Official United Kingdom figures record annually 1400 deaths and 145,000 sufferers from chronic effects of occupational injury and disease. Evidence indicates that occupational disease directly due to work is underestimated. With more understanding of the multiple causes of disease, the concept of work related disorders has broadened to include four categories: work as a direct cause, a contributory cause, or an aggravating factor, and work offering easy access to potential dangers (alcohol). As an example, work factors that increase the risk of coronary heart disease are discussed. Evidence for work stress as a causal factor and the role of leadership are considered. Prevention depends on identifying risks, preferably before anyone is exposed, but more commonly through recognition of adverse effects on workers. The need for occupational health services to have health promotion programmes that include screening for disease and its precursors, counselling and education, is considered. The positive effects of work itself as a protector and promoter of health are discussed. Responsibility for improving health has to be shared by government, management, trade unions, health professionals, and the individual worker.