An account of social deprivation and its consequences across three generations in one family.

Caroline Sayer and Thomas Lee show how the health profession provided sympathetic, personalised and expensive care to a family that remained deprived across three generations.[1] The information is presented on a timeline, providing a vivid illustration of trans-generational deprivation and its consequences. It provides excellent teaching material for “Medicine in Society” seminars. But like so many of these types of study, especially those written by doctors, it is much sharper on diagnoses than treatment. Simply identifying social deprivation and saying that we want a “fairer society” falls far short of a prescription for action.

— Richard Lilford, CLAHRC WM Director


  1. Sayer C, Lee TH. Time after time–health policy implications of a three-generation case study. N Engl J Med. 2014; 371(14): 1273-6.

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