Promoting swimming: a positive approach to public health.

I Agree

Dear Editor
There are an estimated 236,000 drowning deaths worldwide each year, most of them young children.(1) In addition, those who survive a dangerous water incident are sometimes left with catastrophic brain damage and long-term disability. The family, social and economic toll of these losses is intolerably high and entirely preventable(2-4) which is why we are grateful to McNally for highlighting that swimming is an important but neglected public health issue.(5)

Although the causes of drowning are numerous and can be multifaceted, prevention can be achieved through the combination of many simple cost-effective strategies. The World Health Organisations’ recommendations include developing a national water safety plan; improving drowning data; and teaching school-age children basic swimming, water safety and safe rescue skills.(1-3)

It is refreshing to read the article by McNally as it reminds us that swimming is a positive intervention that can be used to target a range of important public health concerns: diabetes, falls, obesity, mental health and physical activity are just a few.(5-8) Swimming and aquatic activity can also be extremely beneficial before and after surgery.(9)

Given the current crises in youth mental health (10) and support for special educational needs and disability, also associated with worsening mental health, access to swimming should be prioritised as a positive health intervention to help improve the health and wellbeing of young people and their families. SEND guidelines relating to swimming should be made widely available for parents and teachers, alongside increased access to swimming for those with disabilities.(11)

Within the UK the National Water Forum has developed a strategy and they have made some significant achievements.(12,13) For example, they have developed a water incident interactive database and raised public and professional awareness.(14) However, their work is being undermined by swimming pool closures. England has lost almost 400 swimming pools since 2010.(15,16)

We fear that there may be more closures due to heating costs and the fact that some swimming pools are coming to the end of their useful life.(17) The Government should conduct an audit of swimming pools and develop a clear costed plan for increasing facilities.(17) We need the right facilities within easy travelling distance with the right programmes in place, in order to break down some of the barriers to people swimming.

In the UK and some other countries, we have obesogenic environments that influences our ability to be active and burn up calories.(18) Having more high-quality, low-cost facilities around the country would encourage and enable more people to be physically active.

Exercise has been stated as being a “miracle cure” but it is still overlooked by some health professionals when they are caring for patients.(19) Health professionals need to be more involved in being ‘advocates for health’ and one way they could do this is to highlight the need for more swimming pools in the communities they care for. Positive health data should be widely collected and reported to monitor improvements and encourage further developments.(20)

Swimming and other aquatic activities can benefit many ages and individuals with a whole range of abilities. We need to harness these enjoyable public health interventions and make them available to more children, families and communities. With a staggering estimate of £2.4bn of social value for England alone from swimming and water activities, it is a false economy to allow the increasing barriers to water sports access to continue.(21)

1) World Health Organization. Hidden depths: the global investment case for drowning prevention. Geneva: World Health Organization; 2023.

2) World Health Organization. Global report on drowning: preventing a leading killer. Geneva: World Health Organization, 2014.…

3) World Health Organization. WHO guideline on the prevention of drowning through provision of daycare, and basic swimming and water safety skills. Geneva: World Health Organization; 2021.

4) Peden AE, Franklin RC, Clemens T. Can child drowning be eradicated? A compelling case for continued investment in prevention. Acta Paediatr. 2021; 110: 2126–2133.

5) McNally S. Scarlett McNally: Boosting swimming for health and joy BMJ 2024; 384 :q393 doi:10.1136/bmj.q393

6) Merom D, Stanaway FF, Handelsman DJ, et al. Swimming and other sporting
activities and the rate of falls in older men: longitudinal findings from the
Concord Health and Ageing in Men Project. Am J Epidemiol 2014;180(8): 830-837.

7) Watson M C, Lloyd J. Physical activity: manifold benefits for health and wellbeing. BMJ 2022; 376 :o815 doi:10.1136/bmj.o815…

8) Just Swim. Health Benefits. (Accessed 29/01/2024)

9) Just Swim. Swimming and aquatic activity before and after surgery. (Accessed 29/01/2024)

10) Young Minds. Mental health statistics. (Accessed 23/02/2024).…

11) Swim England. SEND and swimming lessons: a guide for parents and carers. (Accessed 23/02/2024).

12) National Water Safety Forum (2015) A future without drowning: The UK National Drowning Prevention Strategy 2016-2026.…

13) The National Water Safety Forum (NWSF). (Accessed 23/02/2024)

14) The National Water Safety Forum. WAID. Interactive Database. (Accessed 23/02/2024)

15) BBC. Swimming pools: Concern as closures across the UK revealed. [viewed 28th October 2022].

16) Goodier M. England has lost almost 400 swimming pools since 2010. Guardian 12th March 2023.…

17) House of Lords. A national plan for sport, health and wellbeing. HL Paper 113. London: House of Lords, 2021.…

18) Watson M C, Lloyd J. Obesogenic environments: the UK government needs to act now BMJ 2023; 381 :p940 doi:10.1136/bmj.p940

19) Academy of Medical Royal Colleges. Exercise: The miracle cure and the role of the doctor in promoting it. 2015.…

20) Watson M C, Watson E C. Time to focus on positive health indicators to reduce health inequalities. BMJ 2013; 347 :f4210 doi:10.1136/bmj.f4210

21) Swim England. Value of swimming. Loughborough: Loughborough University, 2023.

No competing Interests: 
The following competing Interests: 
Electronic Publication Date: 
Friday, February 23, 2024 – 18:17
Workflow State: 
Full Title: 

Promoting swimming: a positive approach to public health.

Check this box if you would like your letter to appear anonymously:: 
Last Name: 
First name and middle initial: 
Michael Craig
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK.
Trustee, Institute of Health Promotion and Education.
Other Authors: 
Dr Karen E. Neil, Trustee, Institute of Health Promotion and Education.
BMJ: Additional Article Info: 
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