Some parents and members of the State Board of Education have expressed concerns about how the process puts up barriers for low-income families, families with limited transportation, and immigrant families that are already on high alert under the Trump administration.

In a Twitter thread, Julie Lawson, a parent of a third grader in the district and PTA president of her son’s school, described roadblocks in the volunteer clearance process. The TB test costs $60 and is not covered by insurance. The single location that offers fingerprinting services for the district is located downtown and is only open during normal business hours, when working parents may have to take time off to go. “All of this is a major access barrier for a parent who wants to chaperone their kid’s field trip,” she said.

Get Talk Poverty In Your Inbox

A traditional TB test takes 48 hours and requires two separate visits — one to take the test and the other to have results read. Lawson has spent a lot of time reminding parents of the cost, where to go, and how to coordinate and communicate with health care providers — some of whom don’t want to give the test to their patients without risk factors present.

The Centers for Disease Control and Prevention recommends TB screening for those who have been in close contact with TB, those who have traveled to countries with a high prevalence of the disease, people who live or work in high risk settings, health care workers, and children who have been exposed to adults with TB. According to the CDC website, “TB tests are generally not needed for people with a low risk of infection with TB bacteria.”

So, why does DCPS require it for volunteers? Jessica Sutter, a member of the State Board of Education, who has fielded concerns from parents about the policy, and who asked the district directly, says she’s still unsure. She says the district told her that they were operating on a Department of Health directive that required proof of a negative TB test of all DCPS employees, volunteers, and contractors.

Further, Sutter says, the district told her that free TB tests were going to be provided at the Tuberculosis and Chest Clinic, a clinic that provides diagnostic and medical management of persons who have been diagnosed with or are suspected of having TB. But after visiting their website, which states that they do not perform routine TB screening, such as those for job or school admission, Sutter says that does not appear to be the case.

“At DC Public Schools (DCPS), the safety and security of our students is our top priority. Fingerprint-based FBI background checks are required by law, and as of this time, proof of a negative Tuberculosis (TB) test is required of all DCPS employees, volunteers, and contractors per guidance from the DC Department of Health,” said DCPS in a statement. “Balancing the safety, health and security of our students with the need to create a welcoming environment for all families in our school buildings as partners in their child’s success is critically important. DCPS is reviewing the TB and fingerprinting policy for parent volunteers to seek out opportunities to provide more flexibility and partnership with family members whenever possible.”

Different school districts around the country have different approaches to volunteer clearance. Some districts do require all of the same components as DCPS, but they also offer vouchers for free testing at local clinics or a tiered process, where the clearance requirements are commensurate with the level of involvement. Many districts require only a background check or a background check and fingerprinting.

School districts need a clear understanding of who is volunteering, of course, but without putting up barriers to family engagement. While Becky Reina, founding chair of the Ward 1 Education Council, a volunteer organization that advocates for public schools in the ward, describes the fingerprinting as easy, with a short wait, she’s quick to acknowledge that entering a government building that requires signing in with a government issued ID is something that could cause anxiety for some parents. “Given the hostile immigration environment parents are living with under the Trump administration, no amount of reassurance will satisfy much of D.C.’s immigrant community,” she said.

Emily Gasoi, a State Board of Education member, representing families in Ward 1, said the fingerprinting piece is driving a lot of the fear among some families. She first became aware of parental concerns about the DCPS policy through school and PTO meeting visits, where she repeatedly heard from constituents that the process, while onerous for everyone, presented a particular deterrent for families with insecure immigration statuses and those unable to afford the costs associated with the process.

“This is more than an inconvenience, it’s an equity issue,” said Gasoi. While Gasoi understands the need for a clearance process that keeps students safe, she suggests there could be more equitable ways of clearing volunteers and that the district consider different policies for different levels of volunteers.

For her part, Lawson spent dozens of hours coordinating with a handful of nearby schools to have a fingerprinting unit stationed in the schools’ neighborhood for a day. In order for the district to send the unit, though, a minimum number of applicants who had already completed the online background check and TB test had to sign up.

In the end, only 16 applicants out of 40 who initiated the process completed fingerprinting. While some parents said they completed the fingerprinting on their own time, Lawson said that for most, she couldn’t confirm an appointment because she never received a TB result.

The benefits of having a child’s primary caregiver involved at their school are numerous. Research shows family engagement results in improved student achievement, reduced absenteeism, and better grades, test scores, and behavior. Sutter says, “We absolutely want every child in the care of our schools to be kept safe, but whose responsibility is that, financially? And how do we make this accessible rather than burdensome in such a way that it will discourage especially low-income families from participating?”

