Healthy Recreational Waters

Healthy recreational waters
16 October 2003
Recreational water activities can have substantial benefits to health and well-being. Swimming pools,
beaches, lakes, rivers and spas provide environments for rest and relaxation, physical activity, exercise,
pleasure and fun. Yet they also present risks to health. Polluted and unsafe recreational waters can lead to
infections, exposure to chemicals, injuries and death.
Recreational waters for positive health

Water-based recreational activities have long been recognized as having a positive influence on health and
well-being. Since ancient times, bathing in mineral waters has been reputed to cure a variety of illnesses.
While there have been few scientific studies of these postulated effects, there is no doubt of the benefits of
warm water therapy in pain relief, joint mobility and relaxation.
These days, more and more people are taking up recreational activities in and around water, and these are
an important part of leisure and tourism around the world. Swimming is recognized as one of the most
beneficial forms of exercise and is also an important therapy for rehabilitation after operations such as hip
replacements.
Hazards of recreational water use

Water-based recreation, however, can expose people to a variety of health risks, which vary according to
the type of water, geographical location and local conditions. These are linked to physical, microbial and
chemical hazards.
Physical hazards: drowning and injuries
Drowning is one of the unequivocal dangers of recreational water use. An estimated 400 000 people drown
each year(1). In children, drowning is one of the leading causes of accidental deaths (more information
on drowning).
Most cases of drowning are the result of drinking alcohol or poor supervision. In seas and rivers, tides and
currents are also important hazards and can cause even strong swimmers to drown. In spas and pools,
drowning can result from hair or body parts getting caught in inlets and outlets. The clarity of the water can
also be a factor. In murky water, people may not see that someone needs help. Overcrowded swimming
areas present a similar problem.
Water-based recreational activities can also result in a variety of injuries. Diving or jumping into waters of
unknown depth can lead to serious injuries, including spinal injury, which may ultimately result in
paraplegia or quadriplegia. Diving into shallow water is the most common cause of spinal injuries. More
common, but usually less severe, are injuries arising from discarded glass, cans and needles on beaches or
near bathing areas, or injuries from slipping on wet surfaces around pools.
Reducing the risk of drowning and injuries – some solutions
:: Educate children and adults about the risks of water activities, including basic life saving and first aid
techniques
:: Supervise children and weak swimmers at all times in or near to swimming areas and water bodies
:: Teach children to swim
:: Keep beaches clean
:: Install fencing around pools
:: Display warnings and water safety instructions
:: Improve pool design for safety.
Microbial hazards: infections

Millions of litres of raw or partially-treated sewage are pumped into seas every day, polluting the
environment and resulting in an estimated 250 million cases of bathing-related gastroenteritis and upper
respiratory disease each year. Pathogenic viruses and bacteria such as Escherichia coli O157 are commonly
found in untreated sewage, rendering swimmers, surfers, and children, at risk from infection.
While the water quality in swimming pools and spas is generally well-monitored, there may be outbreaks of
disease due to contamination. The majority of outbreaks are caused by viruses or bacteria linked to faecal
contamination. An increasing number of infections are associated with protozoa such
as Giardia and Cryptosporidium, which are resistant to commonly used pool disinfectants. Spas present
particular risks and require particularly stringent monitoring, as the warm, nutrient-containing, aerobic
waters provide an ideal habitat for bacteria to proliferate.
Reducing the risk of infections – some solutions
:: Employ effective sewage discharge procedures

:: Implement beach management and award schemes
:: Set international norms, standards and limits for microbial levels in seas, lakes and rivers
:: Apply appropriate levels of chlorine or other disinfectants to pools
:: Empty, disinfect and clean pools, and filter pool water in cases of accidental faecal release
:: Encourage pre-swim showering, toilet use and good hygienic behaviour at pools and spas
:: Monitor pH, disinfectant levels and other parameters frequently as part of a routine pool and spa
maintenance schedule
:: Clean spas and spa filters regularly.
Chemical hazards
Chemical contamination of seas and rivers arises principally from direct waste discharge (e.g. industrial
effluent) or chemical spills, and is typically local or regional in nature. Chemicals found in swimming pools
and spas include those related to water treatment (disinfectants and their by-products), and those that
come from swimmers (soap residues, cosmetics, suntan oil). Disinfectant by-products, such as chloroform,
are produced from chemical reactions between the disinfectants and organic or inorganic material in the
water. Little is known about the adverse effects of exposure to chemical contaminants, although there is
concern about the possible long-term toxicological effects.
Reducing the risk of chemical exposure – some solutions
::Monitor and regulate industrial effluents

::Develop damage limitation action plans in the event of chemical spills
::Ensure good ventilation in rooms housing pools and spas
::Encourage pre-swim showering and good hygienic practices
::Monitor pH, disinfectant levels and other parameters frequently as part of a routine pool and spa
maintenance schedule.
Tropical waters
Recreational waters in the tropics and subtropics pose special hazards, not just from some of the local
aquatic or amphibious predators such as crocodiles, but also from a number of tropical diseases. First and
foremost is schistosomiasis or bilharzia, a disease caused by parasitic worms. The complex life-cycle
requires the parasites to spend part of their development inside aquatic snails found in freshwater lakes
and streams. Infectious larvae are shed by the snails and penetrate the skin of people wading into or
bathing in the water. The parasites then lodge as adults in people’s veins around the intestines and liver, or
around the bladder. Children and adolescents are particularly vulnerable to schistosomiasis as they
frequently play or bathe in unsafe water in hot tropical climates (more information on schistosomiasis).
Healthy recreational waters: WHO’s role
The health aspects of recreational water use are attracting increasing attention by members of the public,
concerned professionals, regulatory agencies, and the tourist industry. WHO’s principal role in improving
the safety of recreational water environments is to develop, publish and help implement guidelines for use
by national and local authorities. Based on a critical review of the available scientific evidence and
representing views of world experts, the purpose of the guidelines is to ensure that recreational water
environments are as safe as possible in order for the most people to get the maximum benefit.
Water is the essence of life. Without water, we cannot live for more than a few days. The desperate need
to improve access to safe drinking water in many parts of the world means that the recreational role of
water is not seen as a health priority. Yet children will play in water whether it is safe or not, and the use of
water for relaxation, exercise and pleasure will continue to grow. It is essential, therefore, to ensure that
recreational bathing becomes safer and healthier.
(1) This number includes accidental drowning and submersion, but excludes drowning due to floods, water
and other transport accidents, assaults and suicide.

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Healthy Recreational Waters

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Healthy recreational waters

Recreational waters for positive health

Hazards of recreational water use

Physical hazards: drowning and injuries

Microbial hazards: infections

Reducing the risk of infections – some solutions

:: Employ effective sewage discharge procedures

::Monitor and regulate industrial effluents

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