April9,2019DepartmentofHealthBudgetHearing

TestimonySubmittedbyMarciaBernbaum,Mentor&AdvisortothePFFCDowntownDCPublicRestroomInitiative

HealthCommitteeChairGray,membersoftheCommitteeonHealth,DepartmentofHealthDirectorDr.Nesbitt.

MynameisMarciaBernbaum.IserveasmentorandadvisortothePeopleforFairnessCoalition(PFFC)DowntownDCPublicRestroomInitiative.

BeforeIbegin,Iwouldliketoagainextendmyappreciationtoyou,CouncilMemberGray,formarshallingBill22-0223,PublicRestroomFacilities&InstallationActof2018,throughtheCommitteeonHealthandfromtheretotheflooroftheCounciloftheWholewherethebillreceivedtwounanimousvoicevotesinDecember.ThisBillisanticipatedtobecomelawdayaftertomorrow,onApril11.

Iamtestifyingtodaytorequestyourassistance.Toourdisappointment,theMayordidnotsetasideinherFY2020budgetthe$336,000neededtofundthefirstyearofthepublicrestroompilots.UnlesstheDCCouncilisabletoidentifyandsetaside$336,000forthispurposeinitsFY2020markupthelawwillremainonthebookswithnoactiontaken.

Accesstoclean,safepublicrestrooms–inadditiontobeingaHumanRight1–iscriticalforpersonalandpublichealth.

Therearemanyindividualswithhealthconditionswho,duetotheseconditions,mustfindarestroomurgentlywhentheneedarises.Iftheydon’tmakeittoarestroomintimetheyriskhavinganembarrassingaccidents.Thislistincludes:

Ø PeoplewhosufferfromCrohnsandColitisØ PeoplewithDiabetesØ Those with bladder or colon cancer Ø Some wounded combat veterans Ø Victims of abdominal or nerve trauma Ø Women being treated for Vaginal Candidiasis Ø 10 to 40% of stroke victims Ø OtherwisehealthypersonssufferingbowelincontinenceØ Menwhohaveenlargedprostates

1UNResolution64292,July28,2010;https://www.un.org/waterforlifedecade/human_right_to_water.shtml

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Aswegetolderadditionalchanges/healthconditionsthatbecomemoreaccentuatedwithagemakeitevenmoreimportanttofindarestroomontime

Ø BladdersgetsmallerresultingintheneedtogomorefrequentlyØ IncreasedchancesofcontractingdebilitatingdiseasessuchasAlzheimers,Parkinson’s,

CongestiveHeartFailure,andArthritisallofwhichslowsdownwalkingability.Ø Individualsonmedicationsforhighbloodpressurewhichhaveadiureticeffect.

Andthenthereareconditionsparticulartowomenwhichmakereadyaccesstoaclean,saferestroomimperative:

Ø WomenwhoarepregnantØ WomenontheirmensesØ Womenwhoholdtoomuchurineintheirbladdershaveanincreasechanceofgetting

UTI’swhichinsomecasescanleadtokidneyfailure

Anunfortunateconsequenceforpeoplewhosufferfromintermittentorchronicconditionsthatcausethemtoneedtousearestroomfrequentlyisthatthislimitstheirchoiceofshoppinglocations.Businesses,inareaswheretherearenoclean,safepublicrestroomavailable,loseoutsincetheseindividualswillnotcometotheirvicinitytoshop.

Italsolimitstheirparticipationinphysicalfitnessactivitiesasmanywillnotchoosetoleavethehousestoexerciseorvisitparksunlesstheyaresuretheycanfindaclean,safepublicrestroomwhentheyhavethatsuddenurge.

Turningtothepublichealthhazardsofnothavingreadyaccesstoclean,saferestroomswhennaturecalls….

