The global financial crisis that began in 2007 can be classified as a health system shock – that is, an unexpected occurrence originating outside the health system that has a large negative effect on the availability of health system resources or a large positive effect on the demand for health services. Economic shocks present policy-makers with three main challenges: • Health systems require predictable sources of revenue with which to plan investment, determine budgets and purchase goods and services. Sudden interruptions to public revenue streams can make it difficult to maintain necessary levels of health care. • Cuts to public spending on health made in response to an economic shock typically come at a time when health systems may require more, not fewer, resources – for example, to address the adverse health effects of unemployment. • Arbitrary cuts to essential services may further destabilize the health system if they erode financial protection, equitable access to care and the quality of care provided, increasing health and other costs in the longer term. In addition to introducing new inefficiencies, cuts across the board are unlikely to address existing inefficiencies, potentially exacerbating the fiscal constraint. In 2009, WHO’s Regional Committee for Europe adopted a resolution (EUR/RC59/R3) urging Member States to ensure that their health systems would continue to protect and promote universal access to effective health services during a time of economic crisis.