Public sanitation and pandemics, not just an 18th-century problem
The Bubonic Plague killed almost half of Europe’s population in the 5th Century.
In the 14th Century, the Black Plague surpassed its grim predecessor to claim the lives of almost 60 percent of Europeans.
For centuries, smallpox toppled civilizations and ravaged communities from Japan and South America to the United States, amassing a pernicious death toll of 300 million in the 20th Century alone before being declared eradicated in 1980.
In 1793, as a Yellow Fever outbreak overwhelmed Philadelphia, twenty-thousand people, including most of the federal government, evacuated the City, escaping an unbearably humid summer as the epidemic wiped out a tenth of the nation’s then-capital.
About a hundred years later, as crowds swarmed Philadelphia for the Centennial Exhibition, the city experienced one of many typhoid fever outbreaks. Typhoid fever would claim the lives of over 5,400 in the 1890s in the Birthplace of America. In 1910, approximately 100 people per 100,000 in the United States contracted typhoid fever.
The search for preventative answers to outbreaks led to the development of sanitation procedures and sewer systems that we largely take for granted today. By the mid-1900s, sewer and water lines, public policy, and urban planning efforts eliminated the spread of most waterborne pathogens in the United States.
But, over two centuries after the Yellow Fever ravaged Philadelphia, California experienced several disease outbreaks: the 2016–18 Southern California Hepatitis A outbreak and the 2019 e. coli contamination of the American River. Access to sanitation is not a distant 18th-Century problem; it is a modern, dire need, especially as we face, now in the summer of 2020, a historic public health pandemic.
Throughout history, pandemics magnify weaknesses in our systems and infrastructure. They lay bare public health risks and vulnerabilities but also present opportunities to build more resilient communities in response.
Epidemics remind us of how interconnected we are: as humans and to the natural world.
The novel coronavirus (COVID-19) is no different. Scientists believe that the coronavirus originated from an animal in Wuhan, China, most likely a bat, and spread to humans. From there, it spread around the world. In the United States, as in much of the world, we live in societies and urban areas that often divide us. Epidemics remind of us how connected we truly are. Our health and well-being rely on the health and well-being of all people around us and of the natural world. Scientists expect that as climate change disrupts a delicate natural balance of the world’s ecosystems deadly viruses will become more and more common.
We often think about medical professionals, healthcare clinics, and hospitals when we think about responses to epidemics. However, the medical field says that sanitation systems were some of the most important medical advances in the 20th century. As urban designers, we believe it is our responsibility to design public space and infrastructure proactively to prevent the spread of disease and reduce the impact of disease. Design can, and should, make us healthier, prevent people from getting sick in the first place, and better care for people when they get sick.
Sanitation is critical for personal hygiene and health, and it is critical for public health.
We are all at greater risk of the potential spread of disease if anyone is without sanitation. We must continue to affirm sanitation as a basic human right. The United Nations recognizes safe drinking water and sanitation as basic human rights. And California recognizes the universal right to sanitation through AB685 passed in 2012: “It is established policy of the state that every human being has the right to safe, clean, affordable, and accessible water adequate for human consumption, cooking, and sanitary purposes.”
Despite significant advances in sanitation in the 20th Century in the United States, we still do not have universal access to sanitation. Effective sanitation is as much about access as it is about infrastructure. In a society that has largely individualized sanitation into workplaces and private homes, we may think that public sanitation is a thing of the past. However, it is still a critical part of achieving universal access to sanitation.
We all rely on public sanitation. Whether we take public transit or interact with public spaces, like parks, commercial areas, and markets, sanitation is important. People experiencing homelessness rely heavily on various types of public sanitation. Transit workers and rideshare and delivery drivers too-often lack access to restrooms, hand washing, and clean drinking water. And everyone is affected when limited access to sanitation means high levels of open urination and defecation as seen in cities across the United States today. Our current epidemic has underlined a dissolution of the social and economic boundaries we construct between each other. This must inspire a change in thinking that underscores our connected world.
Access to sanitation is an equity issue.
Universal access to sanitation improves general public health and begins to address deeper societal needs for inclusion and justice. Certain populations have less access to sanitation, require more frequent use, or require varying accommodations access facilities. These include children and people of advanced age. This also includes people who are pregnant, experiencing homelessness, have a disability, and have medical conditions. People who are homeless, disabled, and transgender, in particular, are often denied access to restrooms and experience discrimination in trying to access facilities.
