The U.S. Occupational Safety & Health Administration provides the necessary regulations to ensure that people in the work place will not suffer the adverse health effects that can result if toilets are not available(1) when needed.  The agency mandated to protect the public’s health outside of the work place,  the Department of Health and Human Services, provides no similar regulation or even guidance.

This lack of federal recognition makes it easy for

• schools not to allow students to use the lavatories
• municipalities to close public restrooms
• transits systems to put their amenities off limits to passengers
• airlines to deny passengers use of toilets throughout certain flights

The mission of the Department of Labor’s (DOL) Occupational Safety & Health Administration (OSHA) is to assure the safety and health of America’s workers.(2)  Per its mission, OSHA recognized that a person’s health is jeopardized when they are not able to use the toilet.  OSHA promulgated 29 CFR 1910.141(c)(1)(i): Toilet Facilities “…which requires employers to provide their employees with toilet facilities so that they will not suffer the adverse health effects that can result if toilets are not available…” (1)  Unfortunately, the authority of the Department of Labor does extend beyond the workplace.

The Agency that DOES have the authority to address the adverse health effects that can result if toilets are not available is the Department of Health and Human Services (DHHS).  DHHS is the principal agency of the United States Government for protecting the health of all Americans. (3)

There appear to be no DHHS regulations or guidance-based recognition that lack of access to restrooms is a serious health issue.   This is ironic since the DOL used research published by the National Institutes of Health, a DHHS agency for conducting medical research, as support for their Code of Federal Regulation (A CFR is federal law that is enforceable by the Justice Department)

Since DHHS has the mandate to protect the health of all Americans, ARA requests that federal legislators take the necessary action to require DHHS to address their omission of the public health requirement for toilet facilities, at least the degree it has been addressed by OSHA.   We are NOT asking for new legislation, only that an existing mandate be met.

(1) http://osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=22932
(2) https://www.osha.gov/enforcement/directives/adm-02-01-002
(3) https://www.hhs.gov/about/agencies/iea/regional-offices/region-8/what-we-do/index.html

Health impact to others when someone voids in locations not designed for sanitation.
Ex: Transit station stairwells, doorways, school room trash receptacles

Likely Agency –  DHHS’s Center for Disease Control’s (CDC) National Center for Infectious Diseases

Airport Terminal Announcement

Lavatory access will not be available on Flight from St Louis to New York.  28 May 2004  6:00 – 7:00PM, most likely Flight AA 682 or AA 5856″…I know it was American Airlines and I do believe it was to New York. What stands out in my mind is that the flight was at least as long or longer than our flight back to Washington. I would have hated to been on that flight. …
Source: phone call and follow up email dated:  Wed, June 16, 2004 9:36 AM  –  phone call to airline for flight number confirmation –  Jun 18th.  Click here for more on Airline Restrooms.

CHARLESTON, S.C  A  fifth-grade teacher allowed five students — a boy and four girls — to use a
trash can as a toilet during a school lockdown drill…  Three students held up jackets to shield the view while other students stood on the opposite wall with their backs turned.  …students were given
sanitary wipes.
KSAT TV  10/16/06

NYC  …In case you’re thinking this is not a health issue, think again. The stench of urine on subway platforms, city streets and building alcoves, the occasional deposit of human waste, and the desperation experienced by those in dire need of a safe, clean and open facility add up to a public health problem in my book. …  I’ve met many women who limit their consumption of liquids, ignore thirst and even risk dehydration for fear that they would have to find a public facility. From a health standpoint, this is a highly undesirable solution.

Public Toilets – New York Times Jane E. Brody ‘A Simple Need, All Too Often Unmet’  5/1/07

TAMPA FL – Freedom High School is getting national attention a week after deciding to close restrooms to curb vandalism. CNN and local TV stations quoted students Thursday saying they had to urinate on school grounds and in bottles because of the ban…
St. Petersburg Times, FL – 3/8/2007

GLENWOOD , MN  Our local area high school has a situation they call”lock down” where in situations where there is writing on the bathroom stalls insinuating a bomb threat, insult to the principle, etc, they close all the bathrooms
ARA Feedback 04 Oct 2006

The Dept of Health & Human Services has a legislative mandate to protect the public health and the Dept of Labor has documented that ‘holding it’ too long impacts ones health. Nudging Congress to take action, while still a challenge, will likely be significantly easier  then getting new legislation.  We’re our advocating for more complete implementation of existing legislation.  A few congressman asking in concert, or perhaps even just one, could get DHHS to better address the issue.

If DHHS had a clear-cut statement that forcing people to ‘hold it’ has a negative impact on their health it would help in almost every aspect of ARA’s goals. While school restrooms are outside ARA scope, a clear DHHS mandate on the subject would provide much more power to those challenging school principals even if the schools were outside the scope of the Federal  mandate.

Now, few people, including apparently some school principals, seem to understand there are health implications when people are forced to ‘hold it’ when they have an urgent need to void.