Why Does the United States Only Care about Bathroom Sanitation in Other Countries?

When the typical American thinks about obstacles to sanitation access, we imagine slums in India or villages in Africa. When we consider the US government’s role in sanitation access, we think of Peace Corps volunteers building latrines or army engineers building sewers in faraway lands. Along with access to food, access to sanitation is a known and expected recipient of US foreign aid. Everybody should be able to go the bathroom safely, we say. It’s obvious.

Although the US gives less as a percentage of its gross income than many other countries to foreign aid, in total dollars the US provides more assistance than any other country. Our foreign aid budget is divided roughly in half, between Economic and Development Aid (providing food, healthcare, refugee assistance, etc.) and Security (counter-drug and counterterrorism funding; providing arms and security assistance to allies). 

Of the $25.6 billion we spend on Economic and Development Aid, a significant part goes to sanitation. It comes out of programs funded by the $8.6 billion earmarked for Global Health Programs, the $2 billion for International Disaster Assistance, and the nearly $3 billion we spend on Migration and Refugee Assistance; it is also complemented by many other areas of the economic and development aid we sent abroad. Indeed, WASH, the catchall term for “water, sanitation, and hygiene” is one of the core components of US foreign aid spending. 

And, at least nominally, the United States definitely supports access to sanitation. In 1997 the US signed the International Covenant on Economic, Social, and Cultural Rights (ICESCR), Article 11 of which recognizes the right of “everyone to an adequate standard of living.” In 2010, the United Nations General Assembly enshrined water and sanitation as a human right in Resolution 64/292. When the UN Human Rights Council endorsed the right two months later, the United States stated that it was “proud to take the significant step of joining consensus” on the resolution. 

But on US soil, sanitation is not a priority. While it is true that we spend far more on health and sanitation in the US than we do abroad in terms of percentage of GDP, we like to think of sanitation as an ‘out of sight, out of mind’ system. Unfortunately, that’s no longer working. America is in the middle of a bathroom-availability crisis—one so bad that the UN got involved. 

In 2011, the United Nations sent a Special Rapporteur, Catarina de Albuquerque, on a mission to the United States, where she reported on the right to safe drinking water and sanitation in America. De Albuquerque investigated sewage contamination in Massachusetts, the lack of sewer infrastructure in Appalachia, and the inaccessibility of public bathrooms across the country, among a variety of other issues. The Special Rapporteur was “struck by the fact that in the richest economy in the world there are still people lacking access to safe, affordable water and sanitation.” 

Since her visit, the state of bathroom access has only gotten worse. The streets of San Francisco are covered in human feces, with 28,084 defecations reported on the streets of the city in 2018. That’s five times the number of poops reported in San Francisco during 2011, the year the UN report was written. The problem is so bad that in 2018, the city formed a ‘poop patrol,’ armed with a steam cleaner to proactively search for and remove human waste. 

This is a nationwide problem. In her United Nations report, de Albuquerque notes that “it is often the poorest and most marginalized groups that lack access to sanitation.” As homeless populations across the country have increased, so too has the problem of public sanitation. Homelessness is key to the poop problem in San Francisco, and that pattern can be seen in cities across the country. 

Over the past few years, the homeless population in Los Angeles has ballooned, leading to a public health crisis within the city. A 2017 audit of public toilets on LA’s Skid Row used the UNHCR standards for public toilets in refugee camps to measure public toilet access. The standards state that every person should be within fifty meters of a toilet and there must be a minimum of one toilet for every twenty people. It found that Skid Row was drastically short of that bare minimum-- by as many as 164 public toilets during daytime hours. The problem has lured rats and brought medieval diseases such as typhoid to Los Angeles. 

Similarly, in New York City in 2015, the New York Police Department issued 17,744 summonses for public urination. Though public urination has since been rightfully decriminalized in New York, the issue of public urination and defecation remains. In New York City, there are approximately 1,100 public toilets in a city of 8.6 million. Singapore, in contrast, has 30,000 public toilets for 5.6 million residents. The lack of bathrooms in New York is striking.

This deficit exists because sanitation in America is a local issue. It is organized by cities and states, and there is no law in the United States federal code that requires sanitation to be provided to the public. Providing public bathrooms is something cities can choose to do, but it is not something they are required to do by law. Arguably, the general public does not even expect cities to provide such facilities.

The EPA does do some national work on sanitation, as articulated in its Clean Water and Drinking Water Infrastructure Sustainability Policy. But even the name focuses on just water, when water and sanitation are two sides of the same coin. 

