Across the United States, concerns over bud-get deficits and a weak economy have prompted federal, state, and local governments to propose controversial spending reductions to balance their budgets. Debates and protests incited by these decisions dominate the news, but what is their relevance to medicine? The reflexive answer might be that government spending policies are relevant if they compromise health care services, essential public health programs, or biomedical research. However, the biggest threat to public health may come from funding cuts outside the health sector. Namely, budget decisions that affect basic living conditions-removing opportunities for education, employment, food security, and stable neighborhoods-could arguably have greater disease significance than disruptions in health care.
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