TestimonyforFebruary17,2017DepartmentofHealthOversightHearing

SubmittedbyMarciaBernbaum,PeopleforFairnessCoalitionDowntownWashingtonDCPublicRestroomInitiative

GoodmorningCouncilMemberGray,DepartmentofHealthDirectorNesbitt,membersoftheCommitteeonHealth.MynameisMarciaBernbaum.IamamemberofthePeopleforFairnessCoalition.IserveasmentorandadvisortoPFFCsDowntownWashingtonDCPublicRestroomInitiative.

Iwouldliketofocustoday’stestimonyonthefollowingtopics:

• Whyhavingclean,safeavailablepublicrestroomsiscriticaltopersonalhealthandpublichealthandwhyitmakesgoodbusinesssense.

• ComparepublicrestroomavailabilityindowntownareasofEuropeanandAsiancapitalswiththerealityofpublicrestroomavailabilityindowntownDC.

• BriefyouonourDowntownDCPublicRestroomInitiative:ouraccomplishmentsandwhatweareinvolvedinoverthecomingmonths.

• WewouldalsoliketolendoursupportforthePublicRestroomFacilitiesTaskForceBill22-61thatwasinspiredbyourPublicRestroomInitiative.

Whyaccesstopublicrestroomsiscriticaltopersonalhealth

Iamattachingtothistestimonyexcerptsfromthreearticlesthatshowwhyaccesstopublicrestroomsiscriticaltopersonalhealth.Theycomefrom:theNationalInstitutesofHealth,theScandinavianJournalofNephrology,andtheAmericanRestroomAssociation.

Thesearticlesmakethefollowingpoints:

• Peoplewhosufferfromintermittentorchronicmedicalconditionsthatcausethemtofrequentlyneedtousearestroomarelimitedintheirchoiceofworkandshoppinglocations,andintheirparticipationinphysicalfitnessactivities,andbythelimitedavailabilityofpublictoiletfacilities.

• Womengenerallyneedtourinatemorefrequentlythanmen.Adversehealtheffectsthatmayresultfromvoluntaryurinaryretentionincludeincreasedfrequencyofurinarytractinfections(UTIs),whichcanleadtomoreseriousinfectionsand,inraresituations,renaldamage.

• Medicalevidenceshowsthathealthproblemscanresultifindividualsdelaydefecation:constipation,abdominalpain,diverticuli,andhemorrhoids.

Humanfecalwasteisahealthhazard

We all know how disagreeable it is to be walking down the street and either suddenly smell and/or step on human or animal feces. Urineemitsaverydisagreeablesmell,nottomentionthatitdegradeslamppostsandtelephonepoles,anddamagescars.Cleaningupwasteswater,anddetergents are damaging for the environment. While urine is not a health hazard, human feces definitely pose a health hazard:

• Humanfecesmaycontainarangeofdisease-causingorganisms,includingviruses,bacteriaandeggsorlarvaeofparasites

• Once out of the body feces are subjected to environmental bacteria that may use the excrement as food and thrive. The longer the stool has been outside the body, the more potential for harmful bacteria to inhabit the gases originating from the fecal material.

Accesstopublicrestroomsmakesgoodbusinesssense

• Knowingthattherearepublicrestroomsnearby,touristsvisitingWashingtonDCaremoreapttoleavetheMalltoeatandshopindowntownDC’scommercialareas,thuscontributingtoDC’seconomy.

• Peoplewhoarerestroomchallenged(seniors,pregnantwomen,individualstakingcertainmedication),knowingthatthereareaccessiblepublicrestroomsnearby,aremoreapttocometoareastoshop.

• Fewerpeoplewillaskbusinessestousetheirrestrooms.• Andtherewillbelesspooptoscoopaswellurinetoscruboffofbuildings,sidewalks,

lamppostsandotherareas.

Ifothercapitalcitiesplacepriorityonhavingclean,safe,availablepublicrestroomswhycan’tournation’scapitaldothesame?

CapitalsinEuropeandAsiarecognizetheimportance–fromapublichealth,personalhealth,andbusinessperspective,--ofinvestinginclean,safepublicrestroomsthatarereadilyaccessibletoshoppers,walkers,joggers,andtouristsintheirdowntownareas.

InGreatBritain,forexample,theGreaterBritishPublicToiletMaplists8,000publicrestroomsthroughouttheIsland.Appuserscanidentifypublicrestroomsnearaspecificlocationalongwithcharacteristicsofeachpublicrestroom.GermanandAustraliahavesimilarmaps.

Bywayofcontrast,ifyouareindowntownDCandyouareoutsideoftheMallyouwillhaveaverydifficulttimefindingaclean,safepublicrestroom.Thereareonlythreepublicrestroomsthatareopen24/7inallofWashingtonDC:UnionStation,theLincolnandJeffersonMemorials.Andthereareatotalof5,soontobe4,publicrestroomsdowntownthatareopenduringtheday.TwoarelocatedneartheWhiteHouse–atLafayetteSquareandtheWhiteHouseVisitor’sCenter.ThreearelocatednearGalleryPlace-theNationalPortraitGallery,theNationalBuilding

Museum,andtheMLKLibrary,whichwillbeclosinginearlyMarchfor3years.Therearenosignstodirectyoutoavailablepublicrestrooms.Ifyouaredowntownintheearlyhoursandurgentlyhavetogo,chancesareyouwillhavetowalkalongdistancetofindanopenpublicrestroomthatisifyouknowwheretheyare.PFFC’sDowntownDCPublicRestroomInitiative

SincePFFClauncheditsDowntownDCPublicRestroomInitiativealittleovertwoyearsagowehave:

• Identifiedviableoptionsforinstallingandmaintainingclean,safeavailablepublicrestroomsincludingspecificinformationonthecostsofpurchasing,installing,andmaintainingthem.

