Using Informational Murals and Handwashing Stations to Increase Access to Sanitation Among People Experiencing Homelessness During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has upended every aspect of life in the United States and forced Americans to rethink their daily activities, including how they work, attend school, secure food, obtain health care, and maintain social connections. For vulnerable populations that were already facing significant barriers to health, such as people experiencing homelessness, the pandemic has only generated new hardships and exacerbated existing inequities.

1700 Block of East-Bound Vine St., Philadelphia, PA. (Mural by Nilé Livingston. Photograph by Conrad Benner.)

Compared with the general population, people experiencing homelessness suffer from poorer health and have higher rates of mental illnesses, infectious and noncommunicable diseases, and premature mortality.^1,2 Since the start of the pandemic, this highly vulnerable population has also faced increased risks of being exposed to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—the virus that causes COVID-19. Nightly, many of these individuals must make the difficult decision between lodging in crowded shelters, where the risk of outbreaks is high, and staying outdoors, where they must weather the elements and risk their safety.^3–5 Many people experiencing homelessness also have little or no access to personal protective equipment and testing, and even when testing is available, it may be challenging to conduct contact tracing and quarantine individuals in this population because of their lack of housing and limited access to mobile phones and mailing addresses.⁶ Furthermore, given their preexisting medical conditions and other factors such as poor nutrition and lack of health insurance, people experiencing homelessness are also more likely to have worse outcomes if they develop COVID-19.^1,7

The COVID-19 pandemic has also affected the nonprofit organizations that provide people experiencing homelessness with basic needs such as food, clothing, and medical care. Across the United States, communities are engaging in a collective effort to shelter in place and practice social distancing to reduce the person-to-person transmission of SARS-CoV-2. Although these measures are essential to “flattening the curve” of active cases of COVID-19, they have dramatically reduced the number of people who are able to volunteer for nonprofit organizations.⁸ Likewise, the temporary and permanent shuttering of businesses has resulted in sharp declines in the monetary and material donations that sustain these entities.^8,9 It is also likely that the high unemployment rate will eventually translate into increased numbers of people experiencing homelessness.

Before the pandemic, there were an estimated 5700 people experiencing homelessness in Philadelphia, Pennsylvania.¹⁰ Broad Street Ministry, a local nonprofit organization that continues to provide hospitality services to the homeless and other vulnerable populations during the pandemic, recognized the need for improving access to sanitation for the people it serves. Although handwashing with soap and water for 20 seconds or more remains a simple yet crucial way to reduce the spread of SARS-CoV-2, the closing of local businesses and other public facilities has significantly reduced the homeless population’s access to restrooms and showers with soap and water.

Broad Street Ministry, 315 South Broad St., Philadelphia, PA. (Mural by Dora Cuenca. Photograph by Conrad Benner.)

2774 Kensington Ave., Philadelphia, PA. (Mural by NDA. Photograph by Conrad Benner.)

In late March 2020, Broad Street Ministry collaborated with Mural Arts Philadelphia, the nation’s largest public arts program; Streets Dept, a street art photo blog; HAHA MAGAZINE, a global arts magazine; and four local artists to use art as a public health intervention. In just a little more than a week, the community partners installed Wash Your Hands, a series of informational murals and portable handwashing stations.

As shown in the accompanying photographs (Images 1–4), each of the colorful and vibrant eight foot by eight foot murals stands in stark contrast to its urban surroundings and draws attention to one or more handwashing stations. The murals also raise awareness of steps viewers can take to protect themselves against COVID-19, including washing one’s hands with soap and water for at least 20 seconds, refraining from touching one’s face, maintaining physical distance of at least six feet with others, and wearing a mask. Notably, as people engage with the murals and use the handwashing stations, they become a part of the messaging and effort to end the pandemic.

To date, the community partners have installed four murals and 15 handwashing stations in parts of the city that have heavy foot traffic of people experiencing homelessness. Broad Street Ministry estimates that more than 2500 people, including members of the larger public, use the handwashing stations daily. With dedicated funding from the Starbucks Foundation and Independence Foundation, the nonprofit organization and its community partners have committed to refilling the stations with soap, water, and paper towels for the duration of the pandemic so that all Philadelphians will have access to sanitation regardless of their housing status.

839 South St., Philadelphia, PA. (Mural by NDA. Photograph by Conrad Benner.)