Calling a spade a spade: meaningful definitions of health conditions.

This issue of the Bulletin features an article on a new definition of “drowning” (1). Most of the time we intuitively know what drowning is until someone asks us explicitly to define it. In scientific research, meaningful definitions are essential for comparability and reproducibility. Drowning has been listed as the second leading cause of death from unintentional injury in WHO reports, after road traffic accidents (2). Many questions can be asked as to whether this is really the case in various countries, whether the data are comparable across cultures, and what can be done about it. Surely such a frequent event, with its serious consequences of death and disability, requires widespread public health attention, especially as drowning can be prevented by simple measures. To take effective public health measures, solid monitoring and evaluation programmes are necessary, for which the definition of the concept must be clear. Be it drowning or any other condition, a definition should include a full conceptual representation as to what the condition includes: what it is, how it is generated, and also what it is not. In simple terms, drowning is the state in which a person cannot breathe because access to air is blocked by going under water or any other liquid. The process may include various aspects such as voluntary stopping of breathing, lowering of oxygen in blood and subsequent bodily changes. Such definitions guide a more precise identification of the exact cause of death. The proposed definition of drowning will affect the international classifications of diseases (ICD) (3) and external causes of injuries (ICECI) (4), and in the future become part of them within the revision of the ICD. The impact of this definition on cause of death statistics will have to be analysed to reveal