Editorials 177
duty-holders perceive that health and safety regulation is of little importance. There is overwhelming evidence that there is a positive correlation between injury rates and enforcement [12] and the HSE itself has accepted that a ‘lower level of enforcement’ would mean ‘a consequent decrease in health and safety standards throughout Great Britain, with ensuing costs to society’ [13]. It now appears that the downward trend has not only stalled but may be in reverse. Given that we have over 2 million people living with injuries or illnesses caused or made worse by work, we still have a significant problem where work is making a considerable proportion of the population ill, and this deserves to be tackled through evidence-based interventions rather than short-termism or simplistic analysis. Hugh Robertson Senior Policy Officer, Trades Union Congress, London, UK e-mail: [email protected]
References 1. Hansard. 19 November 1968, vol. 773, cc1116-24. 2. Bonnell J. A. Br J Ind Med 1973;30:199–201. 3. HSE. 2004. Thirty Years on and Looking Forward. 4. Br J Ind Relat 1976;14:92–101. 5. HSE Annual Statistics. October 2014. 6. DWP. Good Health and Safety, Good for Everyone. March 2011. 7. Lofstedt. 2011. Reclaiming Health and Safety for All. 8. Young. 2010. Common Sense Common Safety. 9. Triennial Review Report: Health and Safety Executive, Temple January 2014. 10. HSE. 2014. Costs to Britain of Workplace Fatalities and SelfReported Injuries and Ill Health, 2012/13. 11. Daily Telegraph. Speech in Maidenhead. 5 January 2012. 12. http://www.tuc.org.uk/sites/default/files/HSinspection.pdf (12 November 2014, date last accessed). 13. HSE. 2011. Impact Assessment for the Proposed Replacement of the Health and Safety (Fees) Regulations 2010.
doi:10.1093/occmed/kqv016
Working for a healthier future The Health and Safety at Work Act received royal assent 40 years ago and provided a new ‘goal setting’ regulatory framework for occupational health and safety in Great Britain. The Act implemented the recommendations of the 1972 Robens Report and introduced a new non-prescriptive model, based on the view that ‘those that create risk are best placed to manage it’ [1], an enduring © Crown copyright 2015
principle that remains relevant today. Two recent reviews of the Health & Safety Executive (HSE) and health and safety regulation have supported this view. The 2013 triennial review of HSE found that ‘the Act has stood the test of time’ [2] and endorsed the risk-based approach to regulation. An earlier review by Prof. Löfstedt [3] sought views from a wide range of organizations and found
Downloaded from http://occmed.oxfordjournals.org/ by guest on June 7, 2016
that of Professor Lofstedt [7] in 2011 which proposed no changes to the Act itself, beyond one on self-employment which was rejected by the government who came up with their own, very different, proposal. However, the broad conclusion that the HSWA was still relevant today was also made by Lord Young [8] and also Martin Temple [9] in their reviews, where they also reported general support for the Act from stakeholders such as employers, unions and safety professionals. So why have the changes happened? In part, it is simply that modern politicians have little direct knowledge of the world of work and are likely to be influenced by the sensationalist reporting of ‘health and safety’ by the media. However, there is also an ideological basis for it. This government is committed to cutting regulation and reducing what it perceives as ‘burdens’. The emphasis has therefore moved away from protection as the government has been swayed by arguments of the business benefits of reducing regulation over the advantages to the individual worker, despite the economic evidence for deregulation never having been demonstrated. The HSE estimates that the cost of health and safety failings, excluding cancers, is £14.2 billion [10]. Another factor is that government ministers, of any party, are likely to prioritize those issues which have an immediate effect. These are the high-injury or high-profile safety issues rather than long-term effects which will not be known about (or reported) for some years. The average health and safety minister lasts less than 2 years whilst occupational cancers are unlikely to show up until decades after exposure. Hence the priority given to process safety over occupational health issues. The unanswered question is whether the changes are likely to lead to an increase in injury and illness. Is occupational health and safety more about workplace culture rather than legislation or does one drive the other? When the government attacks the ‘health and safety culture’ itself, as the prime minister has done [11], and introduces reductions in both the funding of the regulator and their ability to inspect, that helps create a culture where
178 OCCUPATIONAL MEDICINE
example in workers manufacturing asbestos sheeting or pipes, for others the cause is less clear. We know that this is exacerbated by the difficulties in reporting and capturing information on occupational disease. Latency periods of up to 30 years between exposure and development of ill-health and/or disease make the links even more difficult to establish. We also need to consider situations where exposed populations are changing. There has been significant change in Great Britain’s industrial structure, labour market and working population since 1974. Trades people like plumbers and demolition workers working with legacy products are now considered to be most at risk from asbestos; a much more challenging problem where the risks are sometimes less obvious to those exposed. Current estimates suggest there are at least 13 000 [7] deaths from occupational lung diseases and cancers each year caused by past exposures, primarily to dust and chemicals at work. More than half of the 8000 cancer deaths were caused by past exposures to asbestos (mesothelioma or asbestos-related lung cancer). A significant number of deaths from occupational cancer are due to lung cancers attributable to past exposure to respirable crystalline silica, diesel engine exhaust emissions and mineral oils [8]. Tackling occupational disease, including cancers and respiratory diseases, is high on HSE’s agenda. Just as with every other aspect of driving up health and safety performance, HSE cannot tackle things alone. We need a mix of employers and trade unions, and occupational medicine and occupational hygiene professionals to work together to tackle these issues. We need to ensure that we have a range of activities in place if we are to make progress—with all of us doing what we are best placed to do to improve occupational