The Health and Safety Executive (HSE) welcomes this informed contribution to the debate on measuring progress against the government's targets for occupational health and safety. We recognise the importance of identifying criteria against which the success of the “Revitalising health and safety”2 and “Securing health together”3 strategies will be assessed, and also the difficulty of doing so.

We agree that in the area of occupational health, measuring progress against targets presents particular challenges. Three were highlighted by Coggon1:

• The difficulty of meaningfully attributing individual cases to work: and the fact that such attribution will be done differently by different people—for example the people themselves, their doctors, or their employers.

• The effect of cultural or psychosocial factors on reporting of symptoms: including the possibility of improved awareness leading to a “paradoxical” rise in symptom reporting (especially in the early years of a new strategy or campaign).

• The latent interval after exposure: so that the incidence of some diseases—such as cancers—will not be affected by actions taken during the 10 year period of the …