Publication Date

Spring 2026

Degree Type

Master's Project

Degree Name

Master of Public Health (MPH)

Department

Health Science

First Advisor

Matthew Moore

Second Advisor

David Anderson

Keywords

Drowning prevention, Early childhood, Aquatic competency, Water competency, Injury prevention, Evidence mapping

Abstract

Drowning is a leading cause of child death globally, and is the leading cause among children aged 1–4 in the U.S. as well as diverse countries including Bangladesh, Vietnam, Cambodia, parts of India, and China. Among children aged 5–14, drowning ranks third worldwide. In Bangladesh, more than 40 children drown each day, the majority under age 5. U.S. child drowning rates have risen annually since 2019 after seeing virtually no progress for decades. Meanwhile, despite decades of vital prevention efforts, the developmental period of highest risk remains insufficiently addressed as a public health problem.

Using evidence mapping across developmental science, motor learning, ecological psychology, and injury prevention, this paper identifies critical gaps in how early aquatic competency is operationalized within drowning prevention strategies both domestically and globally. Preliminary data from a 2025 community-based program suggest that floating ability decreases with age in the perinatal and early childhood period, supporting a developmental competency hypothesis that early aquatic exposure shapes foundational skill acquisition trajectories across the lifespan.

Two interrelated arguments follow. First, the field's evidentiary framework is too narrow, privileging drowning-endpoint studies (primarily two retrospective case-control studies) while undervaluing upstream developmental mechanisms through which population-level risk decreases over time. Absence of drowning-endpoint evidence for early intervention is not evidence of absence. Second, this paper proposes two age-differentiated, complementary frameworks constituting a complete aquatic competency pipeline: (1) Universal Basic Aquatic Competency (UBAC), a foundational water resilience and aquatic literacy framework from birth through toddlerhood targeting the highest-risk group (age 1–4); and (2) formal, propulsion-based swimming instruction from age 4–5 onward. Original AAP and still-current World Health Organization guidance addresses the second layer; UBAC addresses the missing first layer. The evidence, including a 2025 systematic review by the WHO’s guidance team, supports an expanded “both/and” evidentiary standard incorporating both rigorous interdisciplinary developmental evidence alongside drowning risk reduction analysis.

UBAC is introduced as a systems-based prevention architecture for reducing child drowning mortality across the lifespan.

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