California cities need more bathrooms. Here’s one solution
An inventory of the state’s restrooms would promote public health, especially for people without housing.
California has an opportunity to tackle a problem that affects everyone, but especially unhoused Californians: public restroom access. Unfortunately, there aren’t sufficient data about the scope of the problem for cities to move toward a solution.
A bill in the Assembly, AB 1297, introduced by Sharon Quirk-Silva (D-Fullerton), would require local governments to inventory public restrooms by July 2024, one step to address the chronic lack of restrooms across the state.
Access to public restrooms — facilities available to the general public that do not charge a fee for use — is a human right. Some groups rely more heavily on public facilities: people without stable housing, families with young children, delivery drivers and transit operators, tourists and commuters. But public restrooms are widely important for public health. Making available relatively clean and safe facilities promotes bladder and bowel health and prevents the spread of infectious diseases such as hepatitis A, shigella and influenza. Research shows that when more restrooms are available, open defecation declines.
Cities across California, however, have too few public restrooms to serve their populations. One recent estimate of access in Los Angeles, by far the state’s largest city, with nearly 4 million residents, is especially grim: There are only 14 permanent public restrooms on city streets. L.A. has a network of portable toilets, but they can be here today and gone the next. Access to basic sanitation in skid row falls far short of international standards for refugee camps.
San Diego, California’s secondlargest city, offers a telling case study. The city recently had to confront another uptick in hepatitis A cases — just a few years after a hep A outbreak sickened nearly 600 people and killed 20 from 2016 into 2018, and a 2021 shigella outbreak sickened 53. These outbreaks have repeatedly been linked to inadequate public restroom access, and they overwhelmingly affected unhoused people.
In response to these issues, my colleagues and I investigated a basic question: Where are the public restrooms in our community? We quickly learned that this is difficult to answer.
Information about public restrooms is sparse, hard to access and often inaccurate. San Diego County did not have a standardized database. Several of its municipalities have no public information on the restrooms they manage.
We submitted public records requests to locate these facilities, then compiled the responses with publicly available information to develop an online map of all permanent public restrooms countywide. This inventory has basic information, including the facilities’ hours of operation and features offered, such as menstrual products and baby changing stations.
The data paint an alarming picture. Focusing on downtown San Diego, we identified 22 public restrooms, only two of which are available 24/7. The overnight ratio is approximately one permanent toilet to every 204 unsheltered people living downtown. There are even fewer public restrooms in more outlying neighborhoods.
When we visited the downtown restrooms to audit their features, we found that only one of the 22 offered hot water, four (18%) offered menstrual products, seven (32%) offered baby changing stations and nine (41%) offered a gender-neutral or “family” restroom option.
We interviewed 115 unhoused San Diegans about their restroom experiences on a typical day. Of the people we interviewed, 70% reported using a public restroom — if one is available — and 44% reported practicing open defecation because no restroom is nearby when they need one. Half of the study participants said they experienced discrimination and other barriers when trying to use a restroom.
Passage of AB 1297 would be a critical first step toward increasing public restroom access. It is necessary for local governments to survey what restroom access looks like in their communities and make this information available to the public.
This is the not the first time Quirk-Silva has tried to enact this policy. Opponents contend that a requirement to inventory public restrooms would burden local governments. But a better understanding of gaps in bathroom access would, over the long term, reduce the work that officials have to put toward preventable public health crises linked directly to inadequate facilities.
The state can’t stop there. Once we know where restrooms are, we should use that information to improve the quality of existing facilities, identify where more are needed and explore creative solutions to increase access, such as public-private partnerships and corporate sponsors to create more restrooms.
California cities are perpetually at risk of infectious disease outbreaks. It’s time to collect the information needed to ensure that all Californians can safely meet their basic needs — and to hold local governments accountable to address this public health problem.