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

我们生产食物的方式发生了深刻的变化，因此，我们的饮食摄入量也发生了变化。虽然这些变化导致了营养不良的空前下降，但它们也带来了环境退化和肥胖率上升的代价。今天，世界上三分之一的人经历着某种形式的营养不良，饮食风险是导致死亡的第一行为风险因素和第二行为残疾风险因素。我们的食物系统正在让我们失望。迫切需要采取变革性行动。然而，尽管存在许多可持续食品系统的理论框架，但来自该领域的大规模数据非常有限。这就是“大规模有机农业对人类健康的共同益处”(Bloom)项目旨在填补的缺口。印度安得拉邦政府最近发布了一项命令，支持全邦向有机农业的过渡，这一命令被称为“零预算自然农业”(ZBNF)。目前没有科学证据支持ZBNF方案在改善农民生计和健康方面的有效性，但安得拉邦政府正在推进实施。拟议的科学评估将填补这一关键空白。该研究员将于2021年(基线)对安得拉邦和邻近的泰兰加纳邦(作为对照)的2000户农村家庭进行基于人口的调查，并进行两次年度跟踪访问(2022年和2023年)。Telangana是一个独特的控制区，因为在2014年6月2日之前，它一直是安德拉邦的一部分。Bloom将解决以下目标：(I)确定有机农业是否对人类营养和健康有共同好处，以及(Ii)确定作物产量、家庭经济、体面工作、食品安全和饮食质量在有机农业和这些结果之间的因果路径中的作用。具体的营养和健康结果将被量化，包括(I)接触杀虫剂的尿液生物标记物(有儿童和儿童的家庭中20%的随机亚样本；5岁)，(Ii)儿童发育迟缓(身高/身高)，(Iii)妇女的贫血，以及(Iv)成年人的精神健康，(V)2型糖尿病，和(Vi)慢性肾脏疾病。就提高生产率而言，我们已经取得了很少人认为我们能做到的成就。有理由相信，有了强有力的科学证据、社会需求和政治意愿，我们可以在未来十年再次改变粮食系统，以实现可持续发展目标--其中至少有12项与粮食系统有关。但这将需要在研发方面进行投资，因为没有一条通向转型成果的明确途径。Bloom项目将提供关于有机农业对人口健康共同益处的宝贵科学证据，并推动当前跨学科公共卫生研究的范例。如果与印度的传统农业系统相比，ZBNF计划被发现在改善食品和营养安全以及促进人口健康方面取得了成功，那么它可能会对印度其他邦--世界上大约五分之一的人口居住在那里--以及其他希望过渡到农用化学品投入较少的农业系统的国家的政策产生重大影响。鉴于我们预计英国不会完全过渡到有机农业，这是一个独特的科学机会，可以通过准实验来了解这种做法的好处和意想不到的后果。总体而言，研究员研究方案的发现将对世界各国寻求以证据为基础的解决方案来解决粮食系统的问题具有重要意义。

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.