Whether you call it the loo, john, privy, lavatory or toilet, this facility is essential wherever humans gather or live: toilet provision has even been called the barometer of civilization. The modern development of public toilets dates from the late 19th century when sewer systems and water supplies provided hygienic means of dealing with waste, facilitated by public health legislation that also permitted local authorities to provide toilets in town centres. Yet the statutes in the United Kingdom, where the flushing toilet as we know it was invented, never went so far as to require provision of these facilities outside the home. Pressure on resources during the last 20 years has led to many public toilets being closed, for example, 40% of those in London, or to entry charges that reduce accessibility. At the same time an increasingly mobile population has made public toilets even more necessary. Recent public inquiries into public toilet provision in the UK have revealed the impact of the paucity of facilities on the elderly, women, families with young children, ill health that increases the need for toilet use, visitors and poor or homeless members of the community. There has been little attention in public health on the provision of public toilets. With street urination on the increase and less free access to toilets, it is time for public health to recognize a great need and to campaign to turn the tide on public toilet closures, with imaginative planning strategy and associated opportunities to encourage hand washing and other hygiene health promotion.
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