If hypertension was a real, hot-blooded human serial killer that you may have watched on Dexter, the Showtime television programme, or read about in a James Patterson novel, the average community would be traumatised, unable to function properly; the old and young would stay indoors after dark and walks on deserted streets would be considered to be extremely dangerous, until the killer was captured and executed. But high blood pressure, the silent killer, has sent thousands of persons to their graves, much more than all the serial killers in the world. Yet we take the condition for granted, accepting it in our community as if we had no choice.

Generally, the average Dominican rarely monitors his blood pressure, does not eat a balanced diet with a permissible amount of salt, does not engage in regular physical activity and consumes much too much alcohol. In other words, few people care enough to make the necessary life-style changes that are required to reduce levels of high blood pressure. And we are paying the price.

Medical practitioners tell us that if left uncontrolled, high blood pressure causes blindness, irregularities of the heart beat and heart failure and the risk of suffering from these conditions increases when one is affected by diabetes, one of the most common diseases in Dominica. In fact, one in three adults worldwide has high blood pressure and that proportion increases with age, from one in ten people in their twenties and thirties to fifty percent of people in their fifties. Additionally, persons who live in low income countries or are of African descent, are more likely to be affected by hypertension and diabetes.

High blood pressure is among the many factors that contribute to cardiovascular disease and CVD is one of the main causes of death in Dominica and many other regions of the world. An estimated 17.3 million people died from CDV in 2008, which is 30 percent of all deaths. To observe World health Day 2013, the World Health Organisation (WHO) chose high blood pressure as its theme to highlight the fact that prevention and control of this silent disease requires action by the whole community.

Another significant consideration, when assessing the prevalence and impact of high blood pressure is the fact that the Dominican population has been ageing. And, of course, as bodies age, needs, vulnerabilities and medical requirements change. Then health care cost is one major area which will be most impacted by the increasing older population. It is also important to note that for older persons increased health-care cost is usually accompanied by increased financial need for medications and advanced health care. Clearly, there is the need for long-term planning to ensure that Dominica has the systems, structures and supports to address the challenges of high blood pressure and the other non-communicable diseases for all ages of the population.

As we stated in an earlier editorial, the rising cost of health-care, the increasing prevalence of non-communicable diseases such as diabetes and hypertension, and changes in the structure of the population will undoubtedly force government to consider alternative and sustainable ways of funding health care because the current system is ineffective. And we have been warned.

An International Monetary Fund (IMF) working paper titled "Universal Health Care 101: Lessons for the Eastern Caribbean and Beyond" suggests that "health care plans should be part of the government's medium and long- term strategy and health plan's cost should be incorporated into the medium-term expenditure framework, so as to ensure the current and future financial viability". The IMF paper recommends two ways of financing universal health care. The first is general taxation and the second is mandatory payroll/social security contributions. Reliance on external funding is definitely not an option, the paper argues, because that level of funding has disappeared and the sustainability of any health system cannot be based on the generosity of donors. In other words, Dominicans should not expect either Venezuela or China or Morocco to fund our health care system. We have to it all on our own. It seems obvious, therefore, that small, resource-poor countries like Dominica, operating individually, will find it difficult to offer comprehensive universal health care to its people or to implement a system similar to the one that the United States has just begun. Hence, we suggest that the sub- region must pool its resources and create an OECS health insurance scheme. Some analysts have added that any proposed scheme would be more viable if it incorporated the larger and more populated countries of the region such as Trinidad and Tobago, Jamaica and Guyana.

Hence, the funding of a national health care system should have been a major discussion topic on World Health Day, observed here on April 7, but unfortunately it was just another day during which shocking statistics were revealed about the impact of high blood pressure. It is clear that we are making very little authentic progress in arresting hypertension, the silent killer.