The gun violence epidemic is a deeply complex crisis in America’s cities and urban settings. Despite concerted efforts by government agencies, law enforcement, community organizations, and advocacy groups, gun violence remains a persistent and pervasive problem in the city of Philadelphia. The aims of this writing include a comprehensive analysis of the factors contributing to gun violence in Philadelphia and identification of multi-disciplinary strategies for prevention and intervention. By evaluating existing efforts in Philadelphia, including community-based programs, law enforcement initiatives, and policy reforms, as well as the generation of a theoretical multidisciplinary framework and proposal for gun violence mitigation, this study aims to contribute to the ongoing discourse on gun violence prevention and to inform evidence-based policy and practice in Philadelphia and beyond. / Urban Bioethics

Nesta tese, consideramos que plataformas online configuram instrumentos de comunicação e difusão que muito contribuem para a propagação de discursos formadores de uma nova onda feminista. Analisamos como artistas e ativistas do eixo geopolítico Sul-sul produzem e difundem seus materiais em plataformas on demand, em específico o YouTube. O presente projeto propõe um olhar mais apurado sobre as novas estratégias poéticas na montagem audiovisual, presentes nestas plataformas digitais. / In this thesis, we consider that online platforms configure communication and dissemination tools that greatly contribute to the propagation of discourses which form a new feminist wave. We analyze how South-South geopolitical artists and activists produce and disseminate their materials using on demand platforms, specifically YouTube. This project proposes a more accurate look at the new poetic strategies in the audiovisual editing, present in these digital platforms

Discrimination and marginalisation are still problems, both on a societal level as well as within the field of technological development. Discourses such as HCI and design often fail to deal with the dynamics of race, even when using participatory approach, co-design. This design study aims to tackle and explore the possibilities of co-design using dialogue on the matter of concern, structural racism. The study aims to answer the questions; what could be the role of co-design when facilitating a discussion about structural racism? And how can we use digital mediums to co-design and create dialogue? The theoretical framework of this study, stems from ‘design thing’, where extended knowledge is produced collectively based on subjects’ experiences and Latour’s view on ‘matters of concern’, which is understanding the political situation from a holistic standpoint. The methodology derives from Sanders and Stappers framework called ‘say-do-make’ including an online survey and three digital creative sessions with participants. The results of the study propose guidelines on how to create dialogue about structural racism through a co-design setting. As a result of the proposed guidelines, this study suggests that interdisciplinarity is fundamental in order to integrate the matter of concern into the co-design discourse.

Historical redlining, a discriminatory practice of the 1930s, present-day social vulnerability (SVI), and sports and recreational injury (SRI) hospitalizations are interconnected topics that highlight the intersection of race, class, and health in the United States but the relationships have not been studied to date. Thus, the overall aim of this dissertation is to examine the effects of historical redlining and present-day social vulnerability on SRI hospitalizations in the United States. The first study systematically reviewed studies that examined the relationships between neighborhood characteristics and SRI using multilevel modeling approach. Studies reviewed show that certain neighborhood factors, such as living in urban communities, were associated with increased risk of SRI. The second study examined the association between historical redlining and present-day neighborhood SVI in the United States. Results show that formerly redlined areas have higher SVI presently. The third study examined the association between historical redlining and present-day SRI hospitalization in the United States. Results show that redlining was not associated with increased odds of SRI hospitalizations, but was associated with longer length of hospital stay (LOS) among Black and Hispanic patients, and higher total hospital charges among Hispanic patients. The fourth study examined the association between individual and neighborhood social vulnerability and sports and recreation-related traumatic brain injury (SR-TBI) hospitalizations among pediatric patients in the United States. Results show that Native American children had higher odds of hospitalization for SR-TBI, longer LOS, but lower odds of discharge to post-acute care compared to White children. Older age was associated with higher odds of hospitalization and longer LOS while male sex was associated with shorter LOS for SR-TBI in children. Compared to children with private insurance, children with public insurance had longer LOS while uninsured children had shorter LOS. Also, hospitalization in neighborhood with higher overall SVI was associated with longer LOS. This study advances our knowledge on the impact of structural racism on present-day SRI outcomes and will inform policy makers to prioritize health equity by addressing the underlying social determinants of health and the root causes of disparities in SRI outcomes. / Doctor of Philosophy / Every year, around 9 million people get hurt while playing sports or participating in recreational activities in the United States. Out of these, more than a third go to the emergency department for treatment, and several thousands need to stay in the hospital because their injuries are more serious. Even though only a small number of sports and recreational injuries (SRI) require hospitalization compared to those treated in the emergency department or outpatient clinics, these injuries tend to be more severe. They can cause significant harm to a person's physical, mental, and emotional