Free Library of Philadelphia. The Fashion District. Jefferson Station. Starbucks. Independence Visitor Center. These may seem like a disparate list of places, but for Philadelphians experiencing homelessness, these locations all provide a vital human right: basic sanitation. With indoor plumbing and hand washing stations, restrooms are vital to preventing disease outbreaks such as hepatitis A. Additionally, these restrooms give people experiencing homelessness privacy and dignity. But with the increase in passcode-protected bathrooms and the closing of retailers—due to factors like the rise of online retail and COVID-19—the number of free bathrooms is decreasing. The few public restrooms operated by the city government, including those in libraries, recreation centers, and City-installed porta-potties, do not make up for this gap in access to restrooms.

Philadelphia’s shortage of public restrooms is particularly felt by people experiencing homelessness. As there are only a number of public restrooms open to anyone in public buildings such as libraries, people experiencing homelessness depend on restrooms in privately owned stores and restaurants. Many experience discrimination inside these establishments and are denied access to restrooms. Of the existing bathrooms in private establishments that do not require a purchase to use, many have limited hours and are dirty due to overuse. 

According to the Philadelphia Office of Homeless Services, more than 5,000 people experience homelessness in the city on a given day. About 950 of those people are completely unsheltered. For these residents, public restrooms are some of the few places where they can use the bathroom. 

The lack of public restrooms is part of a growing cityscape that’s unwelcoming and inaccessible for houseless people by design. Philadelphia, like many cities, employs hostile or “anti-homeless architecture.” One does not have to look far from the metal armrests in the middle of Rittenhouse benches that prevent people from sleeping on them, to the modified leaner benches at some subway stops, to see how anti-homeless architecture is employed around the city. The lack of free bathrooms similarly make cities inhospitable for people without permanent shelter.

Miriam Hacker, a senior research implementation lead at the Water Center at Penn, researches how climate change and extreme weather events can affect access to water and sanitation for groups that already have a difficult time accessing these services. One aspect of Hacker’s research centers around how people experiencing homelessness find places for water and sanitation, to set a baseline for how this could change with worsening climate change. Hacker explains that there currently is no formal obligation or policies related to making sure people have access to water and sanitation, which means that if you don’t have access to housing, you might be relying on publicly available restrooms provided by the government, or on getting permission to use local businesses’ facilities. “This sort of access brings in another issue of discrimination or potential criminalization,” Hacker says. “It presents a pretty big gap in how people have access to basic services.”

The gap in access to restrooms also has significant consequences for public health. A study in the International Journal of Environmental Research and Public Health found that a lack of sanitation infrastructure is directly associated with the spread of diarrheal diseases such as cholera and typhoid. These diseases, when coupled with a lack of access to indoor plumbing or hand washing stations, can spread quickly through populations. In 2019, Philadelphia experienced a hepatitis A outbreak of 445 cases, with many among people experiencing homelessness. Hepatitis A is most commonly spread through food or water that’s been contaminated with the feces of an infected person. 

Disease spread due to a lack of public restrooms and sanitation is not limited to Philadelphia alone. According to AP News, in 2017 and 2018, San Diego experienced a hepatitis A outbreak that killed 20 people and sickened almost 600. A grand jury report found that the lack of public restrooms and handwashing stations were some of the causes of the outbreak. The 2018 grand jury recommended that San Diego should construct more secure restrooms and handwashing stations, which had been suggested in reports dating back to 2004. This spread of hepatitis A in San Diego, eerily similar to that in Philadelphia, underscores how vital it is for cities to confront sanitation concerns to prevent the deaths and illnesses of some of Philadelphia’s homeless population.

Kathleen Grady, chief of staff for Health and Human Services, explains that her department's most recent work in public restrooms started with the onset of the hepatitis A outbreak in 2019. In response to the spread of the disease, the City not only set up vaccine clinics in Kensington, the heart of the outbreak, but it also installed temporary public restrooms and handwashing stations. Health and Human Services also expanded their public restrooms during the start of the COVID-19 pandemic, installing porta-potties and restroom trailers in high-use areas such as Center City and Kensington. “COVID just underscores that there is a need, and that hand washing and public restrooms are a critical part of infrastructure in a city,” Grady says. 