The name of the EPA policy demonstrates the fundamental challenge the US faces in regard to improving public bathroom access and improved sanitation infrastructure: a national culture of squeamishness. We just don’t like to talk about bathrooms, so we don’t admit it’s a problem.

It some ways, it was always this way. In other ways, it wasn’t. Let’s start with the always. 

There is a clear difference between the willingness to talk about public bathroom access in Europe and in the United States. Europe has significantly more public toilets—some pay toilets, some not. Many, like the Nette Toilette system in Germany and the Community Toilet Schemes in the UK, are government funded or government subsidized programs that pay businesses to open their restrooms to the public; others are bathrooms funded and cleaned by the state. These exist because of well-organized pressure from the European public, which is comparatively vocal about sanitation. That they are able and willing to be so vocal can be traced back to the Catholic and Protestant religious histories; a societal heritage that is open about the body.

The American unwillingness to talk about, or even care about, bathroom access and sanitation is a direct result of our American Puritan heritage. The Puritan religious and cultural outlook rejects the body: not just in its sexuality but also in its corporeal presence more generally. Cleanliness is associated with Christian purity and respectability—two concepts that have shaped the American cultural consciousness. 

Humanity was not always disgusted by defecation; for much of history, it was normal, and the common person encountered excrement in their daily life. Romans defecated together in communal bathrooms. For much of the Middle Ages and into the Enlightenment, it was entirely normal to defecate in the streets and in public.

The Victorian era’s social puritanism, coinciding with the invention of water-based sewage systems that removed waste before it was seen or smelled, instilled a fear of bodily substances and bodily waste. This Victorian fear of excrement, combined with American Puritanism’s deeply-ingrained fear of the body, has imbued American society with a lasting and intense unwillingness to acknowledge the need to defecate.

And yet, despite that Puritan outlook, the state of sanitation in America used to be better. Before the seventies, there were public pay toilets across the country, and a greater investment in younger, newer sanitation systems. A student-led campaign, The Committee to End Pay Toilets in America, advocated for an end to pay toilets. The campaign was widely successful, and pay toilets were outlawed in regions across America. Cities, in turn, burdened by the expenses of safety and upkeep, allowed existing toilets to fall into disrepair as a result, and failed to build new ones.

The end of pay toilets and the lack of maintenance of existing toilets have converged in a modern dearth of toilets. Take New York City: in 1940, the New York City subway system had a public bathroom in every single station; now, in a system of 472 stations, there are only about 80 bathrooms. It also had bathrooms in all 1,500 parks: most still have bathrooms, but many close at night and during the winter. Even as the population has grown, the number of public bathrooms has decreased—they have been the victim of not only funding cuts and safety issues, but also a city-wide lack of care reflective of the national environment. 

In a democratic society, change only happens when the populace demands it. And nobody wants to talk about poop. American politicians don’t want to, and their constituents don’t want to, so as sewage infrastructure across the country fails and cities across the country struggle with open defecation, almost nobody complains. Domestically, nothing gets done.

Which brings us back to foreign aid. As a nation, we are comfortable talking about sanitation access abroad. Yes, we say, in favelas they need more bathrooms. Appalling, we say, as we discuss the lack of access to feminine hygiene products in other countries that is just as present in American houseless communities. But this is not from an outpouring of generosity or a fundamental spirit of giving. At its core, the difference between how we talk about feces here and abroad reflects a fundamental ideology of ‘othering.’ 

Americans are unable to discuss sanitation because it disgusts us. We find poop and pee nauseating. We see it as dirty. It’s a problem over there, our society seems to think, because over there they are dirty. Here we are clean. Sanitation is one example of a system of othering that is ever-present in how the US government’s foreign aid budget is shaped. Our conflicting opinions on domestic and foreign spending on sanitation demonstrates an essential American hypocrisy that cannot help but reveal the government’s political attitude towards developing nations.

We aren’t like them, we say. To have issues with sanitation access, we imply, is to be somehow less. Less hygienic, less sanitary, less human. We can acknowledge it abroad and fund it as foreign aid because of our willingness to look down on the people receiving that aid. To acknowledge the sanitation crisis in America, however, is to mar the image we have of ourselves. For our puritanical society, it is to look into a mirror and see ourselves as unclean.

Everybody poops. Except America.

This piece was authored by Maeve Flaherty, President of NYC Restrooms4All, a public bathroom advocacy campaign. To find out more, visit https://www.nycrestrooms4all.com/.