well-being, and they also put a lot of pressure on the healthcare system and society as a whole. This dissertation assessed how historical discrimination against certain neighborhoods, called redlining, and present-day social vulnerability affect sports and recreational injury hospitalizations in the United States. This research found that the neighborhood where people live or are hospitalized matter for how often they are hospitalized for SRI, their length of stay in hospital, the amount of money they pay while in hospital, and how often they receive follow-up care after leaving hospital. While historical redlining was not directly linked to higher odds of hospitalization, it was associated with longer hospital stays for Black and Hispanic patients and higher costs for Hispanic patients. This research also found that children from socially vulnerable backgrounds were more likely to be hospitalized for sports-related traumatic brain injuries (SR-TBI) and stay in hospital longer, but were less like to receive follow-up care after leaving hospital. For instance, children from Native American backgrounds were three times more likely to be hospitalized for SR-TBI and stayed in the hospital 27% longer, but were 99.9% less likely to receive follow-up care after leaving hospital compared to White children. Also, children with public health insurance tended to have longer stays in hospital for SR-TBI compared to those with private health insurance. This research highlights how structural discrimination can impact health outcomes, and suggests that policymakers should address the root causes of health disparities in order to promote health equity.

This systematic review examined literature spanning the last 10 years from Canada, the U.K., the U.S.A., Australia, and New Zealand. Findings highlight the significant gap in comparative literature examining (structural) racism as a determinant of South Asian healthcare access, utilization, and outcomes, and identifies areas of future research to address South Asian health equity concerns. / Background: Race, or specifically racism, has been well-established as a critical determinant of health, though current healthcare practices and policies in Western countries do not adequately address these issues. South Asians are the largest minority group in Canada, and they face disproportionate rates of chronic illnesses, mental health conditions, and barriers to care globally. However, their experiences in healthcare settings and the impact of race and racism on their health equity remain unexplored. This systematic review examined whether race affects healthcare access, utilization, and outcomes of South Asians compared to White-majority populations in Western countries. Methods: Embase, PsycInfo, Ageline, and CINAHL, were searched following PRISMA guidelines, as well as Google Scholar. Articles from 2013-2022 were included if they discussed racism, discrimination, or disparities/inequalities in South Asian physical and mental health, healthcare access, and utilization, outcomes compared to White populations in Canada, the U.K., the U.S.A., Australia, and New Zealand. The Mixed Methods Appraisal Tool (MMAT) was used to assess methodological quality. Data was synthesized narratively. Results: The review included 89 studies from Canada (n=19), the U.K. (n=51), the U.S.A. (n=17), and Australia (n=2), with most studies (n=76) utilizing cross-sectional or cohort designs and examining physical health outcomes (n=50). Study samples predominantly included Indians, Pakistanis, and Bangladeshis over other subgroups. Notably, there was no overall increase in comparative studies over the last decade; however, the U.K. observed an 85% increase compared to an 82% and 64% decrease in Canada and the U.S.A., respectively. The review also identified limited research on experiences within healthcare settings and mental health outcomes, sexual/reproductive health, and all health outcomes for children/youth. Few studies directly discussed the impacts of structural or organizational racism or discrimination on outcomes, though some commented on individual racism as well. Instead, studies relied on the social determinants of health as proxies for structural racism, such as education and income. Conclusion: This review highlights the significant lack of comparative research on the impact of structural, organizational, and individual racism on the healthcare access, utilization, and outcomes of South Asians compared to White-majority populations in Western countries. The review emphasizes the need for more primary, comparative research that quantifies and contextualizes South Asian experiences in obtaining healthcare services. Future research must employ rigorous and representative sampling methods, diverse study designs, and quantitative and qualitative measures that capture implicit, covert, and overt racism in healthcare among South Asians. Additionally, studies should measure factors such as religion, housing, language, and racialized institutional policies, in addition to the typically examined social determinants of health. Finally, this review highlights the need to collect and report disaggregated race and ethnicity health data with input from community leaders, and stratify these data by South Asian subgroups to avoid homogenization of distinct cultures and differential experiences in healthcare systems. Overall, acknowledging racism in healthcare and institutional policies is essential to effectively dismantle these issues and ensure health equity for South Asians. / Thesis / Master of Public Health (MPH)

