted back, trying to keep their mouth out of the water, so they can't yell because their mouth is basically going up and down in the water as they try and get breath. They're not waving because their hands are trying to push down on the water to push their heads up out of the water. And very quickly, they they get exhausted, and then, you know, tragedy is happening. So we always say to parents, you know, you've got to keep your eyes on them. And if they're really little, you want to be what we call touch supervision. You want to be within arm's length of, of non-swimmers and very young children at all times. Because one of the really interesting things and I think any parent knows this. One minute they're, you know, just joyously playing in the water and the next minute their lips are blue, they're chattering and then they're just exhausted. They run out of energy, boom, it's just taken a lot out of them. And we, we often talk to parents who think their child, they thought their child was absolutely fine one minute and then suddenly they weren't. So again that that close act of supervision is so important. And we actually recommend that rather than sort of leaving it to chance that families actually assign an adult to be a Water Watcher, if you've got kids in the pool or kids on the beach. Yeah, lifeguards are doing active surveillance. But there's nothing like having an adult that specifically keeping their eyes on the children, whether it's, you know, mom taking 15 minutes and spelling deck for 15 minutes, or yen, or whatever, we really recommend a Waterwatch or in any situation when the kids are in the water.

Mighty Fine: 1:10:46

Absolutely. Bekah anything to add for from your perspective.

Bekah Thomas: 1:10:52

I just want to fully endorse everything that more anxious, especially when it comes to the secondary drowning, that is much more like pneumonia, than it is like an injury. So just thinking of what needs medical attention and involvement, but it will it'll be apparent in other ways. And it's so it's just I would love to call on the field of injury prevention to dispel those myths and you know, to really focus on the actual drownings, not so much on the on the secondary or After Effects. Those are, you know, it's in often be like a bacterial pneumonia infection. And it's just not the same thing as an injury. So focus where those numbers are highest focus where those disparities are greatest. And let's work together to make sure we're preventing true drowning.

Mighty Fine: 1:11:43

Got it? Thanks to you both. So those of you listening, this is a call to action. So take note, right? And but thanks, thanks for that. So we're coming towards the end here. And I you both sort of alluded to the next question I wanted to ask you, so I'll pose it again, but also wrap it into if there's anything else you want to share with our listeners thinking about what more should we be doing? Or can we be doing to address this issue comprehensively, holistically, etc. And any other sort of final closing thoughts you have for folks working in injury, violence prevention, and particularly in this space?

Morag McKay: 1:12:23

I think that the thing that I sort of like to say is that I think public health has such an opportunity to grow its role in this area. In 2014, the World Health Organization did this Global Report on drowning prevention, and part of its call to action was for countries to develop national action plans around drowning prevention. And so under the auspices of water safety, USA, which is a roundtable of organizations at the national level here in the US that do water safety and drowning prevention, we started a process a couple of years ago to develop our own US National Water Safety Action Plan. But the reality is, and this is something actually that Rebecca alluded to really early on in this, it's so context specific here in the US whether I live on the coast or live inland, whether I'm living in the South, where everybody has a pool in their backyard, or I'm living up north where you know, the temperatures are colder, and there are just different things you have to think about. It's it is really context specific. So for us to come up with a plan, this is every, every place should do X is not going to work. So we've taken this approach of really saying what does the evidence say are our evidence based strategies, but then every jurisdiction, whether it's a state, a county, or a local community really should be starting off with an assessment of what is the situation in their community? Who is drowning? Where are they drowning? How is it happening? What are the hazards? What are the what are the programs and protective strategies that are already in place, and then figure out where the gaps are and help build it. And that requires bringing together this crazy multitude of stakeholders because while public health looks at often from a data and public health surveillance perspective, a lot of the solutions lie outside of health. They lie in the Aquatics field, they lie in, you know, Coast Guard, they lie you know, so it's it's, it's it's a big broad group of stakeholders that are needed in order to address this issue. And like it's done in other areas of unintentional injury, I really feel like public health can play that leadership role to bring together the stakeholders and try and help, you know, build collaboration and a cooperative effort to comprehensively address the issue and ensure that we're thinking about advocacy efforts to ensure we've got policy and legislation in place that protects kids I'm advocacy to try and encourage the educational system to take up that challenge of ensuring every kid has an opportunity to learn to swim through school programs, that that's going to take a lot of work. And it's probably a long term mission. But I, you know, we've seen such progress in other areas like road safety and the opioid epidemic in terms of that collaboration occurring under the leadership of public health. But I am, I have full faith that we can do something similar around drowning,