When most people who are unsheltered (7 out 10 homeless people in Oakland) are Black, we have no choice but to see access to sanitation as a racial justice issue.
Addressing sanitation proactively with sufficient and accessible facilities can be more affordable than reacting to water supply contamination or disease outbreaks. Plus, it can be more humane and affordable than investing in power washing to clean streets daily from open defecation. The economic case is clear, especially as we navigate our current public health and economic crisis.
Proactive interventions also honor people’s basic dignity and will to survive. They aim to meet everyone’s basic needs instead of punishing and criminalizing open defecation.
So how do we design public sanitation that actually increases access and hygiene?
First, we understand who uses and needs public sanitation and listen to them. Their lived experience makes them experts. At Hyphae Design Laboratory, we start from this principle of “community as expert” and from there thoroughly define and identify who is “community” and who are the users. And then we take the time to engage and learn from these experts.
For public sanitation, this means broad engagement with the diverse users of public toilets to business owners impacted by open defecation, government officials responsible for providing sanitation and protecting public health, and workers who maintain facilities. It means identifying who currently cannot access public sanitation and understanding why. It means knowing that there is no “one size fits all” solution and that we need to respond and adapt to the unique needs of each city, each community, each neighborhood, and each site.
We need to ground ourselves with the goal of public sanitation for everyone. We need to think about scale, understand the scale of unmet needs, and how to fully meet that need. We need to fully evaluate the baseline: how are existing facilities functioning, where are they failing, where are they succeeding?
From here, creativity can lead us to explore a wide range of options and combinations to fill in gaps. This might include temporary mobile facilities, upgrading existing facilities, collaborating with private stores to open their restrooms publicly, increasing maintenance frequency, or strategically adding attendants to some facilities at high-need hours.
And as we do this, we have to understand that many other issues are inextricably linked to public sanitation. For example, we know that accessible, affordable, and sustained housing for formerly homeless individuals will meet their sanitation needs and housing needs.
Public sanitation needs to address this basic human need while we work for more comprehensive long-term solutions.
We know that people change. And cities change. Any solution needs to be flexible and adaptive to change and adjust to the unknown future. Hyphae uses data-driven design to refine sanitation. We put monitors on restrooms so we can understand how many people use them and when. We track maintenance issues and listen to the experience of maintenance workers and attendants. This data lets us refine hours; try out attendants for high-need facilities and adjust; test locations with mobile facilities; and test partnerships with private store owners.
Maintenance is critical.
If facilities aren’t regularly cleaned and maintenance issues fixed expeditiously, facilities won’t be used. People need to feel comfortable and safe to use restrooms from a sanitation perspective and a safety perspective. Some design features can reduce maintenance issues, facilitate cleaning, and improve a sense of safety. Investing in quality maintenance is critical for the long-term success of public sanitation. Attendants are also proving to be successful in improving safety and cleanliness in pilots from San Francisco to Denver.
Public sanitation is as much a thing of the present as the past. We need universal access to public sanitation to make our society more just, more healthy, and more resilient to an unknown climate and health future.
Universal access to sanitation is not only necessary, but it is also possible. Hyphae’s process and tools have supported several cities in planning and implementing significant improvements in sanitation.
Are you ready to address public sanitation where you live?
Hyphae envisions a future where everyone has access to sanitation through safe, accessible, and well maintained public facilities. We are excited to work with you and your community to achieve this vision together. We apply our data and community-driven process to develop healthy and ecological solutions unique to each place and community where we work. With over 20 years of experience in public sanitation, Hyphae has developed community-based sanitation plans and maintenance strategies, designed innovative street-side urinals and public toilets (like the PPlanter, Pooplet, and PProphet), and helped pass new permits for composting toilets. Visit our website to explore our past work, read more about our sanitation vision, and connect with us to envision a new project!
Hyphae is a consulting firm and incubation laboratory. We collaborate with communities, government, designers, and researchers to merge the inseparable links between earth systems, human societies, and built environments to activate healthy, thriving, and connected communities through innovative and imaginative engineering and design. Let’s connect.