Whileurineonthesidewalksandinalleyscanbesmelly(andinsomecaseshasresultedincorrodinglamppoststotheextentthattheyfalldown2),itisusuallynotahealthhazard.Fecesoutintheopen,however,AREapublichealthhazard.AccordingtotheWorldHealthOrganization3“Humanfecesmaycontainarangeofdisease-causingorganisms,includingviruses,bacteriaandeggsorlarvaeofparasites”Inlate2016/early2017592peopleinSanDiegobecomesickfromanoutbreakofHepatitisAand20diedduetocontactwithcontaminatedfeces.4

CapitalsinEuropeandAsiarecognizetheimportance–fromapublichealth,personalhealth,andbusinessperspective,--andhavetakenstepstoinvestinclean,safepublicrestroomsthatare

2https://www.sfgate.com/bayarea/article/City-lamp-post-falls-and-urine-was-a-factor-6424634.php3http://www.who.int/water_sanitation_health/hygiene/emergencies/em2002chap8.pdf4https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/Hepatitis_A.html

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readilyaccessibletoshoppers,walkers,joggers,andtouristsintheirdowntownareas.Theyalsomakeinformationavailabletothepubliconwheretheycanfindpublicrestrooms.

Bywayofcontrast,ourNation’sCapitalhasfivepublicrestroomsopendowntownduringtheday,onlytwoareopen24/7,andbusinessesareincreasinglylimitingrestroomaccesstocustomersonly5.

Fortunately,thereareviableoptionsforincreasingaccesstoclean,safepublicrestroomsinDC.Botharetobethesubjectofpilotsunderthepublicrestroomlaw:stand-alonepublicrestroomsavailable24/7,andprovidingincentivestobusinessestoopentheirrestroomstothepublic.(MoreinformationoneachisavailableinAttachment3).

ForWashingtonDCpilotingoptionsforincreasingrestroomstothepublicisawin-win.

Forarelativelysmallinvestment,ourNation’sCapitalcanbecomeaplacewhere:

Ø Tourists(over20millionin2017)canbeconfident,astheyarewhentheytraveltocitiesinEuropeandAsia,thatwhentheyvisitDCtheywillbeabletofindingpublicrestroomswhentheyneedthem.

Ø Peoplewithhealthconditionsthatcausethemtohavetogourgentlywhennaturecallscangooutshoppingortoexerciseknowingtheycanfindaclean,safepublicrestroomnearbywhentheyneedit

Ø Parentswithlittlechildren;bikers,walkers,joggers;shoppers,peoplegettingonanoffbusesandgoinginandoutofourMetrosystemcanalsobeassuredwhentheyneedarestroomtheycanfindone.

InclosingIurgetheCommitteeonHealthtoassistinidentifyingandsettingaside$336,000fortheestimatefirstyearexpensesofthepublicrestroompilotsinitsFY2020markupas,ifthisdoesnothappen,thelawwillremainonthebookswithnoactiontaken.

Iamattachingtothistestimony:

1. Informationsourcesusedtodocumentthepersonalandpublichealthhazardsandconsequencesoflimitedaccesstorestrooms(pages4&5).

2. Lessonslearnedfromcitiesthathavesuccessfullyinstalledandmaintainedclean,safepublicrestrooms;alongwiththreerestroomoptions(pages6–8).

3. Alistofthosewhoarerestroomchallenged(page9)

Thankyouforgivingmethisopportunitytotestify.Ilookforwardtoansweringanyquestionsyoumighthave.

5ThesedatacomesfromresearchwehavedoneinareasofDCwithhighlevelsofpedestriantraffic.Thestudiesmaybefoundatwww.pffcdc.org//what-we-do/public-restrooms.

