Title: (Pre)diabetic Nation
Description: While the strict boundaries and ideal measurement of prediabetes remain contested internationally, health officials and private donors in the health sector in Mexico have promoted its diagnosis and treatment as a key strategy in the nation’s fight against diabetes. This dissertation examines the circumstances under which officials have come to view prediabetes diagnosis as a feasible strategy for the Mexican context and the implications of treating individuals, situated across deep lines of social inequality, who are not yet sick, but deemed at risk of developing disease. Set against Mexico’s chronic disease crisis, where diabetes was declared a national sanitary emergency in 2016 and where experts suggest up to 40% of adults likely have prediabetes, this dissertation engages the prediabetes diagnosis as a lens through which to illuminate the social forces, values, and assumptions currently at work in Mexican health politics. The project foregrounds the dilemmas raised by highly medicalized and clinic-based approaches to chronic disease prevention and mobilizes the case of prediabetes in Mexico to illustrate the broader convergence of the fields of biomedicine and public health.

Centered in Mexico City, field research for this project was carried out over 30 months, employing multi-sited ethnographic methods, including 106 in-depth interviews (47 of which were with individuals diagnosed with prediabetes and their families), observations of 382 medical exams, and attendance at 71 scientific, community health, and activist-hosted events. Alongside the powerful influence of the pharmaceutical industry, my findings bring to the fore a new set of actors and circumstances involved in the circulation of predisease diagnosis to this developing country context. These include (1) the epistemological limits imposed by “projectification” in global health science, (2) the influence and ideologies of an elite-mega philanthropist and his Foundation’s conviction that technological innovation will foster better health, and (3) local and global imaginaries that endorse the power of Big Data analytics to solve a plethora of development challenges. Further, in tracing the enactment of the prediabetes diagnosis across public and private clinics, I show that the pre-disease condition that economic elites experience when they are diagnosed contrasts sharply with that experienced by working class and low-income patients—I argue that in practice, prediabetes is multiple and its diagnosis amplifies existing social inequities.

I also show that the emotional and ethical responses to the diagnosis among patients can differ substantially, particularly across socioeconomic divides. I argue that in Mexico, increased access to risk knowledge does not foster a spirit of “optimization” among the majority of Mexicans, but rather an alternative ethic, which I term “strategic preservation.” Finally, I show that many health experts in Mexico share a common set of values and norms in thinking about diabetes risk. On a macro level, they discursively link the looming threat of prediabetes, diabetes risk, and diabetes itself to the nation’s potentially disastrous macroeconomic future, effectively charging individuals with the responsibility to mitigate this threat through behavior and lifestyle modification. Health experts in this arena also frequently communicate the notion that the Mexican body itself is a key source of diabetes risk. I point to other elites in Mexico who, relying on a similar conception of the Mexican body, are investing in molecular technologies to better detect embodied diabetes risk, and to expand the reach and precision of medicalized prevention strategies in the future.

These findings have implications for developing countries globally, which now bear the highest burden of chronic disease. Developing countries are already or will soon grapple with a similar epidemiological crisis and, as this occurs, Mexico’s strategies and experience will set precedents and establish key paradigms for public health action globally. With this in mind, I call for the disentanglement of expertise between the fields of biomedicine and public health and for a turn toward more structural, indeed socially radical, policies for chronic disease prevention at the population level.