Access to clean, safe facilities is crucial for public health—especially during a pandemic
The Walrus, July 8, 2020
BATHROOMS ARE HAVING a moment. Since the beginning of the COVID-19 pandemic, we’ve been on alert to stay safe by staying clean, and hand-washing memes have abounded. People are hoarding hand sanitizer and municipalities are pleading with citizens to stop flushing disposable wipes. Yet Canadians have also seen the widespread closure of publicly accessible bathrooms across the country, a by-product of shuttered libraries, malls, cafés, and outdoor trails. This is a problem. The question now isn’t simply when and how our public bathrooms will reopen. It’s whether the pandemic will be the tipping point that teaches people the truth about public bathrooms: far from being unhygienic, unsafe, or simply unimportant, with the correct distancing and cleaning measures, these facilities are a crucial part of any effective plan for preventing disease and easing inequity.
You might not think often about public bathrooms. But that depends on who you are: there’s a spectrum of bathroom need out in the world. Access to clean and safe facilities is a crucial part of life—more so if you are caring for children, have an inflammatory bowel condition, or are unhoused. In my 2018 book, No Place To Go: How Public Toilets Fail Our Private Needs, I showed how lack of public-bathroom access profoundly affects transgender people, caregivers, Black people, people with Crohn’s, anyone who uses a mobility device, poor people, and women—a large majority of Canadians, in fact. Without a network of reliable public bathrooms, who uses the city and how they use it changes; those populations can be effectively excluded from the public sphere.
Even at the best of times, Canadians do not enjoy the same toilet access common in some parts of Europe and the United Kingdom, such as London and many German cities. Canada relies heavily on publicly accessible toilets—which are privately owned by businesses and open to customers—rather than truly public toilets, which are on the street, paid for by taxes, and open to everyone. We have learned to make do largely with mall and café bathrooms (and the occasional public bathroom available in larger urban cores). During the pandemic, however, Canadians who are sticking to the couch, safely quarantining at home, may not realize how our already inadequate access to public bathrooms has dropped off a cliff, affecting those vulnerable populations who most needed the facilities in the first place.
During the initial peak of COVID-19, Halifax parks and trails were closed to enforce social distancing; so were their public bathrooms. Edmonton closed all but two central facilities. Toronto closed all bathrooms in parks and squares and added portable ones in some locations. Some cities expanded access—Montreal and Toronto, for example, installed portable toilets and hand-washing stations for people experiencing homelessness—but there’s no way those few options have made up for the high number of facilities that have closed in transit terminals, parks, recreational centres, malls, restaurants, and stores.
“Somebody called me a couple of days ago saying: ‘Where can folks go when they need to use a public washroom with the whole city shut down?’” Jeff Karabanow, a professor of social work at Dalhousie University, in Halifax, told me this spring. “Right now? There’s nowhere I can think of.” (A couple of bathrooms have since opened up in the city.)
The drastic change in bathroom access across the country is felt most among marginalized people. Lack of facilities hinders any passersby—dog walkers; essential workers on the way to their jobs; Uber, taxi, and bus drivers; and people out for exercise—from practising the basic hand hygiene that health experts are encouraging them to perform. But it also makes already vulnerable people even more vulnerable: they need improved access to public bathrooms during the pandemic in order to wash their hands regularly, but what they’re getting in many cases is less provision than normal.
Take someone experiencing homelessness: not only may they have a harder time social distancing but they tend to have a greater number of overlapping health issues, known as comorbidities, which worsen outcomes if they get sick with COVID-19. A public health priority should be to keep them, as everyone, safe, healthy, and out of the hospital. Yet, at the same time, their access to soap and water is being curtailed by public-bathroom closures. In normal conditions, Halifax’s Out of the Cold emergency winter shelter can host thirty overnight guests, including drop-ins, who can warm up and use the bathroom. But, when the pandemic hit, the shelter’s thirty cots were whittled to ten to allow for proper distancing—and drop-ins were halted entirely, says Karabanow. That means anyone who didn’t find shelter elsewhere was cut off from the only place they had to clean up and stay safe. Similar situations are likely taking place across the country.
