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，我们的饮食摄入也发生了变化。虽然这些变化使营养不良的人数空前减少，但也带来了环境退化和肥胖浪潮上升的代价。今天，全世界每三个人中就有一个经历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导致残疾的第二行为风险因素。我们的食物系统让我们失望。迫切需要采取变革行动。然而，尽管存在许多可持续粮食系统的理论框架，但来自实地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效益”（BLOOM）项目旨在填补的差距。印度安得拉邦政府最近发布了一项命令，支持整个邦向有机农业过渡，称为“零预算自然农业”（ZBNF）。目前没有科学证据支持ZBNF计划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。拟议的科学评价将填补这一关键空白。该研究员将在2021年（基线）对安得拉邦和邻近的特兰加纳州（作为对照）的2,000个农村家庭进行基于人口的调查，并进行两次年度随访（2022年和2023年）。特兰加纳是一个独特的控制，因为直到2014年6月2日，它是安得拉邦的一部分。布卢姆将解决以下目标：（i）确定有机农业是否对人类营养和健康具有共同利益，以及（ii）确定作物产量，家庭经济，体面工作，粮食安全和饮食质量在有机农业和这些结果之间的因果关系中的作用。需要量化的具体营养和健康结果包括（i）接触农药的尿液生物标志物（20%有5岁以下儿童的家庭的随机子样本），㈡儿童发育迟缓（身高/身高年龄比），（iii）妇女和成人贫血，（iv）精神健康，（v）2型糖尿病，以及（vi）慢性肾脏疾病。我们的食物系统在一代人的时间里发生了迅速的变化。在提高生产力方面，我们取得了很少有人认为我们可以取得的成就。我们有理由相信，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个目标与粮食系统有关。但这将需要对研发进行投资，因为没有一条通往转型成果的明确途径。BLOOM项目将为有机农业的人口健康共同效益提供宝贵的科学证据，并推进当前跨学科公共卫生研究的范式。如果ZBNF计划被发现在改善粮食和营养安全方面取得了成功，并且相对于印度的传统农业系统促进了人口健康，那么对于印度其他邦（约占世界人口的五分之一）以及其他希望向农业系统过渡的国家的政策来说，其影响可能是巨大的。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，通过准实验来学习这种做法的好处和意想不到的后果。总的来说，研究员研究计划的结果将对世界各国寻找以证据为基础的解决方案以应对失败的粮食系统产生重要影响。

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.