Open Defecation in the United States: Perspectives from the Streets

Abstract

Abstract

Open defecation (OD) by people experiencing homelessness is common in many U.S. cities. Without sanitation when and where it is needed, the human right to sanitation for people experiencing homelessness has not been realized and concerns about the risks of infectious disease transmission are valid. To address the health care needs of people experiencing homelessness, Street Medicine clinicians provide health care services directly to patients living on the streets and in temporary housing. The experience of Street Medicine physicians has yielded significant insight into how and why people experiencing homelessness resort to OD; the lack of public resources, perceptions about public toilets, feelings of being unwelcome at service centers, concerns about safety, and physical and mental illness—including addiction—are all factors that contribute to OD. Additional public toilets are necessary, would minimize OD, and will alleviate overuse where existing facilities are scarce. However, public toilets alone are insufficient to end OD in the United States. Permanent supportive housing through initiatives such as Housing First provide the best path toward realizing the human right to sanitation and housing for people experiencing homelessness and ending OD in the United States.