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ATTACHMENT1InformationSourcesonNeedforPublicRestroomsforPersonaland

PublicHealthandbyPeopleastheyAge

WhyaccesstopublicrestroomsiscriticaltopersonalhealthAmericanRestroomAssociation6:Therearenumeroushealthconcernsassociatedwithlimitedaccesstopublictoilets,resultinginbothphysicalandpsychologicaldifficulties.Manypeoplesuffereitherintermittentorchronicmedicalconditionsthatcausethemtofrequentlyneedtousearestroom.Thesepersonshesitatetotravelortheyavoidoutdooractivitiesthatputthemoutofrangeoftoiletfacilities.Thissituationisnotonlyinconvenient,butlifealtering.Theseotherwiseproductiveindividualsarelimitedintheirchoiceofworklocations,intheirparticipationinphysicalfitnessactivities,andtowhereandhowtheytravelbythelimitedavailabilityofpublictoiletfacilities.

ScandinavianJournalofNephrology7:Medicalstudiesshowtheimportanceofregularurination,withwomengenerallyneedingtovoidmorefrequentlythanmen.Adversehealtheffectsthatmayresultfromvoluntaryurinaryretentionincludeincreasedfrequencyofurinarytractinfections(UTIs),whichcanleadtomoreseriousinfectionsand,inraresituations,renaldamage.

NationalInstitutesofHealth8:Medicalevidenceshowsthathealthproblems,includingconstipation,abdominalpain,diverticula,andhemorrhoids,canresultifindividualsdelaydefecationSpecificchallengesrelatedtoagingAging.care.com9:UTIsintheelderlyareoftenmistakenfortheearlystagesofdementiaorAlzheimer's,accordingtoNationalInstitutesofHealth(NIH),becausesymptomsinclude:Confusionordelirium-likestate,Agitation,hallucinations,otherbehavioralchanges,Poormotorskillsordizziness,fallingNationalInstituteonAging10:Urinaryincontinencemeansapersonleaksurinebyaccident.Whileitmayhappentoanyone,urinaryincontinenceismorecommoninolderpeople,especiallywomen.Functionalincontinenceoccursinmanyolderpeoplewhohavenormalbladdercontrol.Theyjusthaveaproblemgettingtothetoiletbecauseofarthritisorotherdisordersthatmakeithardtomovequickly.InternationalFoundationforGastrointestinalDisorders11:Diseasesorinjuriesarenottheonlyrisksforincontinence.Asyouage,manyphysicalchangeswilloccurnaturally.Thesechangeshaveaneffectthroughoutthebodyincludingontheorgans,nerves,andmusclesthatcontrolcontinence.Muscleswilllosetheirstrength,somenerveswillfunctionlesswell,andtissueandorganswilllosesomeoftheirabilitytostretch.Humanfecalwasteisahealthhazard.6J.Schmidt,JandBrubaker,R.TheCodeandPracticeofToiletsintheUnitedStatesofAmerica,www.americanrestroom.org/wto/wts04_paper.pdf7Nielsen,A.Waite,W.,"EpidemiologyofInfrequentVoidingandAssociatedSymptoms,"ScandinavianJournalofUrologyandNephrology.Supplemented157,pg.49-53,January19948NationalInstitutesofHealth(NJH)PublicationNo.95-2754,July1995.9https://www.agingcare.com/articles/urinary-tract-infections-elderly-146026.htm10https://www.nia.nih.gov/health/urinary-incontinence-older-adults11https://www.aboutincontinence.org/incontinence-and-aging.html

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AccordingtotheWorldHealthOrganization12“Humanfecesmaycontainarangeofdisease-causingorganisms,includingviruses,bacteriaandeggsorlarvaeofparasites”

MattRussell,Ph.D.inBiochemistry,CellularandMolecularBiologyfromtheUniversityofTennesseeadds13:”Onceoutofthebodythesestoolsaresubjectedtoenvironmentalbacteriathatmayusetheexcrementasfoodandthrive.Itisverycommonforbacteriatoinhabitaerosols….thelongerthestoolhasbeenoutsidethebody,themorepotentialforharmfulbacteriatoinhabittheaerosolsoriginatingfromit.”