Public-bathroom closures are also affecting essential workers disproportionately. The pandemic has had unprecedented effects on the trucking industry, says Jo-Anne Phillips, a professional driver and truck-fleet-company operator in Irishtown, New Brunswick. Truckers are an essential part of the supply chain, delivering food for grocery stores and depanneurs, medicine for pharmacies, and the chemicals that treat our water. Yet, with the closures of many gas-station facilities in the first months of the pandemic, they were short on showers, bathrooms, and hospitality. Even in normal conditions, drivers often deal with poorly supplied bathrooms at delivery stops. “Number one, [the bathroom] may not have a toilet seat,” says Phillips. “Number two, likely won’t have soap. And you’re very lucky to find anything to dry your hands with.” Our response to the pandemic has worsened the situation by reducing delivery workers’ bathroom access, which is already too low, when it should actually be bolstered and augmented. After all, the people staying home to protect themselves and others from COVID-19 are often only as safe as those working on the outside to deliver their foods and supplies.
In Alberta, after vandals stole toilet paper and hand sanitizer from rest-stop bathrooms, a number of the bathrooms were closed entirely (though they have since reopened). The closure was, according to press secretary Brooklyn Elhard, “to ensure the health and safety of the public and highway maintenance crews.” But it left truckers, who are often on the road for days at a time, jeopardized without any kind of bathroom access. As Phillips puts it, “There is nothing safe about having to find a bush to defecate in and not having facilities to wash your hands.”
FOR DECADES, municipal planning departments have largely ignored public bathrooms or treated them as afterthoughts, leaving their installation and upkeep to various local water, parks, and development officials. Yet, when planned and outfitted well, public-bathroom networks benefit cities in a way that’s similar to transit grids: they boost use. It’s the same reason malls have spiffy bathrooms: because they encourage people to stay longer and shop longer. Some small towns in British Columbia have added roadside bathrooms in an effort to become more desirable as road-trip stops. And the benefit of free, reliable public toilets goes beyond the fact that shoppers can spend an extra couple of hours on a downtown street. They also allow commuters to comfortably get to work and back. Public toilets support public health: they help toddlers potty train; they provide opportunities for everyone to wash their hands regularly; and they help reduce public defecation, which can lead to serious health concerns (such as the ongoing outbreak of hepatitis A in San Diego, which is primarily among the homeless population).
We know public bathrooms are a net good, so why don’t we institutionalize their importance? The problem may stem in part from the relationship we develop with bathrooms as children, when we’re taught to keep such issues private. That understanding of bathrooms as personal and embarrassing often carries into adulthood. And mass media, with its depictions of public toilets as dirty and unsafe, only aggravates the problem. As one Smithsonian article put it, “Public toilets have a reputation as disgusting places to be avoided whenever possible.” (How many times have you read a headline like: “Fifteen Everyday Items Dirtier than a Public Toilet Seat”? Or watched a movie, such as Trainspotting, with a toilet scene cringe-worthy enough to make anyone question their next trip to the restaurant bathroom?) Of course, it’s difficult to have a serious policy conversation about a place considered impolite to discuss and dangerous to frequent. Yet, when it comes to viruses, public bathrooms are a solution, not a problem.
Lisa Barrett, an infectious-disease specialist, says that fears about public bathrooms’ unsanitariness stem from misunderstandings about disease transmission. It’s true that infectious diseases such as Norovirus are spread through fecal-oral transmission, which means someone experiencing diarrhea or vomiting could contaminate an entire bathroom. If other users touch an infected surface without washing their hands well, they could subsequently spread the infection. But this happens just as easily in public bathrooms as on, say, cruise ships, Barrett says. And, when it comes to respiratory illnesses, such as COVID-19, public bathrooms are no riskier than other high-touch areas with shared air, like elevators and public buses, which are staying open, with some restrictions, out of necessity. “If it gets cleaned and people clean their hands and don’t touch their faces, then respiratory illness shouldn’t really be spread unless you’re packed into a public bathroom. Like, jammed in there.”
Living means living with viruses; we can’t always avoid them all, Barrett says. One of the safest things to do while out in the world is to be diligent about regularly washing your hands with soap and water—which means public bathrooms are “a saviour, not a risk.”
