Calm Water

Trends in Aquatic Health & Safety

By Wynn St. Clair

Few things matter more to an aquatic center's prosperity than the health and safety standards that the facility adopts.

It's one of the most critical issues facing the pool industry today, yet it's one continuously hobbled by disparate codes and an uneducated public. Fortunately, progressive recreation managers have allies willing to help them in their quest to make facilities safer and more sanitary. Whether it's funding research, analyzing best practices or reducing drowning risks, the federal government and industry advocates are working tirelessly to improve our pools.

The Model Aquatic Health Code

The Centers for Disease Control and Prevention (CDC), for example, is expected this year to finalize the Model Aquatic Health Code, a guidance document that can help local and state authorities make swimming and other water activities both healthier and safer. The MAHC, as it's commonly known, will offer non-binding standards for the design, construction, operation and maintenance of public pools, waterparks, spas and other aquatic facilities.

It also will give U.S. aquatic facilities a groundbreaking opportunity to be on the same page when it comes to health and safety standards. There currently is no federal regulatory authority responsible for pools and waterparks, meaning each state and town must write its own code.

While there are benefits to localized power and autonomy, the disparate codes and standards long have been a source of concern for industry advocates and the Atlanta-based Centers for Disease Control and Prevention. The first industry standard was issued in 1958 and in the subsequent 53 years, no two states have had the same code.

That is expected to change shortly.

The advisory code will tackle 14 key areas, including contamination burden, water quality, lifeguarding, recirculation systems and training, among others. Communities are not required to follow any part of the MAHC, though experts will promote its complete adoption in the coming year.

"This is an opportunity to improve safety and health at aquatic facilities across the country. The public will benefit from it, and so will the entire aquatic industry," said Dr. Michael Beach, the CDC's associate director for healthy water. "It's a guidance document, not a national code. It will need to be adopted in each location to be the standard."

As part of code's development, the CDC and industry experts put together 14 modules, which have gone through an arduous vetting process. Under the initiative, each module was developed by the appropriate technical committee, approved by the steering committee and posted for public comment for 60 days. The steering committee and appropriate technical committee then review the input and revise the modules accordingly. Once all the modules have been revised after their respective 60-day reviews, the entire MAHC will be posted for another 60-day public comment period to allow the public to review the new code in its entirety and check it for thoroughness. All comments will be addressed by the committee, along with an explanation as to why they were or were not incorporated in the final draft.

Beach expects the entire MAHC—the complete document that knits all 14 modules together—to be posted for review in the first half of 2013. After the public comment period ends, the input will be weighed before the final draft is posted. The official MAHC should be ready by year's end, Beach said, but some communities have already adopted some of the existing modules as part of their codes.

CDC officials acknowledge that they wish the process could have moved faster, but they stress the importance of transparency and public input over a hurried timeline. With more than 130 volunteers serving on the various technical committees and hundreds of pages of public comments submitted, the initiative benefits from myriad viewpoints.

"It was a very transparent process. It wasn't written by someone who locked themselves in a room and came up with a new model code," Beach said. "We keep telling people that this is an evolution, not a revolution. We're not looking to turn this thing upside down."

Without the code, requirements for preventing and responding to recreational water illnesses will continue to vary significantly from state to state—and sometimes even city to city.

Even when national laws like the Virginia Graeme Baker Pool & Spa Safety Act or the Americans with Disabilities Act were enacted, state and county agencies were left to evaluate the codes on their own. Having so many codes places an exceptional financial burden on industry and government, experts said. A lack of uniformity also fails to ensure that aquatic managers and public health officials are getting the most up-to-date information about industry data and new scientific studies.

"Imagine all the money and time being wasted with each community writing its own code," said Thomas M. Lachocki, Ph.D., CEO with the National Swimming Pool Foundation (NSPF). "It's a fabulous waste of money, and it's a fabulous waste of time."

Fear of the Water

Unified codes alone, however, won't be enough to convince some people that aquatic centers are safe, healthy places for recreation. In fact, getting a large percentage of the public into the water may prove difficult, as about half of Americans have a fear of swimming pools, studies show.

That statistic alone should leave aquatic managers feeling as if a cold bucket of water has been thrown upon them.

If that many people are frightened by pools, it means nearly 100 million Americans cannot enjoy the benefits of aquatic exercise and—far worse—pose a greater drowning risk.

Roughly 17 percent of American adults swim at least six times per year, studies show. But even more adults—a jaw-dropping 39 percent—described themselves as being afraid to put their heads under water, while 46 percent claim to be scared of deep water.

The CDC reports that overall, 37 percent of Americans are unable to swim. Those numbers are even larger among minority populations, where 62 percent of African-Americans and 47 percent of Hispanics don't know how.

There are myriad reasons why people can't—or, in some cases, won't—swim. Many say they don't have access to pools, while others have had negative experiences. Some admit they're too embarrassed to wear a swimsuit, and others cite racial or ethnic factors such as hair care and other norms.

This insight, coupled with the country's staggering number of non-swimmers, should serve as both an inspiration and a challenge to the aquatic industry. With an estimated 5,000 instructors in the United States today, that means each instructor has a pool of roughly 10,400 potential patrons he or she could be teaching.

