Sitting uncomfortably: public health goes down the drain as toilet access dries up

When people think about what is needed to make a city sustainable, a public toilet will probably be low on that list — if it’s there at all. But this most convenient of conveniences is vanishing from cities like London, making us all — but certain groups particularly — much worse off.

Some time back, my late mother was visiting London and needed, as she would say, to spend a penny. She went into an Italian café, ordered a coffee, paid the money and asked if they had a toilet. Returning to the counter, the owner asked what coffee she wanted. “No, don’t worry about that. I just needed to use your lavatory. Please give a coffee to the next customer.”

The owner might have been happy to let her use the facilities without buying a coffee but many cafes either have signs reading “For paying customers only” or a lock on the door, for which the combination is available only on a till receipt for a drink.

My mum, with her old school values, was disappointed by the lack of public toilets but also aware of what bargain she needed to strike. But for many people and especially lower income mothers in cities with overpriced coffee, that is not an option.

Public toilets are essential for everyone, regardless of age, class, ethnicity, gender or physical and mental abilities. They are particularly crucial for the elderly, people with disabilities, menstruating and pregnant women, families with young children and visitors. Although the Public Health Act 1936 allows local governments to provide public toilets, it does not require them to do so. This lack of obligation, combined with concerns about potential problems these facilities might cause, has likely contributed to fewer public toilets being available in recent years.

Public toilet availability in London has significantly decreased over the past decade, according to recent findings from Age UK London. The data show that between the 2013/14 financial year and now, public toilet closures have outpaced openings by a ratio of 3:1. In concrete numbers, 97 public toilets have been permanently shut down during this period, while only 32 new facilities have been established. In February, the British Toilet Association initiated a campaign advocating for legislation to require local councils to increase the number of public facilities available.

My own borough, Camden in northwest London, may have as few as three public toilets still open (of which one is closed for an upgrade). Of the others, one became a cocktail bar (now shut), another a coffee bar, a third is a music studio and a fourth is, pardon the pun, “to let”. The gap is filled to some extent by what academics have called “away from home toilets” — for example in restaurants, shopping malls and department stores.

To let, London NW1

Music studio, London NW5

Shopping centres have certainly supplemented provision, but they are few and far between, while department stores tend to be in traditional town and city centres such as Oxford Street and Croydon. This leaves the unspoken deal whereby staff and managers at big pubs and large counter-service hamburger joints turn a blind eye to people coming in just to use the facilities. Some railway stations woefully installed turnstiles that required payment although some — such as Victoria — have now correctly reverted to free provision.

The reason to reverse this trend is that inadequate public toilet facilities interfere with effective health initiatives, economic growth, social integration and environmental conservation efforts. For governments aiming to develop sustainable urban centres and encourage use of public transport, bicycles, and pedestrian travel, sufficient public restrooms are crucial as they represent a critical but often overlooked component. Limited toilet availability restricts people's freedom of movement and ability to navigate cities effectively.

Of course, what I am writing about could be seen as a “first world problem”. While the United Kingdom faces serious deficiencies in public toilet provision, global conditions are substantially worse: of the world's 7 billion inhabitants, over 2 billion lack access to basic necessities including water, sanitation, electricity and toilets. Mobile phones now outnumber toilets worldwide. In our increasingly urbanised world where half of people live in cities, one-third reside in informal settlements.

Both situations are imperfect, and the gravity of the global situation should not be an obstacle to rich countries pulling their belt up a bit. The outstanding example is Tokyo. A groundbreaking initiative in Japan is highlighting this typically overlooked infrastructure to showcase the significance of toilet design globally.

THE TOKYO TOILET Project engaged renowned architects and artists to transform public restrooms across the city into spaces fostering creativity, community, and inclusion. The initiative has already developed 17 new facilities designed by 16 different creators throughout the Shibuya area, each featuring unique designs and characteristics that have turned the project into both an internet phenomenon and a popular attraction for visitors.

The results received international attention thanks to the Wim Wenders film Perfect Day that centres around the daily routine of a public toilet cleaner. If that is what it takes to flush some excitement into this overlooked infrastructure, so be it.

Derelict, London NW5

Working toilet, London NW3