12http://www.who.int/water_sanitation_health/hygiene/emergencies/em2002chap8.pdf13Matt Russell, Ph.D. in Biochemistry, Cellular and Molecular Biology from the University of Tennessee

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ATTACHMENT2LessonsLearned/BestPracticesfromCitiesthathaveSuccessfully

InstalledandMaintainedClean,SafeStand-AlonePublicRestrooms

Keyconsiderationsinselectingsiteforstand-alonepublicrestroom

1. Locatedinvisiblearea

2. Highlevelofpedestriantraffic

3. Inputandsupportfromthesurroundingcommunity(ANCs,communityassociations,businesses)

4. Nearwaterandsewerfacilities,5. Provisionsinplaceforcommunity,business,andpolicemonitoring.

Keyconsiderationsinselectingappropriatestand-alonepublicrestroommodel

1. Designedwithsafetyconsiderationsinmind2. Includesprovisionstodiscourageillicituse

3. Encouragesuserstospendalimitedamountoftimeinthefacilityinordertomaximizerestroomuse

4. Keptclean

5. Reasonableinprice

6. Easytomaintain

7. Arrangingforsignsforuserstoidentifyrestroomslocations

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ThreePublicRestroomOptions

PORTLANDLOO14(sizeofaparkingspace)

www.portlandloo.com

Designed using crime prevention measures to avoid being used for illicit activities and for easy maintenance.

Installed and successfully maintained in 23 cities in US and Canada; number of cities in US & growing.

Attractive Open 24/7 Clean Safe

$94,000 purchase/transport. $32,000 - $38,000 installation if close to water/sewer lines $12,000 -$ 20,000/yr. maintenance

AUTOMATEDPUBLICTOILET(sizeofaparkingspace)

https://en.wikipedia.org/wiki/Sanisette

Found in New York City, San Francisco, many cities in Europe & Asia

Attractive Open 24/7 Clean, issues in some locations Safety issues in some locations

$250,000 - $1,000,000 purchase $25,000 - $35,000 installation if close to water/sewer lines $100,000 - $150,000/yr. maintenance

14PreferredbyPFFCDowntownDCPublicRestroomInitiativebasedonresearchonlessonslearned/bestpracticeselsewhere:designedusingcrimepreventionmeasures(louverssocanseeandhearwhatishappeninginside,lightinginsideandoutsideatnight,bluelighttodiscourageneedleuse),lowercosttoinstallandmaintain(utilitiesaresolarpowered,1.25-gallonflush,easiertokeepclean.,maximizesusebynothavinghandwashonoutside.

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LONDONCOMMUNITYTOILETSCHEME

https://www.cityoflondon.gov.uk/services/transport-and-streets/clean-streets/Pages/Community-Toilet-Scheme-(CTS).aspx

Government provides a financial incentive (600 Euro/year) to private businesses to make their toilets available to public Businesses display special stickers in their windows Signs indicate where they are located 75 participating businesses in downtown London borough. In use in other cities in England, Germany, and throughout Australia

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ATTACHMENT3WhotheRestroomChallengedAre

(from the American Restroom Association website 15)

Ø Middle age women (NAFC) Ø Pregnant women Ø Parents touring with young children Ø Children in School Ø Women experiencing an irregular menses Ø People suffering certain congenital defects Ø Those with bladder cancer (2) Ø Some wounded Combat Veterans Ø Victims of abdominal or nerve trauma Ø Women being treated for Vaginal Candidiasis* Ø 10 to 40% of Stroke victims Ø OtherwisehealthypersonssufferingbowelincontinenceØ PeoplewithInterstitialCystitisØ ThosesufferingIrritableBowelSyndrome,UlcerativeColitisØ TheElderly(functionalcapacityishalvedasweage.)Ø PatientssufferingthediureticeffectofbloodpressuremedicineØ MensufferinganenlargedprostateØ DinersexperiencingthediureticeffectofcoffeeoralcoholØ PatientsonmedicationsthatactasbowelorbladderirritantsØ Ostomypouchesrequirepromptattentionwhenatcapacity

15https://americanrestroom.org/pr/who.htm