Abstract
On 23 May the Trump administration released its hotly anticipated 2018 budget proposal. Entitled A New Foundation for American Greatness , the document sets out a radical, and oddly self-defeating, ‘America first’ agenda that has sweeping ramifications for global health.1 The 2016–2017 budget ran to just over $4 trillion, with a $500 billion deficit feeding America’s $20 trillion debt mountain (∼100% of GDP).2 The administration aims to eliminate the deficit over 10 years by slashing $4.3 trillion from government spending; however, total expenditure will remain unchanged for 2018. You already know that the Department of Defense is receiving a $52 billion bump, and social security and federal health insurance for the elderly are to remain untouched. To balance the books Trump proposes swingeing cuts to virtually every other area of non-defence spending. The Department of Health and Human Services, National Institutes of Health (NIH), and Centers for …
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