• LearnedfrombestpracticesofothercitiesintheUSthathaveinrecentyearshavesuccessfullyinstalledandmaintainedpublicrestroomswiththesecharacteristics.

• DesignedandcarriedouttworestroominventoriesindowntownareasofDCwherewehavevisitedprivatefacilitiesinfiveareasofdowntownDCthathavepublicrestroomsinordertofindoutifweareletinwithoutpurchasingsomething.

Inkeepingwithlessonslearned/bestpracticesfromothercities,wearecurrentlyintheprocessofbuildingsupportforpublicrestroomsfromANCs,neighborhoodassociations,churches,andBIDsatthecommunitylevel.Wearealsoreachingouttoassociationsofhotelowners,restaurantownersthatsupportseniorsandindividualswithdisabilitiestoobtaintheirendorsement.

WeareverypleasedthatourInitiativeservedastheinspirationforthePublicRestroomFacilitiesTaskForceBillintroducedbyCouncilMemberBrianneNadeauandwillbereachingouttothefiveDCCouncilMemberswhoco-introducedthisBillaswellasmembersoftheCommitteeonHealth.

Welookforward,oncetheTaskForcebeginsitswork,tohavingaseatontheTaskForceandtoprovidingsupportinanywaywecan.WealsolookforwardtohavingtheopportunitytomeetwithyourandCommitteeonHealthstafftosharemoreinformationonpublicrestroomoptionsandlessonslearnedfromothercitiesintheUSandelsewhere.

Iamattachingtothistestimony:

1. Theinformationsourcesusedtodocumentthepersonalandpublichealthhazardsoflimitedaccesstorestrooms.

2. Informationonthreeoptionsforclean,safe,availablepublicrestrooms.3. Alistofwhoisrestroomchallenged.

Thankyouforgivingmethisopportunitytotestify.

ATTACHMENT1PersonalandPublicHealthInformationSources

WhyaccesstopublicrestroomsiscriticaltopersonalhealthAmericanRestroomAssociation1:Therearenumeroushealthconcernsassociatedwithlimitedaccesstopublictoilets,resultinginbothphysicalandpsychologicaldifficulties.Manypeoplesuffereitherintermittentorchronicmedicalconditionsthatcausethemtofrequentlyneedtousearestroom.Thesepersonshesitatetotravelortheyavoidoutdooractivitiesthatputthemoutofrangeoftoiletfacilities.Thissituationisnotonlyinconvenient,butlifealtering.Theseotherwiseproductiveindividualsarelimitedintheirchoiceofworklocations,intheirparticipationinphysicalfitnessactivities,andtowhereandhowtheytravelbythelimitedavailabilityofpublictoiletfacilities.

ScandinavianJournalofNephrology2:Medicalstudiesshowtheimportanceofregularurination,withwomengenerallyneedingtovoidmorefrequentlythanmen.Adversehealtheffectsthatmayresultfromvoluntaryurinaryretentionincludeincreasedfrequencyofurinarytractinfections(UTIs),whichcanleadtomoreseriousinfectionsand,inraresituations,renaldamage.

NationalInstitutesofHealth3:Medicalevidenceshowsthathealthproblems,includingconstipation,abdominalpain,diverticula,andhemorrhoids,canresultifindividualsdelaydefecationHumanfecalwasteisahealthhazard.

AccordingtotheWorldHealthOrganization4“Humanfecesmaycontainarangeofdisease-causingorganisms,includingviruses,bacteriaandeggsorlarvaeofparasites”

Matt Russell, Ph.D. in Biochemistry, Cellular and Molecular Biology from the University of Tennesseeadds5:” Once out of the body these stools are subjected to environmental bacteria that may use the excrement as food and thrive. It is very common for bacteria to inhabit aerosols…. the longer the stool has been outside the body, the more potential for harmful bacteria to inhabit the aerosols originating from it.”

1J.Schmidt,JandBrubaker,R.TheCodeandPracticeofToiletsintheUnitedStatesofAmerica,www.americanrestroom.org/wto/wts04_paper.pdf2Nielsen,A.Waite,W.,"EpidemiologyofInfrequentVoidingandAssociatedSymptoms,"ScandinavianJournalofUrologyandNephrology.Supplementum157,pg.49-53,January19943NationalInstitutesofHealth(NJH)PublicationNo.95-2754,July1995.4http://www.who.int/water_sanitation_health/hygiene/emergencies/em2002chap8.pdf5Matt Russell, Ph.D. in Biochemistry, Cellular and Molecular Biology from the University of Tennessee

ATTACHMENT2PublicRestroomOptions

PORTLANDLOO

Designed, at request of Portland, OR Mayor, to avoid being used for illicit Activities.

Installed and successfully maintained In 12 cities in US and Canada; number of Cities growing.

Attractive

Open24/7

Clean

Safe

$90,000purchase

$30,000/yr.maintenance

$25,000-$35,000installationifClosetowater/sewerlines

AUTOMATICPUBLICTOILET

MaybefoundinNewYorkCityandSanFrancisco;manycitiesinEurope&AsiaAttractive

Open24/7

Clean

Safetyissues

$250,000-$1,000,000purchase

$100,000-$150,000/yr.maintenance

$25,000-$35,000installationifclosetowater/sewerlines

CITYOFLONDONCOMMUNITYTOILETSCHEME

Government provides a financial incentive to private businesses to make their toilets available to public

Businesses display special stickers in their windows

Signs indicate where they are located 70 participating businesses in London In use in other cities in England, Germany, and throughout Australia

ATTACHMENT 3 Who the Restroom Challenged Are

(from the American Restroom Association website 6)

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

6https://americanrestroom.org/pr/who.htm