But Republicans have proposed another, less obvious threat to Americans’ health: President Trump’s budget.

Poverty causes poor health. The poorest men in America die 15 years earlier than the wealthiest; the poorest women die 11 years younger than the most affluent women. Despite frequent statements to the contrary, America’s safety net programs reduce poverty. In 2012, 19 percent of children under 18 lived in poverty. In the absence of the resources provided by the safety net, 30 percent of them would have had insufficient means to meet basic human needs. (The child poverty rate descended to 16 percent in 2015, the last year in which data is available; the share that would be affected by resource cutbacks has not been calculated yet.) At a time when we are seeing worsening societal trends in death rates, this is not the time to shred the safety net.

Americans have poorer health outcomes — higher infant mortality, shorter life expectancy — than people in other developed nations. Why? Although we spend much more on health care, we spend much less on social programs such as housing, nutrition, child care and family leave, job training and income support. The same pattern holds true across states and counties in the United States. Greater public social spending, not less, results in more babies reaching their first birthdays and more grandparents attending their grandchildren’s weddings.

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The credit for these results belongs to specific programs. Housing takes one of the biggest cuts in Trump’s proposed budget — $3 billion from the Community Development Block Grant program and $1.1 billion from several “lower priority programs” including the CHOICE neighborhood program. Yet adults who live in public housing (compared with those eligible but not receiving such housing) are much less likely to report fair or poor health and similarly are much less likely to report serious psychological distress. Adults who either lived in public housing or received housing vouchers during childhood and adolescence both have higher incomes and are less likely to be incarcerated than comparable adults (in this case, siblings) who did not experience these benefits, according to government data.

The HUD programs targeted in the budget proposal, as well as the Community Development Financial Institution grants cut from the Treasury budget, not only support the creation of affordable housing. They also create stronger and more health-promoting neighborhoods. Both fund construction of community health centers. Both, along with the TIGER grants from the Department of Transportation (also on the chopping block), fund the development of spaces for physical activity such as parks and bicycle paths. Both provide funding to enhance access to healthy foods by supporting the development of grocery stores, farmers markets and urban farms in low-income communities.

The budget proposes to eliminate the Community Services Block Grant from the Department of Health and Human Services. This grant funds Community Action Agencies in poor neighborhoods across the country. The agencies typically operate Head Start programs, distribute vouchers for energy/heating assistance, provide job training, assist in applications for the earned income tax credit, and provide training in financial literacy and empowerment. Each of these has health implications. In the absence of adequate heating assistance, low-income families cut back on food and health care, use unsafe heating sources, and are more likely to live in unsafe housing. Children who attended Head Start (direct funding was not explicitly addressed in the budget proposal) are less likely to be placed in special education or retained in grade, are more likely to graduate high school and attend college, have higher earnings in their 20s, and are also less likely to be charged with a crime than their non-Head-Start-exposed siblings. Each of these outcomes is associated with better health.

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Upward social mobility — the likelihood your child will do better than you — has been declining in America. Social mobility varies across our country, with some communities having much higher levels of upward mobility than others. People who live in communities in which the future is bright, where hope lives, are healthier (better self-reported physical and mental health) than people in communities without that sense of hope — even holding income levels constant. One of the characteristics of communities of hope is the sense of connection and trust among their residents. Trusted community institutions such as health centers and local agencies that build upon the assets of those who live there are one key part. The two community block grants help build the foundation of hope for a better future.

The health of Americans is in a precarious state, and the health-care bill is not the only proposal that will radically affect it. Taking away health insurance from poor and low-income Americans is not going to help. But further dismantling our already meager system of public social support will exacerbate the problem, causing shorter lives, greater disability, lower productivity, less social mobility and higher health-care costs.