[pt] Discutir saúde mental e os diversos fatores que implicam na produção de saúde ou de adoecimento, se faz necessário enquanto forma de dar suporte à problematização do processo de trabalho de diversos profissionais que estão neste campo, mas, também, os impactos que os possíveis reposicionamentos, a partir da reflexão acerca das práticas de trabalho, podem trazer à vida daqueles que são atendidos, principalmente, em equipamentos públicos. O objetivo geral deste trabalho dissertativo é discutir como questões como racismo, machismo e a desigualdade social se atravessam nas práticas manicomiais e podem causar o encarceramento perpétuo de pessoas tidas como indesejáveis, constitui-se como pesquisa estratégica e descritiva. Para isto, discute-se a interseccionalidade dos fatores supramencionados e os seus efeitos que, neste caso, levaram ao encarceramento, por medida de segurança, de uma mulher negra, pobre e com transtorno mental por boa parte de sua vida. Para atingir o objetivo desse estudo, utiliza-se o relato de experiência e fragmentos do caso. Trata-se de uma pesquisa qualitativa e traz a revisão de literatura acerca da referida temática. A seleção do arcabouço teórico para a realização do estudo se deu através da seleção de livros e artigos, utilizando-se de bases de busca como o ScientificElectronic Library Online/Biblioteca Eletrônica Científica Online (SciELO), o Pantheon (UFRJ), o Maxwell (Pontifícia Universidade Católica do Rio de Janeiro [PUC-Rio]), e os Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). / [en] Discussing mental health and the several factors that imply the production of health or illness is necessary as a way of supporting the problematization of the work process of different professionals who are in this field, but also the impacts that possible repositioning, based on reflection on work practices, they can bring to the lives of those who receive care, mainly in public facilities. The general goal of this dissertation work is to discuss how issues such as racism, male chauvinism and social inequality intersect in asylum practices and can cause the perpetual incarceration of people considered undesirable, it constitutes strategic and a descriptive research. To this purpose, the intersectionality of the aforementioned factors and their effects is discussed, which, in this case, have led to the incarceration, as a security measure, of a poor and black woman with a mental disorder for a large part of her life. To achieve the objective of this study, experience reports and the case fragments are used. This is a qualitative research and presents a literature review on the aforementioned topic. The selection of the theoretical framework for carrying out the study was done through the selection of books and articles, using search bases such as Scientific Electronic Library Online (SciELO), Pantheon (UFRJ), Maxwell (PontifíciaUniversidade Católica do Rio de Janeiro [PUC-Rio]), and the Journals of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes).

The current study examines racial differences in the management of Attention Deficit Hyperactivity Disorder (ADHD) among Black adolescents. This study also examines Black adults' reflection upon adolescent symptoms of ADHD. Drawing on literature from racial/ethnic disparities in diagnosis and treatment of ADHD, health care service utilization, health behaviors, structural racism and medicalization, this study examines the health behavior and health care utilization practices of Black people, analyzing the avenues through which racism structures the management of symptoms. This study also explores the ways in which management of adolescent symptoms of ADHD shape Black adults' self-management of symptoms in adulthood. To investigate such ideas data from the National Comorbidity Survey- Adolescent Supplement (NCS-A) and the Parent Self-Administered Questionnaire (PSA-Q) were analyzed to offer a descriptive picture of differences in management and treatment of adolescent ADHD symptoms. Ten interviews were conducted with Black adults to offer depth to reported interpersonal causes of racial differences in management and treatment and assist in placing such causes within a framework of structural racism. Interview questions focused on participant's articulation of the socio-political landscape in which adolescent symptoms of ADHD were experienced. Additional questions targeted processes around parent's management of symptoms, the school systems management of symptoms, participant's relationships to medical care providers and avenues to treatment. Quantitative findings suggest there are racial differences present in the management of adolescent ADHD and qualitative findings offer that these differences are reflective of a structural system of power and privilege that shapes Black people's engagement with and access to care for symptoms of ADHD. This research contributes to existent knowledge about reported racial differences in management of symptoms of ADHD, and has implications for the ways in which literature approaches racial disparities in diagnosis and treatment of ADHD among Black adolescents. / Doctor of Philosophy / The current study examines racial differences in the management of Attention Deficit Hyperactivity Disorder (ADHD) among Black adolescents. This study also examines Black adults’ reflection upon adolescent symptoms of ADHD. Drawing on literature from racial and ethnic disparities in diagnosis and treatment of ADHD, health care service utilization, health behaviors, structural racism and medicalization, this study examines the health behavior and health care utilization practices of Black people. This study also explores the relationship between adolescent and adult management of ADHD symptoms. To investigate differences by race data from the National Comorbidity Survey- Adolescent Supplement (NCS-A) and the Parent Self-Administered Questionnaire (PSA-Q) were analyzed. In addition, interviews were conducted with Black adults to offer depth and give context to the ways in which race and racism shaped quantitative findings. Interview questions focused on participant’s adolescent management of symptoms by familial networks and school systems, as well as participant’s adult relationships to medical care providers and symptom management. Quantitative findings suggest racial differences are present in the management of adolescent ADHD and qualitative findings offer that these differences are reflective of the ways in which racism shapes Black people’s engagement with and access to care for symptoms of ADHD. This research contributes to existent knowledge about reported racial differences in management of symptoms of ADHD, and has implications for the ways in which literature approaches racial disparities in diagnosis and treatment of ADHD among Black adolescents.