To address the issue, the NSPF has launched the "Step into Swim" campaign, which aims to create 1 million new swimmers within the next 10 years. The organization recently announced plans to direct $40,000 to four nonprofit agencies—American Red Cross, JCC Association, U.S. Swim School Association and 21st Century Swimming Lessons—to teach children and adults the "lifelong, lifesaving" activity of swimming.

"The idea is to empower organizations that are already doing a great job and help them make their programs even better," Lachocki said.

Creating more swimmers prevents drowning, improves people's health by opening a wide spectrum of aquatic activities, and creates economic growth for the health and family-focused pool, spa and aquatics industry, Lachocki said.

One of the initiative's main goals is to reduce the risk of drowning in the United States, where an estimated 700 people drown in pools each year, according to CDC studies. Although drowning rates have dropped during the past 15 years, drowning remains the second leading cause of unintentional injury and death in children 1 to 19 years old. African-American children are six times more likely to drown in a swimming pool than their peers, according to CDC statistics.

While the emotional toll of drowning is immeasurable, the financial cost is staggering, as well. According to a recent NSPF report, the lifetime medical costs for unintentional drowning deaths in 2005 in the United States totaled almost $13 million. Lifetime medical costs for non-fatal drowning in 2005 reached more than $82 million. If indirect costs such as lifetime productivity losses are included, the fatal and nonfatal costs to society top $4.6 billion and $600 million, respectively, the report said. This means that in a single year, the direct and indirect cost from fatal and nonfatal drowning is more than $5.3 billion.

"The emotional and psychological impact of drowning is absolutely devastating, and nothing can compare," Lachocki said. "But the financial impact can be incredibly high too."

In addition to helping keep people safe and healthy, there is also a very practical reason for aquatic managers and industry leaders to back the "Step into Swim" program. If half of Americans are afraid to swim, then they're also unlikely to take their families to pools and aquatic parks.

Teach them a person to swim and you're adding to your customer base.

"If you're an aquatic facility manager or in the industry and more than half of the market is closed off to you, that's not good for business," Lachocki said. "Teaching people to swim benefits the entire industry on many different levels."

Support Healthy Swimming

Without question, the aquatic industry has an obligation to promote the benefits that water immersion, exercise and activity provide, experts said. It's a way to get patrons excited about coming to the pool and making aquatic exercise and recreation a part of their regular routine. In return, you reduce the number of potential drownings at the facility.

To that end, the National Swimming Pool Foundation has three grants for year 2012-2013, totaling $67,974, with the potential to fund an additional $50,000 to extend the studies through 2014, for a total of $117,974.

"Physicians, therapists and insurance companies rely on published science when considering options to treat patients. As people age, medical costs increase and mobility and quality of life decreases. We believe we have the magic potion. Our funded research will prove it," said Bill Kent, chairman of the foundation's grant review committee, when he announced the awards.

The foundation awarded $25,000 for the first year of a two-year program to Hirofumi Tanaka, Ph.D., associate professor and director of the Cardiovascular Aging Research Laboratory at the University of Texas at Austin. The study aims to investigate the effects of regular swimming exercise on cardiovascular functions in middle-aged and older adults with osteoarthritis. Researchers will explore how aquatic activity can benefit the nearly 27 million Americans who suffer from osteoarthritis, the leading cause of disability in older adults. Though arthritis advocates often promote the benefits of swimming, there have been no previous studies proving that, Tanaka said.

The American College of Rheumatology recommends aerobic exercises be included as part of the treatment for osteoarthritis. However, arthritic joint pain is a significant barrier for adults attempting to perform land-based activity. Tanaka's research will examine whether aquatic activity is the best exercise for these people. A total of 40 osteoarthritis subjects will be assigned to one of the 12-week exercise interventions.

"Swimming has been lumped in with all other 'cardiovascular exercise' when people talk about health benefits, but there hasn't been even one scientific study so far of swimming, specifically, for people with arthritis," Tanaka said. "If the study can show the benefits of swimming exercise for people with arthritis, then the aquatic industry will be able to share those benefits with the public."

The foundation also awarded a $17,974 grant to Joel Stager, Ph.D., professor and associate chair, Department of Kinesiology, at Indiana University and director of Counsilman Center for the Science of Swimming. Stager will study the effect of long-term aquatic conditioning on aging-related cognitive, neuromuscular and cardiovascular functional decline.

A third grant totaling $25,000 was awarded for the first year of a two-year program to Paul D. Chantler, Ph.D., assistant professor in the School of Medicine, Division of Exercise Physiology at West Virginia University. He will study the effects of aquatic exercise on arterial stiffness in Metabolic Syndrome (MetS) patients. Metabolic Syndrome affects about 35 percent of adults, making them three times more susceptible to developing cardiovascular disease and stroke. Because obesity is one of the causes of MetS, Chantler's research will study arterial stiffness and cardiovascular function in MetS patients who perform aquatic activity.

Both Tanaka and Chantler presented recent findings at the October 2012 World Aquatic Health Conference. The industry's vitality and future growth is dependent upon aquatic managers embracing these studies and sharing their results with the general public, experts said.

"We will all get older. We will all die. Why not explore to what extent water activity will help us maintain our mobility and minds while we are alive," Lachocki said. "It is no coincidence that people believed in the fountain of youth and not a football field of youth."

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