Our two editorials consider the impact of the UK's 1974 Health & Safety at Work etc. Act, 40 years after it became the central piece of legislation intended to protect work- ers and the public from harm caused by work activities. Karen Clayton of the Health & Safety Executive (HSE) (1) highlights the reduction in the number of workplace fatalities and of working days lost through work-related illnesses in the past 40 years, but acknowledges the con- tinuing toll of work-related illness on the UK workforce. This is not simply explained by long-latency diseases caused by workplace exposures many years ago, and she assures us health remains high on HSE's agenda, empha- sizing its current partnership approach. Hugh Robertson of the Trades Union Congress (2) reflects on the political consensus supporting the Act's introduction and acknowledges its early successes but voices concern about declining rates of improvement in key indices of workplace health and safety, the near-total disappearance of Employment Medical Advisory Service doctors and the slowing or halting of work on health- related topics, as well as significant recent changes in the scope of the Act and arrangements for enforcing it, despite successive independent reviews confirming it remains fit for purpose and broadly supported. He criticizes politi- cal 'short-termism', prioritizing high-profile safety issues at the expense of occupational health, often concerned with preventing diseases that take years to develop. The key question to be answered is whether recent changes in arrangements for enforcing the Act will cause a decrease in health and safety standards throughout Great Britain, and if so with what costs to society. Against this background we have papers showing that 'old' hazards to health are still causing serious disease in UK workplaces, and that new ones are always waiting to be identified and controlled. Nicol et al. (3) report six cases of silicosis in young asymptomatic Scottish stonema- sons with workplace exposures ranging from 7 to 20 years, despite a low predicted probability of pneumoconiosis based on respiratory symptom questionnaires, spirometry and duration of exposure. Despite silicosis being one of the oldest known occupational lung diseases and long- established legislation intended to prevent harmful expo- sure to respirable crystalline silica, these cases emphasize once again the importance of enforcing effective expo- sure control and of comprehensive health surveillance programmes, with a low threshold for early radiological screening to promote early and effective disease detection. By contrast to this long-known hazard, Cannon et al. (4) report a first case of occupational asthma and rhinitis in a pharmacist, linked to airborne exposure to a novel antimalarial drug and confirmed on inhalation test - ing. Using an established quantitative structure-activ- ity relationship (QSAR) model with high sensitivity and specificity, the molecule concerned has an asthmagen hazard index of zero. As they observe, this false negative provides an opportunity for improving the QSAR model by its inclusion in learning data sets to generate further models based on a wider range of chemical structures shown to be asthmagenic, adding incrementally to our store of knowledge and the resulting opportunity to identify hazards and manage risks to health before harm results. Meanwhile, in the developing world, workplace haz- ards that many here may view as historical curiosities continue to cause harm, too often invisible to us as we enjoy the resulting cheap manufactured goods. Dianne Baxendine describes her experiences in an Indian 'slum clinic' (5). As she observes, the priority needs to be improved public health with simple, regular, preventive health care and education, provided by local trained people. Those who vilify the 'stranglehold of health and safety' in the UK and press for further deregulation may care to consider the evidence, readily available elsewhere in the world, of the consequences for health of inade- quate legislation and enforcement.