Esse trabalho teve como ponto de partida as raízes históricas dos Direitos Humanos com análise das vertentes ignoradas nos dias atuais. Apesar da moderna concepção e função entendida dos Direitos Humanos, ao observamos os efeitos das implementações de determinadas políticas públicas de Direitos Humanos em uma realidade Estruturalmente racializada, a exemplo da Brasileira, podemos constatar que os resultados dessas intervenções não interferem na segregação racial histórica que foi construída e ainda experimentamos no país, mas os perpetuam e até acentuam. A pergunta que se pretende responder é como se situam os Direitos Humanos na correlação de forças entre uma idéia de criação elitista, de origem burguesa para proteção de determinados grupos, e a necessidade atual, de utilização desses direitos como instrumento de uso efetivo das classes oprimidas.A análise dessa correlação de forças será feita sobre a observação da realidade brasileira através da análise crítica da literatura disponível sobre o assunto. Buscaremos uniformizar os conceitos sobre raça, racismo, preconceito, discriminação e outros mecanismos que explicam as dinâmicas das relações raciais no Brasil e no mundo. Apresenta-se a raiz da idéia de Direitos Humanos como eles foram inicialmente concebidos e como o são hoje em dia. Identifica-se essa raiz no conceito de Dignidade da Pessoa Humana e apresentamos como o racismo em suas diversas formas de manifestação nega esse direito, tornando-se, assim, uma ameaça para o Estado democrático de Direito, que tem como elemento fundador e legitimador a dignidade humana. E feito um levantamento histórico de formação da idéia de controle social no Brasil, as origens teóricas da idéia que estruturou o nosso sistema criminal, as suas bases racistas e como esses elementos de origem refletem-se nos dados de desigual acesso ao sistema de justiça criminal até os dias atuais. A seletividade é tratada como um elemento constituinte e pouco considerado do sistema de controle social moderno. A Dissertação é finalizada com uma análise dos dados referentes à política penitenciária do Estado de São Paulo e os reflexos que uma estrutural racializada, do sistema de controle social brasileiro, implica na implementação desigual, racialmente falando, do programa de penas alternativas. / This paper had as point of departure the historical roots of Human Rights, with the analysis of aspects still ignored at present days. Despite the understanding of the modern conception and function of Human Rights, when one observes the effects of the implementation of certain public policies in a society racially structured, as the Brazilian society, it is possible to note that the results of these public policies do not intervene in the historical racial segregation that was developed and still experimented in the country. The question to be answered is how Human Rights, having its roots based on the elites and conceived to protect certain groups, can really be effective as an instrument to serve the oppressed groups. The analysis of this correlation of forces on Human Rights will be made over the observation of the Brazilian reality and through the critical analysis of the available literature on the subject. We will seek to standardize the concepts about race, racism, prejudice, discrimination and other mechanisms that explain the dynamics of the racial relations in Brazil and in the World. The root of the Human Rights idea is presented, as it was initially conceived and as it is now. Within the concept of Human Dignity we present how racism in its various forms denies this right, becoming then, a menace to the Democratic State of Rights, which has as founding element the human dignity. A historical research is made, about the formation of social control in Brazil, and the theoretical origins of the ideas that structured our criminal system and its racist bases and how these elements of origin reflect on the unequal access to the criminal justice system, nowadays. The selectivity is treated as a constitutive element and less regarded in the modern social control system. The paper is finished with an analysis of the data concerning the penitentiary policy of the State of São Paulo and the reflexes that a racially structured society can have on the Brazilian system of social control, precisely on the program of alternative penalties.

