You’re running late, you need to pee, but arriving at the toilet turnstiles, you realise that the lack of a shiny 50p piece prevents you from carrying out a basic bodily function. You join the cash machine queue, staring daggers at the guy who is in no rush to find his bank card. With a £10 note finally in the palm of your hand, you join another queue – to buy a KitKat, a Mars bar, whatever. After minutes of this palaver, you’re through the barrier, finally able to find relief. Annoying, sure: but what if you were a pensioner or disabled, and caught short? According to a report by the Royal Society for Public Health (RSPH) – appropriately titled Taking the P*** – a fifth of Britons don’t leave their home as often as they’d like because they know they’ll struggle to find facilities, a phenomenon known as “loo leash”. For those with medical conditions, this affects more than four in 10. Ever found yourself deliberately not drinking in case you get caught short? Over half the public intentionally dehydrate themselves for fear of not finding a loo, according to the report.

By next year, 60% of government funding for local authority services will have vanished compared with 2010

The people must take to the urinals, conveniences and the cubicles, or what remains of them, because the right to pee is under threat. The decline of the public toilet – leaving us creeping into pubs and hoping to avoid the disapproving glare of the bartender – is just one symptom of the assault on the public realm. By next year, 60% of government funding for local authority services will have vanished compared with 2010. Toilets are not statutory services – that is, councils are not legally obliged to provide them – and so hundreds have been axed. The British Toilet Association tells me that up to half of public loos may have been closed over the last decade. In Cornwall, the council has stopped maintaining 94% of its toilets. Three in four Britons polled think there are not enough facilities within their communities. But why should we be resigned to this, legs firmly crossed, as a fact of life? Why is removing waste from our doorsteps regarded as an essential, universal service, but allowing us to remove waste from our bodies is not?

The public realm has been subordinated to the whims of the market and profit for over a generation, and toilets are no exception. You’ll often need to spend considerably more than a penny to have a pee. While Network Rail thankfully scrapped toilet charges in busy stations such as King’s Cross and Edinburgh Waverley earlier this year, they remain in place – or are expanding – in parks, stations and public squares across the country. You are, bluntly, being ripped off by what should be described as a bladder tax.

‘Network Rail thankfully scrapped toilet charges in busy stations such as King’s Cross earlier this year.’ Photograph: Graeme Robertson/The Guardian

This is about dignity and public health. What should sufferers of Crohn’s disease or irritable bowel syndrome do? Up to 43% of people have conditions requiring the frequent use of a toilet. Do the 3.4 million over-65s who experience urinary incontinence not have the right to take part in their community, or to travel the country with ease? What of heavily pregnant women being turned away from cafe toilets because they’re not customers? With public urination treated as a potential public order offence, why leave many with no option but to break the law? And, as Toby Green, policy executive at the RSPH tells me: “At a time when we’re seeing obesity levels rising and we’re trying to encourage physical activity, and we’re trying to row back on social isolation among vulnerable elderly people, seeing fewer and fewer toilets encouraging people to go outside and relate to their environments flies in the face of all that.”

There’s a gendered element too: women are resigned to regularly queueing for a toilet in a way that men – for whom an excursion to a urinal can take just seconds – aren’t. While, as the RSPH notes, “potty parity” legislation in North America has stated that a fair ratio for toilet facilities would be at least 2:1 in favour of women, the British standard is a mere 1:1. Twenty-first-century toilet provision must cater for gender-neutral spaces and ensure that the rights of trans people are protected too.

What to do about the national toilet scandal? Here is another reason why cuts to local authorities must be reversed in their entirety, and toilets made a statutory service. The “bladder tax” should be ended: it should be made illegal to charge people to exercise basic bodily functions. Perhaps councils could enforce a rule for all high-street businesses: no one who needs to go should be turned away. For a nation supposedly obsessed with toilet humour, we are remarkably embarrassed talking about our national loo scandal. But the privatisers of public space have taken the piss for too long, and the great toilet fightback should start here.

• Owen Jones is a Guardian columnist