My personal quest for equal rights now informs my push for a revamped public health approach to homelessness.
“I never met a Kentuckian who wasn’t either thinking about going home or actually going home.”- Kentucky Senator A.B “Happy” Chandler.
There is nothing quite like the beauty and comfort I find in my home state of Kentucky: from the state’s signature bluegrass and stunning Red River Gorge canyons to the “Bourbon Capital of the World” sign that signals I am nearly home when back for a visit.
These places represent my roots and growth, where I evolved into my authentic self.
I grew up on a farm among the rolling hills and world-renowned bourbon distilleries of the Kentucky Knob Region and couldn’t wait to move to the city (Lexington, Kentucky) after graduating high school. I spent eight pivotal years among the horse farms and bluegrass of Lexington, completing both my undergraduate and master’s degrees.
As I reflect on this pivotal period of my life, the steep terrain and unbridled horses remind me of the obstacles I overcame as a first-generation female academic and the passion that fuels me (almost) every day. As I discovered more about my identity in those years, the intricate canyon system of Red River Gorge with its enormous rocks, sandstone cliffs, and waterfalls have come to exemplify my journey to uncovering and accepting my queerness. Each step and breath took amongst the leaves and water representing new, exciting spaces that I am continually exploring and understanding within myself.
I would be lying if I said that I have always felt this way about Kentucky. My love is the kind that has evolved over time, requiring me to move away and realize that the relationship status “it’s complicated” can apply to more than just a romantic partnership.
Unfortunately, as a queer female, this state and its people have not always been kind to me. I grew up in an environment that made me ashamed of who I was, an environment that refused to recognize me or my basic human rights.
From an early age, I was told being gay was wrong. I never saw same-sex couples. And queerness was spoken about in whispers with discomfort; people at barbecues gossiping about this person’s cousin’s best friend or that neighbor who keeps to themselves.
I have struggled to feel dignified because of queer guilt and shame because so many of my loved ones have and continue to erase my identity. They distill me down to just being “liberal.” They have never asked about my sexual identity, but love to ask where my friend is during family gatherings. They leave me with feelings of guilt for being the “problem” child.
Being in such an environment made me hide parts of myself. I tucked pieces of myself away, hiding them so well that even I forgot they are there. Then I spent my adulthood in search of dignity. I had to uncover my true self, to decipher between the parts I created to make the world happy and those that are truly me. Queer readers out there know exactly what I am talking about.
My personal quest for dignity and equal rights connects me to those who often experience stigma and are stripped of their dignity. It shapes and drives my work as an environmental health scientist as I seek to address the environmental and social conditions that impact an individual’s ability to access water, sanitation, and hygiene while experiencing homelessness. Because of my struggles and experiences, I now actively and intentionally ground my work in dignity and human rights. Just as I have been afforded the opportunity to feel prideful in my queerness, people experiencing homelessness deserve to feel respected, valued, and seen regardless of their housing status.
Beyond the basics
Homelessness is an ongoing national crisis, affecting 2.3 to 3.5 million people in the United States (U.S.) each year. Economic conditions during the COVID-19 pandemic may leave hundreds of thousands more homeless: 85 million households struggled to pay for their usual household expenses in the past week and 14.3 million adults living in rental housing are not caught up on rent, according to data collected in December.
When discussing the struggles and needs of people experiencing homelessness (more on the importance of people-centered language can be found here), we often drift toward “the basics:” food, water, warmth, and clothing. And while it is true that these are essential to survival, this approach defines our needs as humans too narrowly and fails to include dignity. We fail to ask:
Where can people experiencing homelessness get drinking water?
What else do they need water for (personal hygiene, handwashing), and where can they get this water?
Is clothing alone enough, or do people need to bathe regularly and have clean clothing to meet their basic needs?
Where does sanitation (or bathrooms) come into this? Where do people experiencing homelessness urinate and defecate? Why do they use these places?
And what are the physical, mental, and emotional impacts of all of this?
Dignity for people experiencing homelessness in relation to water, sanitation, and hygiene is rarely discussed in the U.S. This is because national estimates indicate that U.S. citizens have near-universal (99% percent) access to basic water and sanitation and because we rely on bathrooms and laundry facilities mostly inside our homes: a one-stop-shop.
Like many of you reading this, I wake up every morning and walk across the hall to brush my teeth in my bathroom. I drink water from the faucet in my kitchen. I urinate and defecate using my indoor, private flush toilet and wash my hands in my bathroom. And I shower at night in that same bathroom before I go to bed. All of these movements are done without thinking, other than being burdened with expensive period products (the “tampon tax”) and procuring toilet paper (#thankscovid19).
This is not the reality for people experiencing homelessness.
Instead, those living in encampments in Fresno, California, walk a mile and a half to access the nearest drinking water fountains. They are forced to urinate and defecate in public because there are no public restrooms nearby and they are denied access to facilities in local businesses.
Women living in shelters and on the streets of New York City deal with an insufficient number of clean, functioning, safe, and private toilets and an inadequate stock of items such as toilet paper and period products. They also report a loss of dignity because they have to wash their bodies in bathrooms at places like McDonald’s. They experience stigma and feelings of shame because of the possibility of period blood leakage and odor resulting from the inability to change and bathe as needed.
And these struggles extend beyond city limits, impacting the rising number of rural people experiencing homelessness through limited research has focused on homelessness in rural communities.
Whether in large metropolitan areas or the mountains of rural Appalachia, too often we fail to consider the circumstances that people experiencing homelessness deal with every day and how our research, programs, and policies may contribute to such circumstances. We assume that if we build facilities, they will come but, the result is ineffective approaches that contribute to diminished self-worth and self-esteem among people experiencing homelessness.
But there is a path forward. By using harm reduction approaches, grounded in justice and human rights, and centering those experiencing homelessness in our decision-making and policies, we can create humanistic and equitable approaches to address the water, sanitation, hygiene needs of people experiencing homelessness and related emotional, mental, and physical health outcomes that result from unmet needs. My early work in Appalachia helped me re-imagine what good public health work can look like.
Reflections from Appalachia
My journey in water, sanitation, and hygiene among those without stable housing began amid the mountains and hollows of Central Appalachia where the opioid epidemic has hit hard and there are scant social, economic, and healthcare resources.
After graduating from my master’s program, I began working as a research assistant in Appalachian Kentucky. While working on projects focused on substance use, I spoke with many people experiencing homelessness and later conducted a study to understand their experiences with water, sanitation, and hygiene; the first of its kind in rural America.
I was also charged with co-hosting community cookouts to engage with and recruit participants. People would stop by for free food and stay for quick banter.
It took some time for people to open up and overcome their skepticism. After all, I was handing out free food in random parking lots. But over time my relationships with people grew as did the depth of our conversations.