Public toilets that are poorly maintained and/or poorly designed can pose a hazard, as far as spreading disease, but public facilities are very necessary: in cities that lack availability of toilets, public urination on streets becomes common, which is far worse for the environment.
As with any public service product, there are ways to improve the environmental impact of public toliets. Along with maintenance, as mentioned above, there are low-flow toliets that utilize much less water that can replace regular toliets that use significantly more water. Generally this change is done by the city or municipal authorities for publically own locations.
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