Homelessness, Sanitation, and Health Justice

Our new suite of public health legal resources and learning opportunities examines how shortfalls in equitable sanitation and hygiene access for people experiencing homelessness fueled the worst multi-state hepatitis A outbreak in over 20 years — and provides innovative public and private policy solutions.

The U.S. is grappling with its worst multi-state outbreak of hepatitis A — a viral liver disease tied to insufficient sanitation, hygiene, and clean water — in over 20 years. The outbreak illuminates systemic failures to meet the health needs of people experiencing homelessness (PEH).

In communities nationwide, safe, adequate, and accessible public toilet, hand-washing, shower, and laundry facilities are scarce or altogether absent. For example, in 2017, a group of nonprofit and government organizations, service providers, and residents in Los Angeles’s Skid Row neighborhood audited local public toilet access, finding severe shortages of adequate, accessible, and functional resources for PEH. Inner City Law Center published heartbreaking findings from the audit — including a mere 9 toilets for every 1,777 unsheltered PEH during overnight hours (9pm-6am) — in No Place to Go: An Audit of the Public Toilet Crisis in Skid Row. Similar shortages exist nationwide and leave PEH living in unhealthy environments contaminated by human waste; vulnerable to hepatitis A virus, meningitis, staph infection, lice, and other health harms; and with limited access to health. As data from California’s ongoing hepatitis A emergency illustrate, these inequities have life-and-death consequences for PEH.

Our new suite of public health legal resources and learning opportunities examines how shortfalls in equitable sanitation and hygiene access for people experiencing homelessness fueled the multi-state hepatitis A outbreak — and provides innovative public and private policy solutions:

1. In a recent Network blog post, Walter Johnson and I examine local efforts to address shortfalls in sanitation access for PEH in Los Angeles.

2. In a hot off the press issue brief, Health Justice for People Experiencing Homelessness: Confronting the U.S. Public Sanitation and Hygiene Crisis, I examine the connection between inadequate sanitation and hygiene access the disproportionate impact of the hepatitis A outbreak on PEH. Based on this assessment, I provide numerous legal and policy opportunities to promote equitable access to these basic yet lifesaving public health services, advance health justice for PEH, and catalyze far-reaching population health improvements. I also share exciting policy efforts promoting equitable public sanitation and hygiene access around the world, with snapshots of community empowerment in Los Angeles, California, public-private partnership in Bremen, Germany, and a municipal public toilet strategy from Kingston, Victoria, Australia.

3. On a June 28 webinar , Greg Spiegel, Corey Davis, Lauren Dunning and I will continue the conversation, exploring:

  • The connection between sanitation and hygiene access, homelessness, and the national HAV outbreak;
  • Legal and policy opportunities to further equitable sanitation and hygiene access for PEH; and
  • How meaningful participatory processes can strengthen policy efforts to address sanitation and hygiene inequities from advocacy to implementation.

4. At the 2018 Public Health Law Conference, Lauren Dunning, Gerson Sorto, and I will share cross-sector legal, policy, and community strategies to advance health justice for PEH, including those that strengthen public sanitation and hygiene.

If you are engaged in initiatives to advance equitable public sanitation and hygiene access or broader efforts to advance health justice for PEH, I would love to hear from you. You can reach me directly at mmorcelle@networkforphl.org.

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Madeline T. Morcelle

Madeline T. Morcelle

Attorney at the National Health Law Program. Leadership Coach at the Public Health Leadership Lab at Harvard. Former Medicaid enrollee & CMS staff. Optimist.