This piece has been updated to add a statement from DCPS.

But targeting walkers doesn’t do anything to address the actual problem: that roads and sidewalks aren’t safe and accessible for all users. Instead, what this enforcement does is punish vulnerable people, contribute to an already-existing social mentality that blames pedestrians for their own demises, and send a clear message that safe streets are only a priority for people who drive.

According to the Detroit Free Press, Kalamazoo, Detroit, and Warren, the Michigan cities that participated in the pedestrian enforcement campaign, targeted jaywalkers — in particular, those who failed to cross streets at an intersection, who failed to follow traffic signals, who didn’t walk on the sidewalk, who didn’t walk facing traffic when on a roadway, and who didn’t yield to vehicle traffic with the right of way.

In order for traffic to flow smoothly and for people to stay safe, it is reasonable to expect everyone to follow the rules of the road. But when the road isn’t made for you, those rules can be tricky to follow, and in fact, even when they are followed to a T, walkers and bikers are no match for a two-ton vehicle whose driver is unaware of how to share the road with pedestrians — or simply doesn’t care.

Get Talk Poverty In Your Inbox

From 2008-2017, according to a report from the Governor’s Highway Safety Association, pedestrian deaths increased by 35 percent. In 2018, the report estimated that there were 6,227 pedestrian fatalities in the U.S. —  the highest number since 1990.

When bicyclists are included, those figures are even higher. And unlike motor vehicle fatalities, which are declining, pedestrian and bicycle fatalities are increasing.

The report cites things such as population growth and the shift in vehicle-buying from passenger cars to SUV’s as major factors that contribute to pedestrian fatalities. As city populations grow and as pedestrian commuters increase, car-centric street designs are increasingly dangerous.

Enforcing fines on pedestrians doesn’t fix these issues, it just sends an overt message that streets aren’t for pedestrians; they’re solely for people who drive. Meanwhile, it’s low-income people who are least likely to own a car and to have to walk on unsafe roads.

In addition, in communities that have targeted pedestrians with citations, trends have shown that marginalized people are the most impacted. For instance, in December of 2017, ProPublica reported that in Jacksonville, Florida, black pedestrians were disproportionately targeted with pedestrian tickets. Not only did black pedestrians there receive more tickets (55 percent of tickets went to black people even though they make up only 29 percent of the city’s population), they also were most affected by driver’s license suspension for failure to pay those tickets. A similar trend was noted in Seattle.

But there are alternatives, such as developing Complete Streets policies, which are designed to make streets safe for all users, including pedestrians, bicyclists, car drivers, and transit riders of all abilities. The model focuses on reducing pedestrian risk by placing physical barriers between cars and pedestrians, redesigning intersections and sidewalks, and modifying traffic flow. More than 1,400 Complete Streets policies have been passed in the United States. That figure includes 33 states that have adopted some form of a statewide policy.

However, that doesn’t mean those communities and states have full and adequate protections for pedestrians and bicyclists. A Complete Streets Atlas shows large swaths of the U.S. without any Complete Streets model at all, and of those that have adopted some policies, most do not have full bike and walking path protections.

Redesigning streets to accommodate all users requires traffic studies, planning, and redesigning, all of which come at a cost. But when cities are grappling with high rates of pedestrian casualties, they should invest time and money in that crisis. The Michigan cities that participated in the week-long enforcement period targeting pedestrians were each awarded grants to cover overtime for their police officers. Instead of investing in addressing the structures that lead to pedestrian casualties, they took the short-term, punitive approach — an investment that could never produce the kinds of benefits that structural changes to road design could.

In the mid-1980s, Florida adopted a statute requiring that roadway design accommodate walkers and bicyclists from the beginning. A study published in the American Journal of Public Health estimated that in the three decades following, more than 3,500 lives were saved as a result, with pedestrian lives among the most likely to be saved.

Other cities have not only implemented ordinances that protect pedestrians; they center their enforcement of those ordinances on drivers. In Ann Arbor, Michigan, for instance, an ordinance requires drivers to stop for a pedestrian approaching a crosswalk. This is more stringent than the state requirement that a driver stop for a pedestrian in a crosswalk. The city did targeted enforcement of the ordinance between 2017 and 2018, and during that time police issued more than 800 tickets to motorists who violated the city’s pedestrian law.

As much as our culture loves to blame the victims, pedestrians aren’t responsible for their own demise. Still, following each pedestrian accident, the comment stream centers blame on the victim. “Why were they crossing there?” “Were they wearing bright vests?” Instead of focusing on the structural problem of roads with increasingly heavy and fast-moving traffic or the lack of safe pedestrian paths, the culture at large points fingers at the road users who are most in danger. Ticketing pedestrians reinforces this norm.

