Toilets Prevent Disease — If You Can Find One

The other day, as I was walking through the park, I saw a police officer writing a ticket for an unhoused man who had just urinated against a tree. The ticket could have been for being a public nuisance, disorderly conduct, indecent exposure, or lewd conduct, especially since there were kids around.

Several times a day, people living on the streets or in their cars undergo that desperate search for a bathroom. On occasion, we’ve all been there too. Most of us have snuck into a restaurant or hotel lobby when we’re really desperate. We’ve watched tourists frantically looking around or joggers doing that uncomfortable dance.

People who are unhoused face a completely different reality. Most businesses won’t let them through the door, leaving them with no access to toilets, no place to wash their hands, and nowhere safe to change a tampon.

Dr. Kendra Gorlitsky, a family medicine doctor at Charles Drew University, cares for unhoused adults. She explains, “I really worry about women that are so vulnerable because they really expose themselves to possible assault. They look in an alleyway when they get out of their car or out of their tent, and if they see other people there, what are they going to do? What are their choices?”

This is a constant source of misery; it’s humiliating and inhumane for people to be upset with you for something over which you have no control, and is a biological necessity. “The shame is not in the patient who has no place to go safely, the shame is on our city and our administrators and on us for not providing some place to go safely.”

This is also a public health problem. LA County just warned us about a hepatitis A outbreak after seeing cases spike and finding the virus in wastewater. While most people with Hep A recover fine, it can damage the liver and sometimes be life-threatening. The disease spreads through the fecal-oral route, meaning the lack of proper hygiene.

Dr. Gorlitsky explains how the lack of public toilets connects everyone. “When we are visiting downtown, and then we see something that’s mysteriously similar to human waste, and we think, ‘Oh, my God, this is on our sidewalks.’ This is how we can get diseases. So not only do we share the need, we share the risk.”

Luckily, there’s a very effective vaccine for hepatitis A (although reaching vulnerable populations isn’t easy). However, prevention isn’t just about vaccines; it’s also about basic sanitation — public health 101. Clean toilets and handwashing facilities. This isn’t rocket science, but it does require facilities.

The World Cup and the Olympics are coming to LA, and Dr. Gorlitsky sees this as our opportunity. “If we’re going to try to be a good host to strangers, that whatever we do to provide facilities as we should for these folks, this should be something that we can disseminate it around the city where it is most needed, and that way, it’s a win win for the for the whole city.”

Access to a bathroom isn’t a luxury — it’s basic human dignity and is crucial for public health.

– Dr. Michael Wilkes with a Second Opinion