America’s Homeless Deserve Better Access to Water, Sanitation and Hygiene | Opinion

This piece was originally published in the Messenger.

Do you remember a time when you had to use the bathroom but there was no public toilet in sight? For those who are experiencing homelessness and may be treated differently based on appearance, it is difficult to find and use a public toilet, and even more challenging to find a place to bathe and wash clothes. 
 
The COVID-19 pandemic shined a light on the importance of water, sanitation and hygiene access and recognized it as a public health priority. During the pandemic, global hand-washing campaigns and popular dance challenges on TikTok helped enhance the importance of thoroughly washing your hands with soap and water. Some major U.S. cities, such as Los Angeles, installed portable toilets and hand-washing stations to help reduce the risk of COVID transmission, but these were rarely maintained.
 
And although the pandemic highlighted the importance of these services, it also exposed some of the inequities in access for people living on low-income wages or living outside. According to the Department of Housing and Urban Development, on a single night in 2020, an estimated 580,000 people were experiencing homelessness in America.
 
In the three years since, this number continues to rise. The latest point-in-time count estimates that 582,462 people are experiencing homelessness, and many cities across the nation keep failing to provide people with critical services.
 
Access to water — including drinking water fountains, toilets, showers, and laundry services — is essential for human dignity and personal and public health maintenance. Nevertheless, communities experiencing homelessness often do not have safe, affordable, adequate, and equitable access to these life-sustaining services. It is imperative to develop sustainable solutions that focus on the provision of not only housing but also basic services that people need.
 
The lack of a toilet, drinking water and other hygiene services can create added barriers among those experiencing homelessness, increasing stigmatization and reinforcing a cycle of poverty.
 
One study in Phoenix, Arizona, for example, found that forms of water insecurity, coupled with exposure to extreme heat, results in greater social exclusion as people’s physical appearance and health deteriorates. Not being able to shower or wash clothes also often characterizes individuals as potential “pathogen threats,” and that leads to exclusionary policies and further stigmatization that can impact a person’s ability to exist in public spaces and someday exit homelessness.
 
This can be seen in anti-homeless practices such as “customer only” restrooms that businesses enforce. A lack of public toilets forces people to engage in survival-coping strategies such as public urination or defecation, which in some cases leads to misdemeanor penalties or can classify one as a sex offender.
 
Access to water and sanitation services, whenever you need them, is a fundamental human right that’s hard to come by when you have little structural power. Using a toilet, shower or laundry facility is a near-universal human experience, but it becomes more acute and challenging for those living outside in their vehicles, tents and other forms of makeshift housing.
 
Water has become privatized or accessible only within the home space, and some cities and businesses are resorting to criminalizing practices — enforcing encampment sweeps that are unsustainable, inhumane and destructive. These sweeps disconnect people from their community and services that they have come to trust and rely upon, such as nonprofit organizations that fill gaps in service needs. Displacement also can negatively impact people’s health.
 
Temporary water and hygiene access, in the form of portable sinks and toilets, may be ineffective solutions because they often are not well maintained. This reinforces water insecurity and public health risks. In 2017, for example, San Diego was one of many cities with a Hepatitis A outbreak that mostly affected people experiencing homelessness.
 
The solution? Quite simply, we must provide people with better access to sanitation and hygiene services. 

At the intersection of health and hygiene, an Angeles suggests that unhoused people experience health problems from holding their urine or are likely to skip doses of medication whose side effects include frequent urges to use the bathroom. Similarly, a case study report in Berkeley, California, highlights the uneven distribution and placement of publicly available restrooms in parks; most are located in places without encampments for the unhoused. In San Francisco, a water report highlighted how COVID altered people’s ways of accessing services.
 
Yet the need for public access to water, sanitation and hygiene services is not just for people experiencing homelessness — it’s important to everyone. Policymakers, nonprofit leaders, citizens and communities must put forth the effort to provide these basic human needs. These can be expensive, but so can be the cost of another disease outbreak or pandemic.
 
Lourdes Johanna Avelar Portillo (@JohannaAvelar) is a postdoctoral fellow at UCSF’s Benioff Homelessness and Housing Initiative program and a Public Voices Fellow of The OpEd Project.