Co-Benefits of Largescale Organic Farming on Environmental and Human Health (BLOOM): A Natural Experiment in Andhra Pradesh, India

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The way that we produce food has changed profoundly, and, as a result, so too has our dietary intake. Whilst these changes have resulted in unprecedented declines in undernutrition, they have come with a cost in terms of environmental degradation and the rising tide of obesity. Today, 1 in 3 people around the world experience some form of malnutrition and dietary risks are the #1 behavioural risk factor for deaths and #2 behavioural risk factor for disability. Our food system is failing us. Transformational action is urgently needed. However, though many theoretical frameworks exist for sustainable food systems, there is very limited data from the field at scale. This is the gap the 'Co-Benefits of Largescale Organic Farming On HuMan Health' (BLOOM) project aims to fill.The government of Andhra Pradesh in India recently issued an order to support the transition to organic farming across the state known as, 'Zero Budget Natural Farming' (ZBNF). There is currently no scientific evidence to support the effectiveness of the ZBNF programme in terms of improving the livelihoods and health of farmers, yet the state government of Andhra Pradesh is moving forward with implementation. The proposed scientific evaluation will fill this critical gap. The Fellow will conduct a natural experiment using population-based surveys of 2,000 rural households in Andhra Pradesh and in the neighbouring state of Telangana (serving as a control) in 2021 (baseline) with two annual follow-up visits (2022 and 2023). Telangana is a unique control given that until June 2, 2014 it was part of Andhra Pradesh. BLOOM will address the following aims: (i) to determine if organic farming has co-benefits on human nutrition and health, and (ii) to ascertain the role of crop yields, household economics, decent work, food security, and diet quality in the causal pathway between organic farming and these outcomes. Specific nutrition and health outcomes to be quantified include (i) urinary biomarkers of exposure to pesticides (20% random subsample of households with children <5 years), (ii) child stunting (short length/height-for-age), (iii) anaemia among women, and, among adults, (iv) mental health, (v) type 2 diabetes, and (vi) chronic kidney disease.Our food systems have changed rapidly within a generation. We have achieved what few thought we could in terms of increasing productivity. There is reason to believe, with strong scientific evidence, societal demand, and political will, that we can transform the food system again over the coming decade to meet the Sustainable Development Goals - at least 12 of which relate to food systems. But this will require investment in R&D because there is not a clear pathway toward transformational outcomes. The BLOOM project will provide invaluable scientific evidence regarding the population health co-benefits of organic agriculture, and advance current paradigms of transdisciplinary public health research. Should the ZBNF program be found to be successful at improving food and nutrition security, and promoting population health relative to conventional agriculture systems in India, the implications could be substantial in terms of policies for other states in India - where approximately one-fifth of the world lives - and other countries looking to transition to agricultural systems with fewer agro-chemical inputs. Given that we do not anticipate that the UK will transition entirely to organic agriculture, this represents a unique scientific opportunity to learn by quasi-experimentation, the benefits and unexpected consequences of such practices. Overall, findings from the Fellows research programme will have important implications countries around the world look for evidence-based solutions to failing food systems.