Esse trabalho teve como ponto de partida as raízes históricas dos Direitos Humanos com análise das vertentes ignoradas nos dias atuais. Apesar da moderna concepção e função entendida dos Direitos Humanos, ao observamos os efeitos das implementações de determinadas políticas públicas de Direitos Humanos em uma realidade Estruturalmente racializada, a exemplo da Brasileira, podemos constatar que os resultados dessas intervenções não interferem na segregação racial histórica que foi construída e ainda experimentamos no país, mas os perpetuam e até acentuam. A pergunta que se pretende responder é como se situam os Direitos Humanos na correlação de forças entre uma idéia de criação elitista, de origem burguesa para proteção de determinados grupos, e a necessidade atual, de utilização desses direitos como instrumento de uso efetivo das classes oprimidas.A análise dessa correlação de forças será feita sobre a observação da realidade brasileira através da análise crítica da literatura disponível sobre o assunto. Buscaremos uniformizar os conceitos sobre raça, racismo, preconceito, discriminação e outros mecanismos que explicam as dinâmicas das relações raciais no Brasil e no mundo. Apresenta-se a raiz da idéia de Direitos Humanos como eles foram inicialmente concebidos e como o são hoje em dia. Identifica-se essa raiz no conceito de Dignidade da Pessoa Humana e apresentamos como o racismo em suas diversas formas de manifestação nega esse direito, tornando-se, assim, uma ameaça para o Estado democrático de Direito, que tem como elemento fundador e legitimador a dignidade humana. E feito um levantamento histórico de formação da idéia de controle social no Brasil, as origens teóricas da idéia que estruturou o nosso sistema criminal, as suas bases racistas e como esses elementos de origem refletem-se nos dados de desigual acesso ao sistema de justiça criminal até os dias atuais. A seletividade é tratada como um elemento constituinte e pouco considerado do sistema de controle social moderno. A Dissertação é finalizada com uma análise dos dados referentes à política penitenciária do Estado de São Paulo e os reflexos que uma estrutural racializada, do sistema de controle social brasileiro, implica na implementação desigual, racialmente falando, do programa de penas alternativas. / This paper had as point of departure the historical roots of Human Rights, with the analysis of aspects still ignored at present days. Despite the understanding of the modern conception and function of Human Rights, when one observes the effects of the implementation of certain public policies in a society racially structured, as the Brazilian society, it is possible to note that the results of these public policies do not intervene in the historical racial segregation that was developed and still experimented in the country. The question to be answered is how Human Rights, having its roots based on the elites and conceived to protect certain groups, can really be effective as an instrument to serve the oppressed groups. The analysis of this correlation of forces on Human Rights will be made over the observation of the Brazilian reality and through the critical analysis of the available literature on the subject. We will seek to standardize the concepts about race, racism, prejudice, discrimination and other mechanisms that explain the dynamics of the racial relations in Brazil and in the World. The root of the Human Rights idea is presented, as it was initially conceived and as it is now. Within the concept of Human Dignity we present how racism in its various forms denies this right, becoming then, a menace to the Democratic State of Rights, which has as founding element the human dignity. A historical research is made, about the formation of social control in Brazil, and the theoretical origins of the ideas that structured our criminal system and its racist bases and how these elements of origin reflect on the unequal access to the criminal justice system, nowadays. The selectivity is treated as a constitutive element and less regarded in the modern social control system. The paper is finished with an analysis of the data concerning the penitentiary policy of the State of São Paulo and the reflexes that a racially structured society can have on the Brazilian system of social control, precisely on the program of alternative penalties.

