Drownings and injury could be spared through new WHO risk protection plan

Beaches and recreational waters could be much safer

Hundreds of thousands of drownings could be prevented each year through simple preventive tools. To minimize deaths, illness and injuries at the beach, in oceans, lakes and rivers, the World Health Organization (WHO) is today launching Guidelines for safe recreational water environments. Beaches and bodies of water failing to meet safety standards are a worldwide public health problem, and can make people ill, cause disability and death. In Africa, the Americas, Europe and the Western Pacific, for example, coastal and inland freshwater bathing waters are often affected by faecal matter and sewage, rendering their use risky for human health.

“Risks such as infection, injuries and death from accidents and drowning, present a large burden of disease worldwide. Because recreational bathing has so many potential health benefits in terms of exercise and relaxation, it becomes all the more important to ensure that recreational bathing becomes safer,” said Dr Jamie Bartram, Coordinator, WHO Water and Sanitation for Health programme. The WHO Guidelines cover drowning and injury, exposure to cold, heat and sunlight, water quality, contamination of beach sand and exposure to algae, chemical and physical agents and dangerous aquatic organisms. Use of the guidelines can make swimming, fishing, walking, wading, birdwatching, sunbathing and picnicking safer.

The Guidelines include existing knowledge on the impact of recreational use of coastal and freshwater environments on people’s health, and ways to control and monitor the hazards. Preventive measures to protect recreational water users’ health are also described.

“An estimated 400 000 people die each year by drowning worldwide, yet, the vast majority of drowning incidents — along with many other aquatic injuries — are preventable. The adoption of these uniform guidelines for management of recreational waters for safety can be expected to significantly reduce untimely loss of life and suffering globally,” said B. Chris Brewster, Vice-President, International Life Saving Federation. Adult supervision of children, legal limits for blood alcohol levels during water recreation activities, education and the use of lifejackets are some examples of measures that can help prevent drowning.

Sewage contamination of water: a serious risk for health and tourism
Contamination of water with sewage and excreta is widespread and common and affects large numbers of people who use recreational waters. The majority of those affected exhibit mild gastroenteric symptoms. One of the most common and dangerous pathogens in untreated sewage is E.coli O157. This bacterium, which affects the intestinal tract, can cause blood loss, acute diarrhoea and fever. In a small percentage of cases, the infection is severe enough to cause kidney infection, haemorrhage and even death.

Until now, there has been no global consensus for determining an acceptable level of intestinal enterococci (bacteria that usually live in the gut) as an indicator organism in a beach environment. Based on the latest scientific input from around the world, the Guidelines set values for intestinal enterococci in bathing water so that regulatory authorities can reduce the risk of bathers contracting gastrointestinal and acute febrile respiratory illness.

In developed countries, it’s estimated that one third of the wastewater discharged into the environment is not adequately treated. In developing countries this amount may be even higher.

“Too often, we have seen children bathing in the same water where mothers wash their children’s nappies, and where people relieve themselves. People may not currently have other alternatives, but that does not mean that it is any less of a health problem,” said Dr Bettina Genthe, a microbiologist at South Africa’s Division of Water, Environment and Forestry, Council for Scientific and Industrial Research (CSIR).

Each year millions of tourists vacation in coastal areas. Tourism is the world’s third largest industry and the prime economic sector in some states and regions, such as the Caribbean. “The vivid blue waters which surround the small island Caribbean states are among the most sought-after attractions by visitors,” said Mr Vincent Sweeney, Executive Director, Caribbean Environmental Health Institute, St. Lucia. Yet, in the Caribbean and elsewhere around the world, millions of litres of untreated sewage continue to be discharged into the sea every year. Consequently, added Sweeney, “In island states, where all land-based activities, including agriculture, industry and tourism, affect coastal bathing waters, it is imperative to have the means to benchmark and maintain the cleanliness of bathing waters.”

Recreational water quality problems are by no means limited to lower-income countries. For instance, in the United Kingdom, only slightly more than half of the country’s beaches are “recommended” for their cleanliness, according to the UK Marine Conservation Society’s 2003 Guide. Fifty-three beaches fail the minimum European Union standard for bathing water quality (1). In a survey conducted in 2000, Surfers Against Sewage, a UK-based non-profit organization campaigning to end the discharge of raw and partially treated sewage and toxic waste into the sea and inland waters, reported nearly 900 incidents of illness caused by contamination of beaches and seawater in the UK.

The next step: Making water-related recreation safer in countries
Based on the best science available, the WHO Guidelines will assist regional, national and local authorities worldwide in adopting a comprehensive approach to the prevention of bathing-related ill health.

Countries in the Americas have been particularly active on using the Guidelines to shape national policy. Mexico, for example, has already incorporated the principles of the Guidelines into national regulations.

“People recognize that unsafe and unclean bathing waters are a public health problem, but until now many of the countries in this region have not had a framework in which to construct an efficient regulatory policy. Especially for countries where resources are strained, these Guidelines create excellent indicators of how to achieve maximum benefit and return for preventive actions,” said Dr Henry Salas, WHO’s Regional Adviser for Environmental Protection in the Americas.

While the Guidelines are a substantial step forward in preventing bathing-related death and disability, more needs to be done. In coming years, WHO will work with national governments to build the institutional ability to implement the full range of prevention and monitoring activities recommended by the Guidelines.

WHO plans to expand the content of its Guidelines for safe recreational water environments. Future revisions will incorporate the public health risks specific to children, who may be at particular risk, and hazards related to tropical bathing waters about which there is currently insufficient information to provide solid guidance. In 2004, WHO plans to publish a second volume of the Guidelines, which will address the safety for health of swimming pools, spas and similar recreational water environments.