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Michael Silverstein, MD, MPH

The author is with the Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Seattle.

Correspondence: Requests for reprints should be sent to Michael Silverstein, MD, MPH, Department of Environmental and Occupational Health Sciences, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105 (e-mail: masilver{at}u.washington.edu).

The Occupational Safety and Health Act of 1970 (OSHAct) declared that every worker is entitled to safe and healthful working conditions, and that employers are responsible for work being free from all recognized hazards. Thirty-eight years after these assurances, however, it is difficult to find anyone who believes the promise of the OSHAct has been met.

The persistence of preventable, life-threatening hazards at work is a failure to keep a national promise. I review the history of the Occupational Safety and Health Administration and propose measures to better ensure that those who go to work every day return home safe and sound.

These measures fall into 6 areas: leverage and accountability, safety and health systems, employee rights, equal protection, framing, and infrastructure.

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