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Toilets do more to define our lives than we probably care to admit. They’re essential to well-being and lifestyle. In bathrooms, we can find identity. In toilets, health. Behind the locked door of a tin shack with a seat and a hole, dignity.

It might seem ridiculous, as most people just go with no thought to it. It’s not a part of the day that typically makes it into conversations. But this affects everyone, either directly or indirectly.

In bathrooms, we can find identity.

When people can’t properly relieve waste in their homes or aren’t informed about sanitary ways to do so, disease spreads and people (especially children) suffer. This is a widespread issue particularly plaguing developing nations where population is outpacing infrastructure.

When people make the choice between a public restroom labeled with a dress and one without, they commit to or are forced to commit to an idea of their gender. This is subtle bigotry that leads to excruciating experiences for many middle and high school students.

When people wander the streets with nowhere to go until they are forced to squat in the shadowy corner of a stairwell, they leave a piece of their dignity on the pavement. This is part of a systematic denial of humanity to homeless people.

Solutions for these problems have long been within reach but are seldom discussed. There are people, however, all over the world working hard to change that.

All-gender bathrooms

Some cities do it now: single-stall restrooms, private and public, that are designated “all-gender” or just “restroom.” Seattle, Philadelphia, and Vancouver, B.C., among others, have initiated programs.

With each of these laws comes the usual city politics : “The mayor needs to get off his LBGT agenda and focus on ‘real’ city issues … there are a lot to choose from,” one online commenter responded to news of Seattle’s initiative. There’s also fear and hatred. In Houston, the proposed Houston Equal Rights Ordinance (HERO) spurred an ugly backlash. All-gender restrooms were just a small piece of this landmark civil rights law, but opponents zeroed in on it, depicting the moments leading up to—presumably—the assault of a young girl in a public bathroom. “Any man at any time could enter a woman’s bathroom simply by claiming to be a woman that day,” the ad forewarns.

HERO didn’t pass.

In places like Florida and Washington state, opponents are using the same tactics. Clearly, the conversation is stifled. Maybe the best hope for changing the dialogue can be found in what’s happening right now in schools around the country.

“In high school, the bathroom isn’t just a place to pee,” says Harper Zacharias, a bathroom activist. “It’s an environment of its own.”

As a senior at Deerfield High in a northern suburb of Chicago, Zacharias negotiated with the school’s administration to provide a safe and comfortable restroom for transgender students. For him and others, restrooms are a stressful place. It’s where students are vulnerable, away from the protection of teachers and administrators.

Maybe the best hope for changing the dialogue can be found in what’s happening right now in schools.

At Olympia High School in Olympia, Washington, two students targeted for their gender expression were reportedly assaulted in the restroom during the 2014–15 school year. Without faculty witnesses, the assailant went unpunished. To avoid such dangers, Zacharias says, many trans students actually don’t drink water throughout the day, or they hold it for seven straight hours. This is one struggle out of many for trans people around the country.

What is possible in a high school that isn’t in city government? Unilateral change.

At Deerfield, principal Audris Griffith (now retired) was supportive when Zacharias came to her. The immediate solution: make the single-occupancy staff bathroom available to students. It had to just say “restroom” on the door (an “all-gender” sign would likely out students using it), and the news of the switch had to be spread by word-of-mouth to avoid a rush on the private bathroom. The conversation also had to be kept between students and the principal, because most of these students had not made their gender identity known to their parents.

Similar considerations were made at Olympia High School in 2015. Fueled by the two assaults, students pushed for change. The debate grabbed the attention of parents, and the backlash looked and sounded like that of city- or state-level debates. The students brought their plight, their fears, and their humanity directly to a parent connection board meeting. And they got their bathroom.

Ideally, says former Olympia student Grace Meyer, the school would make one or two of the main hall bathrooms all-gender, but it was a step in the right direction.

All-gender restrooms are a form of exposure to gender-nonconformity, Zacharias says, and the earlier the exposure, the more likely students will be to accept their trans peers. It’s a matter of changing one little sign, but it could shift our entire culture.

Restrooms in so-called developing nations

In 2000, the United Nations set a goal for better access and use of improved sanitation facilities (defined roughly as a decent place to poop). This was among their actionable, quantifiable Millennium Development Goals (MDG). But of all their goals, sanitation was the most off-track. The latest MDG report admitted this, highlighting that “2.4 billion people [a third of the world population] are still using unimproved sanitation facilities.” Worse, an eighth of the world population is still practicing open defecation, resulting in widespread disease.

It’s a matter of changing one little sign, but it could shift our entire culture.

The problem persists all over the world, but in recent years India has been the most criticized for poor sanitation. Diarrhea caused the deaths of more than 130,000 Indian children in 2013, according to Johns Hopkins University. The primary cause was drinking and washing water contaminated with feces.

“The blunt fact is that India is toilet-in-a-room-resistant,” has said T.R. Raghunandan, advisor to the Accountability Initiative in India, a watchdog group for government corruption and program effectiveness.

