The role of the public toilet: pathogen transmitter or health facilitator?

This paper discusses the role of public toilets, as transmitters of disease, but also of their importance in contributing to the health and well-being of society. Research has shown that public toilets are vital components in creating sustainable, accessible, inclusive cities. But there is no mandatory legislation requiring local authorities to provide them. Over 40% have been closed in the UK in the last 10 years. The promotion of the 24 hour city, characterized by a male youth drinking culture, along with toilet closure, has resulted in increased street urination, creating the conditions for the spread of previously-eradicated, water borne diseases in city streets. Less visible, but as virulent, has been the effect of toilet closure for women. Women, in response to lack of toilet provision, are likely to ‘hold on’ resulting in urine (and pathogen) retention, and bladder distension increasing the propensity for continence problems. The elderly and people with disabilities may simply not go out for fear of there being no toilet when they need one. Those toilets that are available may be unusable. Lack of regulation or compulsory standards result in poor toilet design, inadequate maintenance and management, and unhygienic conditions, resulting in the spread of MRSA and other drug-resistant diseases. Recommendations are summarized for the provision of a spatial hierarchy of toilet provision that would both meet user needs and reduce the chances of the public toilets acting as epicentres of germ transmission. Unless compulsory legislation, increased funding, and improved management, maintenance and cleaning regimes are instigated, public toilet provision will continue to be a source of disease.