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

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.

Impact goal: to use a natural experiment in India to evaluate the nutrition and health co-benefits of organic agricultural practices and underlying mediating pathways, and to develop detailed evidence-based guidance for policymakers in India with potential for translation to other countries in Southeast Asia and Africa. In order to achieve this goal, my team and I will:

1. Work with farming communities in Andhra Pradesh and Telangana, India, to gather quantitative data on exposure to pesticides, anthropometry, anaemia, blood pressure, glycaemia, kidney function, mental health, crop yield, household economics, indicators of decent work, indicators of women's empowerment, food insecurity, and diet quality.

2. Work with the state Department of Agriculture and local agricultural universities to understand the reach of the programme, programme financing, and the potential for improving the programme's scale, fidelity, and impact.

3. Work with the UN Food and Agriculture Organization to document the impacts and trade-offs identified by this natural experiment and translate findings for global dissemination.

4. Engage with the UK Global Food Security (GFS) programme to learn about the impacts and trade-offs of alternative agro-food strategies being tested elsewhere in the world, and to share findings from this natural experiment of organic agriculture in India.

5. Engage with the US Organic Trade Association and UK Organic Trade Board, among others, by attending industry Expos and Conferences, to identify global market linkages that will be critical for growth and sustainability of the programme in India should we find significant nutrition and health co-benefits.