Health systems internationally are dealing with greater diversity in patient populations. However the focus on 'the language problem' has meant little attention is paid to diversity within and between migrant populations; and how interpreted consultations are influenced by intersecting migratory, ethnicity and sociodemographic variables. Our analysis of the experiences of patients, health care providers and interpreters in Scotland evidences the need to move beyond language, addressing multiple hidden inequalities in health care access and provision that operate in both clinic and, especially, home-based settings. We call for a practice-evidenced research agenda promoting cultural communication across health care and home settings, acknowledging immigration status as a social determinant of health. Sur le plan international, des systèmes de santé font face à une diversité croissante dans ses populations de patients. Cependant, l'accent sur 'le problème de langue' se traduit dans une manque d'attention à la diversité à l'intérieur même et entre des populations des migrants; et la façon par laquelle des variables migratoire, ethnique et sociodémographique influencent elles-mêmes des consultations interprétées. Notre analyse des expériences des patients, des professionnels fournissant de soins de santé et des interprètes offre des preuves du besoin de dépasser le problème de langue. Et en faisant cela, nous adressons des multiples inégalités, souvent cachées dans des contextes de soins de santé, dans les milieux clinique et domicile. Nous proposons un programme de recherche basé sur la pratique, qui favorise la communication culturelle dans des milieux clinique et domicile, et qui reconnait le statut d'immigration comme un déterminant social de la santé.

Seventy 15‐year‐old students in rural and urban Scottish schools, who had previously answered questionnaires about the extent of their part‐time employment, were interviewed. Work appears to be the norm in their communities, 79 per cent having worked and most of the others anticipating working before leaving school. Although the interviewees’ accounts of their jobs give some support to those who argue that most of the paid employment school students undertake is routine and boring, it was also found that most of the young workers found their work satisfying and believed that their experience of working helped to prepare them for adult life. It is proposed that research on the meaning of employment for school students should be extended and that the self‐report techniques currently employed might be supplemented by observational studies. © 2006 The Author(s). Copyright © 2005 National Children's Bureau.

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