a policy analysis on the proactive prevention of chronic disease: learnings from the initial implementation of integrated measurement for early detection (mido)

mexico, like many low- and middle-income countries (lmics), faces an epidemic of chronic non-communicable diseases (ncds), specifically diabetes, hypertension, obesity, and lipid disorders. many people with these ncds may not be aware that they have a disease, pointing to the need for broader screening programs. the traditional prevention policy in mexico was based on screening with a paper-based risk factor questionnaire. however, this was used to screen patients already seeking healthcare services at facilities, and screening goals were set as a function of the number of questionnaires applied, not number of individuals screened. due to this, fundación carlos slim developed medición integrada para la detección oportuna (midotm), or integrated measurement for early detection, an ncd screening and proactive prevention policy. this document is a policy analysis based on early learnings from the initial implementation of mido in eight primary healthcare centers in two central mexican states. mido was found to expand screening programs beyond clinic walls, systematize community screening strategies, emphasize the detection of pre-disease phases, incorporate lifestyle counseling, and propose screening goals based on population targets. in collaboration with the mexican ministry of health, mido has successfully screened over 500 000 individuals—about 40% of whom would not have been screened under previous policies. of these more than 500 000 screened individuals, 13.4% had pre-diabetes (fasting glucose between 100 and 125 mg/dl), and 5.8% had undiagnosed diabetes (defined as fasting glucose above 126 mg/dl or random glucose above 200 mg/dl). however, there is still room for improvement in linking positive results from screening with disease confirmation and with patient incorporation into disease management. the experience of implementing mido in mexico suggests that primary and secondary prevention programs in other parts of the world should consider the need for population-based screening targets, a greater focus on pre-disease stages, and the streamlining of the transition between screening, confirmation of diagnosis, and incorporation of patients into the healthcare system.