Raghunandan is vivid in his critique of Indian bathroom culture and the national government’s failures. He describes Indian trains that “efficiently spray our bodily fluids, solids and semisolids, over thousands of kilometers of track.” For him and the Accountability Initiative, the issue isn’t access. Last year, the government announced plans to build bathrooms at a rate of one per second over a period of three months. They’ve built millions, but people aren’t using them. The problem is education.

Enter Mr. Toilet, the founder of the World Toilet Organization (WTO). The WTO, an NGO based in Singapore, focuses on education around the world, promoting grassroots movements for better sanitation practices. Mr. Toilet has said he’s proud when he hears people call him by his moniker, because “it gives an identity to the work that [he does].” And he’s not shy talking about excreta.

“Shit is like fire,” he says. “If you manage it well, it can cook your food. If you don’t manage it, it burns down your house.” He helped start World Toilet Day in 2001, and has driven a campaign to make toilets attractive to people using capitalist psychology (a decidedly “keeping up with the Joneses” approach).

In a grand public way, WTO showcases different toilet designs that will appeal to different cultures, hosting showcases of different products—toilet seats, urinals, bidets. The WTO also runs the World Toilet College (WTC). Not only are they educating people on best practices, but they’re also building respect for the sanitation worker profession.

The first WTC in India is scheduled for completion this year in Rishikesh, with another location in Delhi and satellites around the country soon to follow. In Rishikesh, the facility will have a capacity of 1,000 students, and it will be free.

India’s goal is total sanitation by 2019. To make that goal, Raghunandan stresses “nothing can be achieved without peoples’ participation.”

Dignity in the first world

In this issue, the U.S. doesn’t have a high horse to sit on. Even here, many people don’t have a place to defecate. In 2014, an escalator to a public transit tunnel in San Francisco actually broke down as a result of too much human poop in the gears (they needed a hazmat team to clean it before repairs could start). Few were surprised. In Seattle, between 2014 and 2015, the Metropolitan Improvement District performed 14,309 human or animal waste cleanups. The first item on the agenda at the 2015 convening of Los Angeles’ Poverty and Homelessness Committee: . New York City is particularly known to be a difficult place to find relief. There are actually .

Instead of providing a few bathrooms, municipalities often lean on private businesses like Starbucks. But Starbucks employees don’t want to deal with it any more than cities do. Barista Adrienne Hubbard says that at the busy Westlake Shopping Center store in downtown Seattle, they would just hang a sign that read “Employees only.”

Few cities have effectively addressed the problem. Among them are San Francisco (with the most expensive program) and Portland, Oregon (with the cheapest).

Instead of providing a few bathrooms, municipalities often lean on private businesses like Starbucks.

San Francisco pays $100,000 per unit per year for their Pit Stop program, which carts public restrooms to designated areas and staffs them with attendants. At night, the bathrooms aren’t just locked—the city takes them back (hours vary). In the Tenderloin neighborhood, which has a high homeless population, Pit Stop is available from 2 to 9 p.m., Tuesday through Friday.

Rachel Gordon, spokesperson for the city’s public works department, admits the short hours aren’t ideal, but says there’s just not enough money to expand it. Cutting staff isn’t an option. “Unequivocally, staff is key” to the usability of public restrooms, she says. The fear is that, given a shred of privacy, people will use it for drugs and prostitution. This fear dominates responses to calls for public restrooms.

In Portland, the price of a public bathroom is $14,000 per year per unit. The city came up with the Portland Loo, which bills itself as “a unique solution to a universal problem.” They are made entirely of graffiti-resistant steel. The sinks are on the outside, so people don’t bathe in them. There’s a back entrance so city workers can come in easily and power-wash them. They feature slats at the top and bottom to allow for some privacy but not too much—passersby can tell if there’s more than one person in there. And inside they’re lit with a blue light that makes finding a vein difficult.

Portland Parks and Recreation official Bryan Aptekar says the Loo has been a success, but that doesn’t mean they don’t get misused. Among Portlanders, they get mixed reviews. On Reddit one resident called them “heroin closets.” Many complain about the price tag, with one commenter writing, “Only the city of Portland can find a way to make maintaining one of these things cost $1,200 a month.”

And crime is still an issue. When San Diego purchased and installed a unit near Petco Park, its baseball stadium, the San Diego Union Tribune characterized what followed as a “mini-crime wave.” Aptekar says it’s a matter of wise placement: highly visible areas with heavy foot traffic. Even the commenters in the Tribune acknowledged this, saying they believe it’ll get better when baseball season starts.

Both the Loo and Pit Stop are major steps forward, but the drive behind them wasn’t “dignity for all”—it was more often “.” In India open defecation makes the sanitation crisis known to the world, but in the United States toilet access is believed to be a problem only if you happen to smell it. Likewise, you might only hear about gender dysphoria if you have a trans friend, or are trans. And you’ll rarely hear about children dying from diarrhea if you only read U.S. news.

Everybody poops, but it’s a privilege to have a safe, reliable place to do it. Bathrooms are private and deeply personal spaces. But the need is so great.