Indoor plumbing that directs human waste into channels where it can be properly treated and disposed of has been one of the biggest contributions to public health. So it is a little surprising that there isn’t a more concerted effort to have more plentiful and easily accessible public toilets because the need for one can arise when one is away from home. But Guido Corradi says that the opposite is happening, that public toilets are getting increasingly scarce.

Toilets were one of the biggest steps forward for humanity: they allowed us to create cleaner spaces, reducing death and improving health. By the 19th century, in Western countries, bathrooms with toilets were increasingly included in home design, catering to essential human needs, such as urination, defecation and personal cleaning.
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And yet, the vast majority of public restrooms have not yet embraced this aspect of wellbeing. On the contrary, the poor state of them often elicits disgust and repulsion. In severe situations, for some people, these adverse psychological responses can escalate to pathological levels, including incontinence, urinary problems, anxiety, and significant alterations to their normal social life.

For many people, most of the time, the state of restrooms is something they think about only when they fail, if they are unusable or unavailable, or there simply aren’t any. Yet toilets often fail when you need them the most. And it’s in such moments you realise that these invisible parts of our cities are fundamental. So, why are restrooms typically tucked away at the back of establishments, hidden both literally and metaphorically? We all must keep in mind that the use of public bathrooms is inevitable, and that making them accessible and appropriate is a matter of human dignity.

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The problem is different when looking to Western, educated, industrialised, rich and democratic (WEIRD) countries. Here we often take adequate sewage disposal for granted. And yet free access to toilets is gradually disappearing. As the journalist Lezlie Lowe documents in No Place to Go (2018), institutions are retiring from ensuring the availability of public toilets. This withdrawal of support for basic sanitary facilities has left many people, especially in urban areas, struggling to find accessible restrooms when needed.
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Yet, having access to toilets is essential for everyone’s dignity and to help support everyone’s mental, physical and social health. When women can’t easily use public toilets, it harms their wellbeing and denies their basic rights. The list of problems associated with public restrooms doesn’t end there. For instance, transgender and gender-nonconforming individuals face difficulties accessing restrooms due to transphobia. There is also a noticeable rise in urogenital issues due to holding in the urge to use the restroom at work or due to schools not adapting to the needs of children. Everyone can easily find a reason to fear public bathrooms, although these fears will be greater in those most disadvantaged by society.

For those of us with gastrointestinal problems, our minds always reserve a considerable space for public restrooms: we often worry about when we’ll have to use them, if we’ll find one, and if it will meet minimum standards. Dependency reshapes your reality: you are no longer concerned about whether you can park at the beach, but whether there will be a nearby restroom; you are not so worried about being late for the bus, but suddenly having an urgency in a 45-minute-long journey. Life changes when you are dependent on toilets. Note that everyone can find themselves toilet dependent, even if only temporarily – like that week after you ate a meal that upset your stomach.
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I have been aware of the monster since 2013 when I was diagnosed with ulcerative colitis. This is a chronic inflammatory bowel disease that causes long-lasting inflammation and ulcers in the digestive tract and affects life in different ways, such as needing the toilet frequently, pain and fatigue. That’s when I realised the impact a simple toilet can have, not only on an individual’s health but also on public health. This is the story of the shitty life that the poor quality of public toilets confers upon us.

In the US, I have often used fast food restaurants when I have needed to use a toilet when I am out of the home. These are often the cleanest, usually better than the ones in gas stations. I wrote sometime ago about going on a long distance trip during covid and finding to my alarm that most of those restaurants had shut down their dining areas (and hence access to the restrooms), providing only drive-thru services. I had to use the less-clean gas station ones.

I have a dream that recurs once in a while where I find myself in an office or public building or space and am in need of using the bathroom but cannot find one, despite going down many hallways where one would expect to find one. Sometimes I find one but it is filthy. Such dreams are apparently quite common and those who interpret such dreams suggest that they point to deep psychological issues. Maybe that’s true but surely one simpler interpretation is that they reflect the subconscious anxiety that most of us feel about fearing that we might need to use a bathroom when we are out and about and not be able to access one.

Just last week I was running some errands and went into a small ethnic grocery store to get some stuff. While there, I felt that need to use the bathroom. I did not have time to go home so I asked the proprietor if I could use their bathroom and he willingly obliged, getting the key to it and letting me in. I had the advantage that I am a regular customer and they know me. I have also walked into hotel lobbies and asked the receptionist to use the bathroom and have not been turned away yet. I have the big advantage of looking middle class. I do not know if poor people would be granted the same courtesy but Corradi says that they are disadvantaged.

When we asked people about the struggles they face with public toilets, such as ‘being unable to find an open unoccupied public toilet’ or ‘feeling unsafe or exposed in a public toilet’, we found that the more often they experienced these negative events, the lower their quality of life (even after accounting for any differences in their health or socioeconomic status). What’s more, we found that people from poorer and less educated backgrounds had more of these negative toilet experiences – probably because they usually live further from work and in places with fewer available high-quality toilets. Consistent with previous research, we found that gender also influences (negative) experiences with public restrooms: women reported more negative incidents than men, perhaps due to distinct needs that are so often ignored.

Access to clean toilets should be right up there with other fundamental human needs like food, water, clothing, and shelter. It is as basic to human well-being as all the others. And it should be easier to provide access to it than the other needs since there are usually plenty of toilets around, at least in cities. What is lacking is the sense that everyone has a right to use one when they need to.

Yet, there’s also reason to hope for a future with better toilets that restore our dignity. Some public administrations are taking the availability of quality public restrooms seriously in their facilities. Increasingly, patient and consumer associations are initiating campaigns for universal access to public toilets. For instance, in my country of Spain, there is the ‘I can’t wait!’ campaign in Catalonia, and the report about public bathrooms from the Spanish Federation of Consumers and Users, which called for their greater availability.

Let’s hope that movement catches on everywhere.