Despite decades of research demonstrating links between many agricultural practices and water quality, the ability to predict water quality on the basis of changes in soil health remains severely limited. By better understanding how soil health affects downstream water quality, researchers and policymakers could prioritize different conservation practices while exploring more innovative soil health management strategies. Focusing on the Great Lakes region, we describe the value and challenges of different approaches to linking soil health and water quality, specifically applying nitrogen and phosphorus mass balances and adapting simulation models to better incorporate changing soil health conditions. We identify critical research needs, including paying greater attention to a broad suite of conservation practices and to biological indicators of soil health. We also discuss key barriers to farmer adoption of conservation practices from field to national scales, highlighting that improved scientific understanding alone is insufficient to drive widespread change.

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