Mighty Fine: 1:15:31

for sure. And to that point, I agree, I think public health is a fantastic convener. And I've tried to get away from this idea of these non traditional partners very much like what you said, just think about who all has a role, and how do we bring them to the table? Yes, we have a perspective from the public health standpoint, yet we recognize that there are these other sectors that are critically instrumental. And that's really seeing true comprehensive approaches to issues like drowning, so very well quit. Becca, from your perspective,

Unknown: 1:16:06

That is so much of what Morag said, I totally agree. And there's a lot we can do, thinking about what's happening at the local level. So one of the challenges we have in the Northeast is that we have a really strong Home Rule, which means if every city or town or county comes up with their own regulations, their own way of doing things. And so we do have like statewide building codes, which are in line with the International Building codes, which has some great information about access to the pools and not having the house is the fourth wall of the fence, which is critical. But we also, as we talked about earlier, have an older infrastructure. And a lot of those pools, a lot of those houses are grandfathered in. So they don't have to meet the most recent safety standards. And there's no expectation for them to meet the most recent safety standards, which is doing no service to anybody, any of our children in in the northeast, or any of our adults. So thinking about those local ordinances and thinking at the local level, what kind of services programs or systems can you do to help people meet those safety standards? Even if they're not required to, you know, like, what are the incentives that you can build out that will get them to put an alarm on the door or build an additional barrier out to the pool. And, you know, we talked to about free access to safety resources. This, you know, that goes for a lot of different injury and violence prevention topics. So if we're talking about low socio economic status, people think about buying a car seat, think about buying swimming lessons, thinking about doing home modifications for grab bars, if you're an older adult who has fallen in the past, these are those all cost money. So thinking about ways that you can start to mitigate those costs. Because I think there's this tendency to think like, oh, accidents and accidents happen, and there's nothing we could do to prevent it. But a lot of times, it's because of an economic decision that had to be made by the family. And it's not, it's not the fault of the family. It's not strictly an accident. It's because our systems are not set up in a way that give them access to the safety resources that they need. So thinking about ways that you can work with your hospitals, your local coalition's your local boards of health, etc, to make those safety resources available. And then spreading the word to I think a lot of people like to think about the individual messaging out to people about water safety. One thing that I'd love to encourage people to do is work with the people who are working with families don't try to go and get every single family on your own work with social workers work with WIC providers work with home visitors, work with early intervention staff had start early education and care, daycare providers, etc. Because if you train them up, then they know what to look for. They can make their own spaces safer, and they can provide that education on your behalf to those families who they already likely have a trusting relationship with. Agree with that thing, and then I have to I always have to put a plug in for the data nerds

Mighty Fine: 1:19:21

plug away

Unknown: 1:19:22

For the data nerds in public health that are working in injury prevention. Drowning data is a it's a real issue for us. We get the fatal drownings, okay. But a lot of the non fatal drownings don't necessarily make it to a hospital so they're not included in the system. We don't have a great sense of what's happening. There's some wonderful projects going on right now with child death review to try and strengthen our death scene investigation around drownings across the country. But if you hear about that opportunity in the coming year, so please He's get involved in it because, you know, our prevention efforts, our ability to evaluate the impact on them is often really limited by the data that are available. So we really have a bit of work to do as well around strengthening data in particular, you know, surveillance so that we really, really understand the full magnitude of the issue, and are able to better target and evaluate the solutions when we implement them.

Mighty Fine: 1:20:26

Absolutely. I think that's a great way to end the conversation. Thanks to you, Morag, and Bekah for helping us here IVP in depth to elevate this critically important public health issue. Hopefully folks who are listening in learned a lot like I did, and as I always say, keep the conversation going and, and see how you can tap in to help save lives through drowning prevention and water safety. Thanks, mighty Thank you. Thanks for listening to IVP indef. Be sure to subscribe and listen to us on Apple podcast, Spotify or Google podcasts. You can also follow safe states on Twitter at Safe States. Same for LinkedIn. And don't forget to check out our website at safe states.org For more injury and violence prevention tools and resources. Again, I'd like to thank our sponsor Safe Kids Worldwide for supporting Safe States and helping us to create space for programs such as this. This is your host mighty fine signing off and until next time, stay safe and injury free.