Public Restroom Access is an Urgent Public Health Issue

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It is sometimes required to fast before a medical test to avoid skewing the results. But for patients of Dr. Zoë Gottlieb, a gastroenterologist and assistant professor of medicine at Mount Sinai’s Icahn School of Medicine in New York City, skipping meals happens for a very different reason. Dr. Gottlieb specializes in treating inflammatory bowel disease (IBD), an umbrella term for chronic gastrointestinal tract inflammation that includes Crohn’s disease and ulcerative colitis. Because people with IBD experience unpredictable and urgent bowel habits, skipping a meal before leaving the house is often the only way they feel safe from being caught without a restroom.

 

That fear is deeply warranted in the United States, where a severe infrastructural failure has turned a basic bodily function into a daily logistical nightmare. A recent Time Magazine article by Jamie Ducharme, titled "Why Bathroom Access Is a Public Health Issue," highlights how the lack of public toilets has evolved into a widespread physical and mental health crisis.

 

A Stark Restroom Deficit

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According to a 2021 report from bathroom-supply company QS Supplies, the U.S. has a mere eight public toilets per 100,000 residents. It is a public health deficit that acutely impacts IBD patients but spares no one. "Everyone needs bathrooms," says Michael Osso, CEO of the Crohn’s & Colitis Foundation. "And, frankly, it feels fundamentally wrong that we can't support people in our community when they leave their homes by meeting this obviously critical need."

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The lack of infrastructure is so severe that it actively shrinks people's lives. Studies show that many individuals with chronic conditions choose to stay home rather than risk ending up in a location with unreliable bathroom access. A 2012 review of IBD research noted that while actual episodes of incontinence were rare, the constant, draining fear of it led patients to pull back from their careers, social lives, and hobbies.

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This fear kicks off a vicious medical cycle:

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• Isolation and Depression: The constant anxiety and lifestyle changes promote severe feelings of loneliness and depression.
   

• Worsened Physical Symptoms: Because the gut and the brain are closely connected, these mental health struggles can directly exacerbate physical IBD symptoms.

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• Increased Mortality Risk: Some research even suggests that IBD patients who become socially isolated face an increased risk of premature death.

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As Dr. Gottlieb notes, true healing is impossible unless both physical and mental health are appropriately addressed—and that requires reliable infrastructure.

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A Problem That Spares No One

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While chronic gastrointestinal conditions highlight the extreme end of the crisis, the toilet shortage affects a massive cross-section of the public. Pregnant individuals, parents with young children, and elderly adults all frequently need restrooms with little to no warning. Furthermore, individuals with mobility issues or disabilities are at a distinct disadvantage, as many existing public spaces are not designed with their needs in mind.

Unhoused individuals and people whose occupations keep them on the road all day—such as delivery and taxi drivers—frequently rely entirely on public facilities.

But even those with no underlying health issues or on-the-job needs are vulnerable to sudden emergencies. In 2021, a shopping trip for a New Yorker named Theodora "Teddy" Siegel turned into a frantic search for a bathroom. She ultimately averted disaster only by purchasing a bottle of water at a Times Square McDonald's to gain access to their customers-only restroom.

Shaken by the experience, Siegel began posting bathroom locations on social media. Her audience exploded, and followers began crowdsourcing their own "bathroom hacks" onto a giant digital map. Google representatives later informed Siegel that her map had become its most frequently used map in the world. While an impressive feat, it serves as an indictment of how difficult it is to navigate a city without insider knowledge or the disposable income to buy your way into a private restroom.

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The Roots of the Shortage

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The U.S. public restroom crisis is a multi-pronged issue rooted in history, economics, and social anxiety:

• Chronic Under-funding: Public facilities are notoriously expensive to construct and maintain.

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• Historical Discrimination: During the Jim Crow era, rather than building "separate but equal" facilities, several cities refused to build public restrooms altogether.

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• Modern Social Hesitancy: Today, city officials are often reluctant to build bathroom complexes because they worry the spaces will become hubs for drug use and sex work.

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However, withholding public toilets does not resolve these social problems. Instead, research shows that public health and community well-being significantly improve when high-quality restrooms are available—not only by aiding those in need but also by cutting down on health hazards like public urination and defecation.

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The Push for Policy and Change

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In response to governmental shortcomings, grassroots movements and advocacy groups are stepping in.

Several states have passed legislation designed to ensure that individuals with eligible chronic conditions can access businesses' employee-only restrooms when necessary. However, due to a widespread lack of awareness and compliance, these laws often fail to work as intended. This prompted the Crohn’s & Colitis Foundation to launch the Open Restrooms Movement, an initiative calling on businesses to voluntarily open their facilities to the public and log their locations on the Foundation's We Can’t Wait app.
 

Yet, advocates argue that the burden cannot fall entirely on private establishments. Siegel, who became an accidental "bathroom influencer," points out that it is fundamentally unfair to rely on retail stores, churches, or grocery stores to solve a government failure. In New York City, only about 1,000 public toilets exist to serve a population of more than 8 million—a ratio she calls a failure.

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Siegel and other advocates in cities like Portland, Washington, D.C., and Cincinnati are actively pushing for local legislation to identify high-need neighborhoods and systematically boost the number of public facilities.

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"Bathroom access is a basic human right. It shouldn't be a privilege," Siegel states. "I hope that this is something we all look back on one day and are horrified by."

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