THE NORMS and importance of good hand hygiene predate COVID-19, and they will certainly outlast it. But our amplified awareness of such issues during the pandemic may open us to broader conversations about bathroom access and public health—something Mikiko Terashima thinks a lot about. Terashima is a professor at Dalhousie University specializing in sociospatial epidemiology, a subdiscipline of epidemiology that maps which parts of communities are at greater risk of disease. People who live near high-traffic areas or fast food tend to be more vulnerable, for example, than those near green spaces or with ready access to their doctors. Another consideration for health outcomes is a location’s walkability: how easy it is to move through a given neighbourhood or city based on infrastructure such as sidewalks and street lights and, of course, public bathrooms. The more walkable the neighbourhood, the lower a resident’s chances of obesity, mental health problems, and chronic disease.
Over the next few years, Terashima is hopeful that cities will be pressured to change their approaches to public-bathroom access—not only to boost walkability but to create so-called complete neighbourhoods, which provide residents with all necessary amenities at a short distance and can play an important role in infection containment. A complete neighbourhood contributes to reducing disease transmission in two ways: neighbourhoods with wide and well-maintained sidewalks and lots of green spaces allow people to more easily practise social distancing, which can boost safety even outside of pandemic times by helping people avoid unnecessary contact with others, preventing the spread of disease. But, because a complete neighbourhood is designed to have the necessary amenities of daily life (grocery stores, doctors’ offices, parks, restaurants, etc.) within walking distance, it also helps people minimize the radius of their social circle. Fully furnished communities limit the distance residents need to travel for essentials—and, by extension, the number of people they come into contact with. All of this is significant for disease containment, and ample well-serviced public bathrooms play a significant role. The average person uses the bathroom six to eight times a day; that biological imperative can’t be put off for long.
Changes to the built environment—such as expanded bike lanes, extended sidewalks, and pedestrianized streets to promote social distancing—have been at the heart of many cities’ efforts to mitigate COVID-19. Canadians who’ve lived through these temporary infrastructure changes might have a new perspective on their cities’ potential moving forward. “I think people will be holding the government to a higher standard,” says public-toilet advocate Stephanie Taylor—and that means, plainly, enough public bathrooms for an equitable city. There’s no magic number; I have noticed in my research that the variables are vast and include such imprecise considerations as the annually fluctuating volume of tourists and the likelihood that someone experiencing homelessness will be welcomed into a publicly accessible bathroom. The best way for cities to calculate and set a benchmark for public bathrooms is to confer with their most vulnerable and least served citizens.
But the solution isn’t only building toilets. It’s also improving the accessibility of the public bathrooms that already exist. Since 2013, the advocacy group GottaGo, which Taylor is part of, has been asking Ottawa’s municipal government to show the public where its bathrooms are hidden. “If people don’t know that the National Arts Centre, for example, or city hall, or the libraries or fire halls or community health centres have toilets that can be used by the public, they don’t know,” says Bessa Whitmore, another GottaGo member. She notes that, when the city set up a COVID-19 assessment centre, it put up directional signs within a week. Given the relative dearth of public bathrooms available during the pandemic and the acute importance of hand hygiene, similar signage for bathrooms would seem particularly pressing. But, while Ottawa has installed ten temporary porta-potties for public use, they haven’t included any indicators or directions.
I believe that, as much as the COVID-19 pandemic has exposed the deep inadequacies of Canadian cities’ public-bathroom access, it has also seeded the idea of a better future, featuring more facilities with easy access, more infrastructure for hand hygiene (such as hand-washing stations in public transit), and even public-bathroom attendants. This isn’t as odd as it sounds: San Francisco already has a small army of attendants for many of its free on-street toilets, known as Pit Stops. These workers ensure the bathrooms are clean and safe. Since the introduction of this program, requests for steam cleaning to remove on-street urine and feces in Pit Stop neighbourhoods have decreased as much as 50 percent.
How we change bathrooms coming out of COVID-19 should better position us for the next pandemic, which means we should prioritize safety for everyone, including truckers, people experiencing homelessness, parents, and essential workers. But, first of all, we need to realign people’s understanding of public bathrooms as essential pieces of urban infrastructure—as important as trash cans, benches, or street lights.
Lezlie Lowe is a freelance journalist and journalism instructor based in Halifax, Nova Scotia. Her first book, No Place To Go: How Public Toilets Fail Our Private Needs, was published in 2018.