work in progress in social theory and cultural sociology

more may drown without better swimming lessons… or more may drown with better swimming lessons (or: beware of policy advice based on foregone conclusions)

05.29.2013 · Posted in Uncategorized

More may or may not drown with better swimming lessons. Who knows? The Amateur Swimming Association (ASA) think they do – and guess what: they think swimming lessons may save lives and that the poor quality of swimming lessons at British schools “may” cost lives further down the line.  They don’t know, of course (hence they do not cite any research and hence they say “may” and not “will”).

Here’s what someone says who should know (i.e. someone who is an expert in accident prevention, does research in the field, knows the literature, publishes in peer-reviewed scientific journals… that sort of thing)

‘Few studies have examined the relationship between swimming ability and the risk of drowning, and there is no clear evidence that drowning rates are higher in poor swimmers. Some have even suggested that, at a population level, increased swimming proficiency might lead to an increase in drowning rates through increased exposure to water.’ (Brenner 2003: 442)

And because it’s frustrating not to know, this expert continued to try to find out, producing the only research I’m aware of that suggests a positive correlation between ability to swim and safety from drowning  a few years later – but not showing the truth of what the ASA wants us to believe:

In this study, we found a protective association between past participation in formal swimming lessons and risk of drowning in children aged 1 to 4 years, with an adjusted OR of 0.12 and a 95% CI of 0.01 to 0.97. This can be interpreted as an 88% reduction in the risk of drowning among those with swimming lessons, with 95% confidence that a protective effect between 3% to 99% includes the true value. We found no statistically significant association between formal swimming lessons and drowning risk in older children or between informal swimming instruction and drowning risk at any age, although all of the estimated ORs were less than 1. (Brenner et al. 2009)

The authors cite a Chinese study with similar results – what both have in common is that the protective effect of swimming lessons disappears at the age of 5 (i.e. school age). They don’t have a conclusive explanation for this, but a working hypothesis may be that the more independent children become, the more the protective effect of being able to survive in water due to swimming skills may be cancelled out by the opposite effect of unsupervised playing in and around water – combined with water confidence created by swimming lessons. To repeat: the ASA’s claim is about swimming lessons at school, not at pre-school.

I have to declare an interest here– I hate swimming and swimming lessons. Always have. (But then, the ASA love swimming and promote swimming lessons.)  As low-water-skills person I feel pressed to counter the non-evidenced claim by the ASA with my own purely speculative claim. Even short of proper evidence, I still think I’ve got the better case. The ASA seems to rely on a very simple scenario: if you can swim and fall into deep water, you don’t drown. If you can’t swim – you drown. Now falling-into is one of the less likely ways of getting into deep water and from experience I can say that whenever there’s a higher likelihood of that in itself very unlikely occurrence I shall be more likely to put on a lifejacket than the strong swimmer next to me and will be likely to stay on the surface for much longer (especially if falling-into inflicts some additional injuries). As Brenner says, there are some studies (not very conclusive, so I’m not making a strong truth claim here) that suggest an inverse relation – suggesting that the more swimmers there are in a population the more people drown as more people venture into deep water. Sounds just as plausible as the falling-in-and-drowning scenario. Since my (interested non-swimming) judgement is as good as that (interested swimming) of the ASA, I go with my sense that it’s safer (for me, maybe not for you) not to be able to swim in the first place. I may die if I fall into the river I cycle along each day because I’m not very good at swimming (just as I may die if I fell onto the road because I’m not very pressure resistant, so can’t take a lorry on the chest). But then I’m certainly not going to die because I’ve underestimated the distance to that island out there or because I’ve overestimated the depth of the lake where I jumped in head first or because I got a cramp in the legs while trying to reach the bottom of my private swimming pool. It’s a difficult case to argue, though, since in any scenario, if I drown after falling into the Exe the judgement would that it’s probably because I’m a weak swimmer. While if a strong swimmer drowns being caught by a rip tide at an unsupervised beach the story will be that they drowned despite being a strong swimmer and not because their swimming-ability induced water confidence. So if someone gave out advice against swimming lessons they might themselves blamed for causing drowning, while those advising for swimming lessons are unlikely to get blamed for the deaths of overconfident swimmers.

While neither my own nor the ASA’s view can be supported by research – it would probably as wise for me not to give out advice on whether you should or should not learn to swim. To be absolutely clear: I do not advise against learning to swim or against sending your children to swimming classes (and if you plan to go in deep water or take your child into deep water – by any means: make sure you and they can swim… or better still: wear a lifejacket). But it certainly isn’t okay for the ASA to make authoritative and dramatic claims either.

As indicated in the title, this isn’t really about swimming – it’s about the necessity of evidence based policy advice and the ease with which unsupported claims are reported in the news without someone going “And how do you know this?” A question that is particularly pertinent if the claim is that people’s lives are at stake…

 

 

 

Brenner, Ruth A (2003): ‘Prevention of Drowning in Infants, Children and Adolescents’, in: Pediatrics, 112, pp.440-45

Brenner, Ruth A et al. (2009): ‘Association Between Swimming Lessons and Drowning in Childhood: A Case-Control Study, in: Archives of Pedriatics and Adolescent Medicine, Vol.163, No.3, pp.203-10

 

update

royal approval for the ASA’s campaign… http://www.bbc.co.uk/news/uk-22750472

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