Abstract The purpose of the study was to broaden understanding of structural racism by examining the relationships between Indigenous peoples and nation-states in the context of education and how this affects Indigenous lives. This thesis delves into understanding both the theoretical and methodological contributions that more critical analyses can have on: the role of de-colonial approaches to Indigenous health research methodologies so that the most urgent health inequities are addressed through more rigorous and Indigenous specific research processes; and to improve our understanding of the complex interactions that historical and contemporary legacies of residential schools and boarding schools have on the health and well-being of Indigenous populations in Canada and Finland. The research design was a qualitative multiple case study informed by a public health critical race praxis. The study was completed in two phases; consisting of a literature study using content analysis of Indigenous research ethics protocols and policies, in Canada and the Nordic countries; and, three case studies developed from open ended questions from structured interview research comparing discriminatory experiences and its impact on self-perceived health with participants from Six Nations of the Grand River, Canada (n = 25) and the Sámi in Inari, Finland (n = 20); and their family members. The case studies were analyzed using both Western and Indigenous methodologies. Results of Phase one shows how Indigenous resistance to colonial structures within academia in Canada and Finland has resulted in dialogical processes to create an ethical space for working between the differing worldviews of academia and Indigenous communities with the aim to produce ethically valid knowledge. Phase two results shows that regardless of contextual differences of the experiences in Canada and Finland, the main parallel outcomes are similar, i.e. the teachings of shame received in these educational environments. This produces both vulnerabilities and resiliencies and the negative effects of shame require an ongoing healing journey for both individuals and their families and communities at large. Conclusion: For a more in depth understanding of structural racism and its influence on Indigenous health, investigations require methodological choices by both Western and Indigenous methodologies. / Tiivistelmä Tutkimuksen päämääränä on tuottaa tietoa rakenteellisesta syrjinnästä. Tämä tapahtuu tutkimalla alkuperäiskansojen ja kansallisvaltioiden välisiä suhteita koulujärjestelmissä sekä sitä, miten rakenteellinen syrjintä vaikuttaa alkuperäiskansojen jäsenten elämään. Tutkimuksen kriittinen analyysi tuottaa dekoloniaalisia lähestymistapoja terveystutkimuksen menetelmiin, jolloin tärkeimmät terveyserot paljastuvat alkuperäiskansalähtöisten tutkimusprosessien kautta. Tutkimus pyrkii lisäämään ymmärrystä siitä, millaisia väliaikaisia sekä nykypäivään asti ulottuvia vaikutuksia sisäoppilaitoksilla ja kouluasuntoloilla on ollut Kanadan ja Suomen alkuperäiskansojen jäsenten terveyteen ja hyvinvointiin. Väitöskirjan tutkimusasetelma on laadullinen monitapaustutkimus, jossa sovelletaan Critical Health Praxis (PHCR) -menetelmän viitekehystä. Tutkimuksen ensimmäisessä osassa vertaillaan laadullisen sisällönanalyysin avulla Kanadan ja Pohjoismaiden alkuperäiskansojen tutkimuseettisiä käytäntöjä ja menettelytapoja. Toisessa osassa on kolme tapaustutkimusta, jotka perustuvat strukturoidun kyselytutkimuksen avovastausten syrjintäkokemuksiin ja niiden vaikutuksiin itsekoettuun terveyteen Kanadan ensimmäisten kansojen jäsenillä (Six Nations of the Grand River, n = 25) sekä Suomen saamelaisilla (Inarin kunta, n = 20). Tapaustutkimuksissa sovelletaan alkuperäiskansalähtöisiä ja länsimaisia tutkimusmenetelmiä. Tulokset osoittavat, että alkuperäiskansojen vastustus kolonialistisia akateemisia rakenteita kohtaan Suomessa ja Kanadassa on synnyttänyt dialogisia prosesseja, joiden avulla voidaan luoda eettistä tilaa tiede- ja alkuperäiskansayhteisöjen maailmankuvien yhteensovittamiseksi ja eettisesti hyväksyttävän tiedon tuottamiseksi. Toisen vaiheen tulokset osoittavat, että vaikka Kanadan sisäoppilaitosten ja Suomen kouluasuntoloiden yhteiskunnalliset lähtökohdat ja käytännön toteutustavat eroavat toisistaan, lopputulos on samansuuntainen: kouluympäristön aiheuttama häpeä, joka tuottaa sekä haavoittuvuutta että resilienssiä. Kielteisten kokemusten työstäminen vaatii pitkää, parantavaa prosessia, joka koskee niin yksilöitä, perheitä kuin yhteisöjäkin. Johtopäätöksenä todetaan, että tarvitaan sekä länsimaisia että alkuperäiskansalähtöisiä tutkimusmenetelmiä, jos halutaan ymmärtää syvällisesti rakenteellista syrjintää ja sen vaikutuksia alkuperäiskansojen terveyteen ja hyvinvointiin.