The BLOOM (Co-Benefits of Largescale Organic Farming On HuMan Health) Study

In December 2023, at COP28 in Dubai, the Food and Agriculture Organisation of the United Nations launched a new 'Global Roadmap' with a plan for attaining global food security by 2050 without breaching 1.5C. The enormity of this task was captured in an analysis finding that even if fossil fuel emissions were immediately halted, current trends in agri-food systems would prevent the achievement of the 1.5C target. Despite the urgent need to transition to sustainable agri-food systems to meet human nutrition, net zero, and biodiversity goals, there continues to be a massive implementation failure. Over the past 3 years, I have been evaluating a unique government programme in the state of Andhra Pradesh, India, called 'Andhra Pradesh Community-managed Natural Farming (APCNF)'-previously 'Zero Budget Natural Farming (ZBNF).' Through this programme, the government aims to transition the entire state-home to more than 50 million people including 6 million farmers-to organic farming. My project, entitled, BLOOM (Co-Benefits of Largescale Organic Farming On HuMan Health), aims to determine if APCNF is an effective approach to transforming agri-food systems for health and sustainability. In collaboration with the state government and Ashoka University, I am leading a cluster-randomised controlled evaluation of APCNF. The two primary outcomes are urinary biomarkers of exposure to pesticides and dietary diversity. Secondary outcomes include crop yields, household income, adult body mass index, blood pressure, anaemia, type 2 diabetes, kidney function, musculoskeletal pain, clinical symptoms, depressive symptoms, women's empowerment, and child growth and development. As part of the Fellowship renewal, BLOOM participants will be followed for an additional 2 years for a total of 5 annual assessments (2022-2026). The biggest challenge to date has been low uptake of organic farming by farmers in BLOOM's intervention villages. The main innovation of the Fellowship renewal is to adapt tools from implementation science to understand barriers and facilitators to adoption of organic farming practices. Implementation science arose from the evidence-based healthcare movement, and is the scientific study of methods to promote the systematic uptake of research findings into routine practice. The Fellowship renewal will provide me with the necessary support and flexibility to further leverage my background in public health, gain skills in implementation science, and apply them to agri-food systems. The way we produce food has 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 agri-food systems again over the coming decade to meet human nutrition, net zero, and biodiversity goals. But this will require investment in R&D because there is not a clear pathway toward transformational outcomes. The BLOOM project will provide rigorous scientific evidence regarding the population health co-benefits of organic agriculture and how to take evidence of impact to scale. Given that we do not anticipate that the UK will transition entirely to organic cultivation, this represents a unique scientific opportunity to learn from a state-of-the-art cluster-randomised controlled evaluation, the benefits and unexpected consequences of such practices. Overall, findings from BLOOM will have important implications for countries around the world looking for evidence-based solutions to failing agri-food systems.