For many San Diegans, the proposal to close dozens of public restrooms due to budget cuts may sound like a minor inconvenience — an unfortunate but manageable reduction in public services during difficult fiscal times.
From a public health perspective, however, this proposal represents something far more consequential.
Public restrooms are not merely conveniences. They are part of a city’s sanitation infrastructure. Dismantling sanitation infrastructure in a dense urban environment is not a cost-saving strategy when it inevitably becomes a public health risk.
San Diego, of all cities, should understand this better than most.
Less than a decade ago, our community experienced one of the largest hepatitis A outbreaks in modern history. From 2016 to 2018, San Diego County declared a public health emergency as hundreds of people became infected and multiple individuals died. While the outbreak disproportionately affected people experiencing homelessness, its implications extended into the general population, including infections among health care workers.
The intensive medical intervention and vaccination response only succeeded when it was combined with sanitation measures, including handwashing stations, sidewalk decontamination, increased street cleaning and expanded restroom access.
That response reflected a fundamental truth that physicians and public health professionals have understood for generations: Sanitation systems are disease prevention systems.
Public health infrastructure must extend beyond hospital walls and into the civic spaces where people live their daily lives. Protecting community health requires investment in systems that seem ordinary until they become essential.
When public bathrooms disappear, human biological needs do not disappear with them.
A growing body of peer-reviewed research demonstrates that inadequate restroom access contributes to increased environmental contamination, reduced hand hygiene, worsening chronic health conditions, and higher rates of urination and defecation in public spaces.
Research specific to San Diego, conducted with the joint University of California San Diego-San Diego State University public health program, found direct associations between inadequate restroom access and urinary, gastrointestinal and skin-related health conditions among unhoused individuals in our region.
One of the study’s most striking findings was that nearly one-quarter of surveyed participants reported engaging in open defecation because restroom access was insufficient.
And while discussions about public restrooms often become narrowly associated with homelessness, the reality is far broader.
The consequences of restroom closures affect residents with urinary urgency, pregnant women, children, tourists, delivery drivers, individuals with Crohn’s disease or ulcerative colitis, patients taking diuretics or cancer therapies and countless workers who spend long hours outdoors.
A city without accessible bathrooms becomes less navigable, less humane and ultimately less healthy. Data indicates that beyond the public health issues, reducing restroom access frequently creates downstream costs that exceed the savings generated by closures. Close the restrooms and the city will be forced to spend more on sidewalk sanitation, environmental cleanup, emergency medical care, policing, complaint response and preventable disease mitigation.
The costs do not disappear. They simply shift elsewhere — resulting in cities that no one wants to live in or visit. San Diego aspires to be a world-class city: a destination for tourism, biomedical innovation, higher education, scientific research and global commerce. World-class cities must maintain the infrastructure necessary for human beings to safely exist together in public space.
This conversation should not center on whether bathrooms should remain open. It should center on how to operate them more effectively and safely: through better maintenance models, strategic placement, partnerships and long-term sanitation planning.
As physicians and public health leaders, we urge city leaders to recognize that this issue is not fundamentally about bathrooms. It is about whether San Diego remembers the lessons it learned during previous public health crises.
We should not wait for another outbreak, another emergency declaration, or another preventable sanitation crisis to rediscover the importance of public health infrastructure that quietly protects all of us every day.
Civilized cities are not defined only by convention centers, stadiums or luxury developments. They are defined by whether they maintain the basic systems that preserve public health and human dignity.
No great city became healthier, safer or more humane by making it harder for human beings to meet their most basic needs.
Torriani is an infectious disease specialist and Health Infection Prevention and Clinical Epidemiology Medical Program director at UC San Diego Health. Yashar is chief medical officer for UC San Diego Health. Anderson, Ph.D., is professor and dean of the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science.