Public handwashing for basic hygiene in people experiencing homelessness
Authors: April M Ballard, Bethany A Caruso
Journal: The Lancet Planetary Health (2021)

As we observe Global Handwashing Day, nearly 2 years into an ongoing global pandemic, we must recognise the strides made to provide hand hygiene access in public spaces and sustain these efforts moving forward to ensure basic hygiene is accessible for all, particularly for people experiencing homelessness. In April, 2020, WHO recommended that member states provide ''universal access to public hand hygiene stations'' to curb the spread of SARS-COV-2.1WHORecommendations to member states to improve hand hygiene practices to help prevent the transmission of the COVID-19 virus: interim guidance, 1 April 2020. World Health Organization, Geneva2020Google Scholar WHO and UNICEF then jointly launched the Hand Hygiene for All initiative, envisioning lasting infrastructure and sustained hand hygiene behavior across multiple settings. Public settings were included to enable infection control outside the home and in institutions such as schools and health-care facilities.2Joint Monitoring ProgramHand hygiene for all. Joint Monitoring Program, World Health Organization, UNICEF, Geneva2020Google Scholar Beyond infection control, prioritising public hand hygiene access is crucial to serving all, especially people experiencing homelessness. Public spaces, after all, are among the places where people experiencing homelessness live, and this population is not insignificant. Although the number of people experiencing homelessness globally is arguably incalculable, in 2005, the UN estimated that more than 100 million people were unhoused and more than 1 billion were inadequately housed.3Busch-Geertsema V Culhane D Fitzpatrick S Developing a global framework for conceptualising and measuring homelessness.Habitat International. 2016; 55: 124-132Crossref Scopus (114) Google Scholar Thus, public handwashing access might serve as a primary hygiene resource for people experiencing homelessness,4Montgomery MP Carry MG Garcia-Williams AG et al.Hand hygiene during the COVID-19 pandemic among people experiencing homelessness—Atlanta, Georgia, 2020.J Community Psychol. 2021; 49: 2441-2453Crossref PubMed Scopus (13) Google Scholar allowing them to perform other bodily hygiene behaviors that enable dignity, social inclusion, and improved life conditions.5Uddin SMN Walters V Gaillard J Hridi SM McSherry A Water, sanitation and hygiene for homeless people.J Water Health. 2016; 14: 47-51Crossref PubMed Scopus (15) Google Scholar Therefore, investment in public handwashing facilities provides an opportunity to be inclusive of people experiencing homelessness, and efforts should be sustained and improved. To effectively serve people experiencing homelessness—a diverse population that includes children and the aging6Wickham S Effective interventions for homeless populations: the evidence remains unclear.Lancet Public Health. 2020; 5: e304-e305Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar—they must be engaged to understand their lived experience and needs. For example, while the WHO guidance suggests facilities be placed in front of commercial buildings and transport facilities, those experiencing homelessness might be less likely to visit or even be deterred from these settings, affecting access.4Montgomery MP Carry MG Garcia-Williams AG et al.Hand hygiene during the COVID-19 pandemic among people experiencing homelessness—Atlanta, Georgia, 2020.J Community Psychol. 2021; 49: 2441-2453Crossref PubMed Scopus (13) Google Scholar Additionally, public handwashing facilities should be evaluated and monitored to determine if they are adequate for and accessible to those experiencing homelessness. A new report assessing progress against Sustainable Development Goal 6 estimated that 29% of the global population (or 2·3 billion people) lack access to basic handwashing facilities with water and soap.7WHOProgress on household drinking water, sanitation and hygiene 2000–2020.https://data.unicef.org/resources/progress-on-household-drinking-water-sanitation-and-hygiene-2000-2020/Date: 2021Date accessed: October 15, 2021Google Scholar However, the unhoused are systematically excluded from this estimate, which is based on household surveys. Monitoring public hygiene facilities opens the door to including people experiencing homelessness, and should go beyond simple enumeration of facilities to query access among them. Provision of public handwashing is a public good that should continue to be prioritised, funded, evaluated, monitored, and improved to truly make hygiene for all possible. We declare no competing interests.