But punishing pedestrians won’t change the stark reality that walkers, wheelchair users, and bikers must navigate spaces that weren’t designed for them to maneuver safely. Municipalities must grapple with this safety crisis and recognize that punishing those who are most in danger while using the road isn’t the answer; safer streets are.

My doctor, recalling my poor insurance, asked, “Do you ever get to the other side of the state?” I looked at her quizzically. “Because there’s an imaging service over there that offers ultrasounds for …” She paused and searched her computer. “Let’s see … $137, maybe closer to $300 if they think you need both abdominal and transvaginal. But it’s like a two-hour drive.”

My eyes bulged out of my head. I was billed more than $1,000 for the last ultrasound I’d had at my local hospital years earlier.

“I’ll drive,” I said.

I was relieved that my doctor told me about the discounted service. If I’d had to pay $1,000 or more out of pocket then I would have put off the procedure, like so many Americans do (and that’s if I ever got it at all). I had no idea that health care service costs could vary so wildly.

Get Talk Poverty In Your Inbox

Not only do prices vary from place to place, but the amount a patient will pay for the same service within the same hospital can vary depending on whether a patient has health insurance and what health insurance plan a patient has. When I called my local hospital to compare their prices for the ultrasound, I was told that it would cost around $700 with my insurance. If I were uninsured, that price would go up to almost $1,200. Meanwhile, that $137 option was a two-hour drive away — I just had to know where to look.

People looking for a car are told to shop around, maybe get a used car, or borrow one from a friend. Too often that same ethos is pushed into the health care space, with patients told to look around for the best deal or negotiate prices with providers. But price shopping for health care services is not as straight-forward as price shopping for a vehicle, despite legislative attempts to solve the problem.

At the beginning of the year, a new rule went into effect that requires hospitals to post their list prices online. But, as Kaiser Health News points out, that kind of transparency won’t have much of an impact because patients can’t understand those prices. The lists are full of incomprehensible abbreviations, list services separately that would always be bundled together, and vary depending on a person’s specific health plan, so consumers cannot get the type of information they need for comparison shopping. Moreover, these are just the list prices charged by hospitals; they do not include the price of physicians’ services during the hospital stay.

Not everyone has a doctor like mine, who actively looked out for my financial interests. And many times, even when people do try to calculate costs ahead of time, the tools they’re given turn out to be wildly inaccurate. One person profiled by the Philadelphia Inquirer, who proactively used her insurer’s price estimator tool to calculate the out-of-pocket cost of a breast MRI, was shocked when she was billed more than twice what the tool had suggested would be the upper-end range of out-of-pocket costs for the procedure.

Plus, finding the cheapest care is just the first hurdle.

My ability to access more affordable diagnostic services depended on a lot of things aligning — I had to have flexibility in my schedule to drive to a discounted imaging service provider, and I needed a vehicle that could make the trip. When all of those things did happen, I still had to shuffle work deadlines, time the appointment so that the drive there and back didn’t conflict with my kids’ school drop-off, and arrange for after-school care for them.

That same flexibility simply isn’t possible for everyone. Nearly 1 in 5 workers experience unstable work hours, which makes it impossible to schedule time to head to a different health provider in order to take advantage of cheaper care. Also, around 9 percent of Americans don’t own a car, and in recent years the number of people obtaining driver’s licenses has been trending downward. In rural areas, the nearest health care provider could be hours away. Though I live in an urban area, the nearest discounted service provider was a two-hour drive.

In an emergency, no one has time to inquire about costs. And even in less urgent situations, there is often no way to accurately determine prices. While hospitals are now required to post their price lists online, health care isn’t Amazon, where items are easily searched for, compared, and where prices are fixed. And high-deductible insurance plans are increasing in number, including in employer-sponsored plans, as insurers attempt to cost-shift onto consumers. That means more people are going to be in the same place I was over time.

On my drive to the other side of the state, I considered how fortunate I was to be able to access discounted health services. But being a self-employed person with a vehicle should not provide me with more options than someone with a less flexible work schedule or who doesn’t have a car. No one should have to waste precious time searching aimlessly for the best deal for treatment, and no one should have to go without because they didn’t know it was more affordable elsewhere or because the more affordable location was not accessible.

Until the U.S. chooses to recognize health care as a human right, rather than a commodity or entitlement, the poorest Americans will continue to suffer.