She shares that on a personal level, while taking long walks away from home during early lockdowns in 2020, she realized how important readily accessible public restrooms are. “It struck me then that with a little bit of a walk, you’re doing a mental map of where every public restroom is,” she says. “[Public restroom locations] are not just something that unhoused folks are thinking about. If you go out or come into a different part of the city, you’re thinking about, ‘Oh, where’s the closest restroom?’”

Expanding public bathrooms will benefit people beyond those experiencing homelessness or who are unfamiliar with an area. Many people, such as pregnant women, people on blood pressure medication, and families with young children, often have to plan their days around access to bathrooms, as they need restrooms more frequently. Having readily available bathrooms while out and about makes the city more accessible. 

The city has seen encouraging success with installing porta-potties. The Health Department’s Substance Use Prevention and Harm Reduction Division hired two public restroom specialists (PRS), who maintain restrooms and engage with the community, specifically focusing on harm reduction. In September of 2021, the Health Department hired Matthew Fitzpatrick, a social worker who has a background in family therapy and as a custodian. It then hired Jason Whittle, an overdose prevention specialist at Prevention Point, a center that serves people with addiction, and who has had personal experience with recovery. The two PRS team members serviced seven public porta-potties in Kensington and Center City, and worked with people in the area using the restrooms on harm reduction practices throughout Philadelphia. 

“Public restrooms were really an amazing engagement tool,” Grady says. “Folks who may be resistant to going inside for services were engaging with our public restroom specialists and connecting with them, which was really exciting. We’re seeing that at MSB [the Municipal Service Building porta-potty location], we’ve actually expanded some of the services. Four hours a week, we’re doing wound care services next to the public restrooms in Center City, because people have really built relationships of trust with our public restroom specialists.”

The City of Philadelphia is taking steps to address the lack of public restrooms beyond porta-potties and restroom trailers. This summer, it announced its Philadelphia Public Restroom Pilot. This project plans to install six public restrooms in different neighborhoods. The City will work with Portland Loo to install stand-alone bathrooms that are durable and have hand washing stations, the first of which will be located on the corner of 15th and Arch streets by the Municipal Services Building by early 2023. While the City is taking the right steps to address the lack of public restrooms, the number of restrooms that are set to be built under this pilot is limited, and its actions may not have a tangible impact for a few years.

Grady emphasizes the importance of public restrooms. “It's definitely a public health and quality of life intervention, but really, we’re talking about dignity here and making our public spaces accessible and inclusive as well,” she says. “Public restrooms are an essential part of the urban fabric.”

Grady explains that public outreach and engagement was the starting point for the Philadelphia Public Restroom Pilot. The City reached out to the business community, local unions, harm reductionists, and homeless service providers in the area, as well as people within the disability rights and LGBTQ communities. Grady’s office also partnered with Mural Arts, a nonprofit arts program, to help citizens engage with the pilot. “We did some art-making around public restrooms, and had some pop-up events for people to give us ideas. These are in public spaces, so we were able to get passersby that you might not be able to identify as a particular stakeholder,” she says. “And we did a survey for unhoused people to get their perspective so that we can have their voice, [as well as] a public survey.” 

Hacker is largely optimistic about the City’s engagement with local communities, citing that you need feedback from “not just the general public, but also from specific communities that are served by these restrooms. You absolutely need to have local investment. And you need to have local voices heard when planning, and also be able to create those types of relationships,” she says.

Hacker was encouraged to see the degree of engagement done by the City to understand local needs and improve the public restroom situation through a more permanent solution. “I think it’s really critical to realize the learning curve associated with adopting new technology. It’s going to be important to identify things that are going well, or steps that are being taken … in the right direction and what adjustments are needed to ensure more fair and equitable access to basic infrastructure,” she says. “It’s not ‘us versus them,’ but really it’s a community partnership. So how do we all rally together—with advocacy groups, communities, researchers, businesses—to make sure everyone has access to these really critical infrastructure services?”

The work to improve Philly’s sanitation services requires an understanding of the crucial role that bathrooms play in the city, as well as community partnership, to ensure that everyone has access to these places that are a basic human right.