Philadelphia’s hepatitis A outbreak is a public health emergency and also the impetus for an essential public conversation about private bodily functions. This discussion is necessary for people living in comfort as well as people living in addiction or experiencing homelessness, and relevant to all of Philadelphia, not only certain neighborhoods or Center City.
The seemingly simple answer — offer more places to go — is complicated. But asking how, where, and why (or why not) is at least a start in a city where many parks and other public places are restroom deserts.
Most of the more than 150 hepatitis A cases reported in Philly so far this year are in Kensington, where hundreds of people live on the street with opioid use disorder but without easy access to toilets or handwashing facilities. Hepatitis A is spread via personal contact with infected human fecal material, and the situation in Kensington is inhumane.
The mess is hardly confined to Kensington, or Philadelphia. Public restrooms — expensive to operate, maintain, and police — have been disappearing from urban America for decades, and San Francisco, Seattle, Portland, Ore., and other cities face more challenging conditions than ours.
In Center City, there are a small but well-located handful of restrooms in public buildings, including the Independence Visitors Center, as distinct from the frequently if not chronically shuttered comfort facilities in nearby Independence National Historical Park. There also are successful faith-based programs, such as Hub of Hope and Broad Street Ministry, offering access to social services, as well as bathroom facilities.
But the hepatitis A outbreak is an emergency and requires immediate action in the form of toilets, running water, and distribution of hand sanitizer. The city is evaluating possible approaches such as a storefront pit stop or a “Portland Loo,” a minimalist, easy-to-install structure. City Managing Director Brian Abernathy said what the city does in Kensington may well spark interest in bringing similar facilities to other restroom deserts, such as the Benjamin Franklin Parkway.
Some advocates of services for homeless, addicted, or mentally ill people question the value of simply providing restrooms, particularly in Center City, where the facilities are apt to attract activities, such as drug use or prostitution, that present risks of their own. But the availability of public places to properly relieve oneself and wash one’s hands would be no more likely to encourage or sustain homelessness than the availability of, say, a supervised injection site would persuade someone seeking recovery to continue living in addiction instead.
If the mark of a successful city is how well it provides for basic human needs, Philadelphia, like many other major cities, falls short. Those in Center City have more options, with restrooms in retail and other private institutions that other neighborhoods don’t have access to. That imbalance suggests that only the privileged few can access a clean and functioning restroom. The hep A outbreak raises the stakes for the lack of facilities throughout the city. It should also raise the alarm that the city should grapple with this issue on a wider scale.