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This memo is part of a series on public policy challenges facing San Diego. Click here to read all memos in the series.
San Diego County has the fourth-highest homeless population in the United States. According to recent data collected by the San Diego Regional Task Force on the Homeless, on any given night, thousands of San Diegans are living outside and thousands more are in temporary shelters. Efforts to secure housing for people experiencing homelessness have received some attention and support, and should receive more. While these efforts continue, San Diego’s policymakers and civic leaders should consider another, related public health challenge that warrants more attention—access to public bathrooms.
Bathroom Access is a Basic Human Right
Recent research highlights the critical role bathrooms play in the everyday lives of youth and adult San Diegans experiencing homelessness. As one youth experiencing homeless noted in Action4Health’s community-based research study, “Being clean, it doesn’t sound like a basic human right, but I feel like it is. You know what I mean -- being able to be sanitary and clean.”
In 2010, the United Nations declared that drinking water and sanitation to be basic human rights (UN Resolution A/RES/64/292). This was affirmed two years later by the California State Assembly, which passed AB-685 to make California the first U.S. state to affirm this right through legislative action. Nonetheless, the nearly 100,000 Californians experiencing homelessness – a significant proportion of whom are San Diegans – have worse access to water and toilets than many refugee camps in conflict zones.
The Lack of Public Bathrooms and Public Health in San Diego
Both the availability and accessibility of public bathrooms in San Diego are extremely limited. While this is true regardless of one’s housing status, it is particularly true for San Diegans experiencing homelessness. Residents experiencing homelessness often access bathrooms in public libraries during operating hours. When these bathrooms are not open or nearby, the bathrooms in local businesses become the next best option. Business owners, however, often forbid certain people from accessing their bathrooms—particularly those who appear to be homeless.
When these San Diegans are unable to access public or private bathrooms, they must find other places to go to the bathroom, which often means they go outside. A lack of regular access to bathrooms can bring about troubling mental and physical health consequences, including chronic stress and anxiety, lower urinary tract problems, and the spread of infections. In some cases, a lack of bathroom access can result in financial and legal problems for residents, including citations or arrests for public urination.
The lack of adequate public bathrooms has far-reaching negative impacts on individuals who are not experiencing homelessness. In the past two decades, numerous groups and organizations have pleaded with San Diego County to provide more public bathrooms in the downtown area. In 2015, the San Diego County Grand Jury conducted a study to examine complaints concerning the lack of public bathrooms in downtown. Based on their findings, the Grand Jury recommended that the City Council and Mayor “Develop, fund and implement a plan to provide additional 24 hour accessible, clean, safe and well maintained public restrooms in downtown San Diego paying attention to both current and future needs.”
The lack of attention by elected officials to this recommendation has been identified as a key factor in the 2017 Hepatitis A outbreak that affected residents across the County. The outbreak hospitalized hundreds and killed 20—70% of whom were experiencing homelessness. The outbreak was largely attributed to the growing homeless population in San Diego and relatedly, human waste on city streets. In response to the outbreak, the County placed porta-potties and hand washing stations in key areas across San Diego, such as the East Village and Ocean Beach. Once the outbreak was declared over, however, many of the porta-potties and handwashing stations were removed.
In order to ensure the basic human right of regular access to bathrooms, and decrease human waste on San Diego’s streets, immediate action is necessary. Short-term solutions, such as temporary porta-potties and handwashing stations, are insufficient to meet the needs of the County’s growing homeless population. In order to prevent future infectious disease outbreaks, San Diego’s policymakers should immediately begin work to expand the availability and accessibility of permanent, public bathrooms.
The following policies and procedures are necessary to ensure San Diegans experiencing homelessness have regular access to safe, well-maintained public bathrooms:
- Increase the number of permanent, public bathrooms across the city, with an emphasis on densely-populated neighborhoods and neighborhoods where people experiencing homelessness access resources and spend time.
- Ensure that public bathrooms are well-maintained and cleaned regularly.
- Create and make available a virtual map of available public bathrooms, including a schedule of available services (e.g., showers, sinks, toilets).
- Ensure that interactions between law enforcement and people experiencing homelessness in and around public bathrooms, and in general, emphasize compassion, support, and personal safety, rather than criminalizing people’s attempts to meet their most basic human needs.
A pilot program in San Francisco providing access to 24-hour public bathrooms in key areas of the city has led to decreases in human waste on city streets. San Diego’s policymakers should consult experts in San Francisco and other cities who have successfully increased access to public bathrooms, such as Portland, and who are launching new initiatives to increase public bathroom access, such as Denver, to guide local efforts.
The authors would like to acknowledge Hunter Call as a community partner/co-author on this piece.