Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California

Abstract

Background Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation. Methods We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people’s ability to access WaSH services. Results Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people’s ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08–6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36–8.07). Conclusion Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.

Heat Risk Perceptions and Coping Strategies of the Unhoused

“…Meanwhile, integral components of the theory, attitudes toward the heat, and subjective norms did not emerge as significant predictors in this specific context, suggesting that the practical aspects of control over behavior could hold greater sway in shaping intentions to avoid extreme heat among the unhoused. Recognizing the prominence of perceived behavioral control provides valuable insights for tailoring interventions and support systems that enhance individuals’ confidence and agency in addressing the challenges posed by excessive heat within the unhoused community [ 35 ].…”

Addressing Colorectal Cancer Disparities in Unhoused Populations: A Call for Equitable Access and Compassionate Care

“…On a structural level, unhoused people living in unsheltered settings have poor access to water, sanitation, and hygiene (WaSH) facilities, including bathrooms, which makes colon prep a near-impossibility. 31 Even in sheltered settings, bathrooms are typically not private and need to be shared with multiple individuals, posing challenges with prepping. Even if an unhoused patient does successfully complete colon preparation, there may be competing priorities and vulnerability to external forces that impact their ability to make it to the appointment, ranging from needing to follow shelter requirements to keep their bed to being exposed to street sweeps.…”