health in Great Britain. By developing a common understanding of the challenges we face, we can identify a realistic picture of what we are able to achieve. We see HSE as a catalyst on this—one part of the solution in tackling the challenge of occupational disease. In 2013, HSE brought together professionals from across the health and safety community to discuss new and innovative ways to help prevent occupational disease. Since then, we have been working with others to develop programmes of activity to raise awareness and promote behavioural change; we are also undertaking focused research in priority areas. Tackling health issues also forms part of HSE’s inspection and enforcement activities; a national targeted inspection focusing on health risks for construction workers saw enforcement action taken at one in six of the hundreds of sites visited. HSE has set out the importance it places on tackling occupational disease. Our dedicated webpages [9] provide an overview of the problems and the industries most affected by respiratory diseases and cancer. We have also established an online community and
Downloaded from http://occmed.oxfordjournals.org/ by guest on June 7, 2016
health and safety regulation is overall broadly supported and that proportionate risk management can make good business sense. The Act replaced detailed, industry-specific regulations, bringing an additional 8 million workers into its scope and, for the first time offered protection to others affected by work activities. It created a flexible system based on a goal setting approach, introducing codes of practice and guidance to support employers. The new regime was based on the principles of consultation and engagement, and was designed to deliver a proportionate, targeted and risk-based approach. When HSE was established in 1975, its first director general, John Locke, described the Act as ‘a bold and far-reaching piece of legislation’ [4]. The introduction of the Act was an acknowledgement that the piecemeal approach of earlier legislation had failed to keep up with industrial and technological developments. The Act imposed a range of duties on employers and employees, designers, manufacturers and suppliers of articles and substances for use at work. The reduction in the number of workplace fatalities since the introduction of the Act, from 651 in 1974 to 133 in 2013–14, is a remarkable achievement. Statistics also show a downward trend in occupational ill-health. In 2001–02, 33 million working days were lost due to ill-health [5]; by 2013–14, this figure had reduced to 23.5 million working days. Although this indicates that some progress is being made, an estimated 1.2 million people are still suffering from an illness that they believe was caused, or made worse, by their current or past work. We cannot afford to be complacent—the number of people being made ill or dying prematurely each year because of occupational disease is still too high. Chronic illness has a huge impact on both the individual and their families. Many find their life permanently affected; they may be unable to return to work, or suffer financial consequences, such as loss of income or extra expenditure associated with illness. Dr Charles Thackrah, a Leeds surgeon and occupational medicine pioneer, writing in 1831, suggested that dusts should be removed from factories by the use of exhaust ventilation, and following the introduction of the Factories Act (1844), the first ‘certifying factory surgeons’ were appointed. The Factories Act (1864) stated that; ‘every factory shall be ventilated in such a manner as to render harmless, so far as is practicable, any gases, dust or other impurities generated in the course of manufacture, that may be injurious to health’ [6]. Even though some of the risks associated with working with hazardous substances were known long before the Act came into force, occupational diseases—particularly those with long latency— remain challenging to address. Although some cases of ill-health, such as mesothelioma, can be clearly related to past work activities, for
Editorials 179
40 years from now long latency diseases have become a thing of the past. Kären Clayton Long Latency Health Risks Division, Policy and Operational Strategy Directorate, Health and Safety Executive, Bootle, Merseyside, UK e-mail: [email protected]
References 1. Robens A. Safety and Health atWork – Report of the Committee 1970–72 (Robens Report). London, UK: H.M. Stationery Office, 1972. 2. Temple M. An Independent Review of the Function, Form and Governance of the Health and Safety Executive (HSE) Martin Temple. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/275233/hse-function-form-governancetriennial-review.pdf (16 January 2015, date last accessed). 3. Löfstedt RE. Reclaiming Health and Safety for All: An Independent Review of Health and Safety Legislation. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/66790/ lofstedt-report.pdf (16 January 2015, date last accessed). 4. Health and Safety Executive. The History of HSE. http:// www.hse.gov.uk/aboutus/timeline/ (16 January 2015, date last accessed). 5. Health and Safety Executive. Historical Picture: Trends in Work-Related Injuries and Ill Health in Great Britain Since the Introduction of the Health and Safety at Work Act (HSWA) 1974. http://www.hse.gov.uk/statistics/history/historicalpicture.pdf (16 January 2015, date last accessed). 6. Eves D. Two Steps Forward, One Step Back: A Brief History of the Origins, Development and Implementation of Health and Safety Law in the United Kingdom, 1802–2014. http://www. historyofosh.org.uk/brief/index.html (16 January 2015, date last accessed). 7. Health and Safety Executive. Health and Safety Statistics 2013/14. http://www.hse.gov.uk/statistics/overall/hssh1314. pdf (16 January 2015, date last accessed). 8. Rushton L. Occupational Cancer Burden Research. http:// www.hse.gov.uk/cancer/research.htm (16 January 2015, date last accessed). 9. Health and Safety Executive. Tackling Occupational Disease. http://www.hse.gov.uk/aboutus/occupational-disease/ (16 January 2015, date last accessed). 10. Health and Safety Executive. Beware Asbestos Campaign. http://www.hse.gov.uk/asbestos/tradesperson.htm (20 January 2015, date last accessed). 11. Construction Dust Partnership. http://www.citb.co.uk/ health-safety-and-other-topics/health-safety/constructiondust-partnership/ (20 January 2015, date last accessed). 12. Welding Fume Team. Bad Air Day—Safe Welding, Healthy People. http://www.badairday.info/home.asp (20 January 2015, date last accessed). 13. Quarries Partnership Team. Stop Dust Before It Stops You. https://www.youtube.com/watch?v=sWLPMgpMQCU& list=PLUgskOJdB41AmQcu-cPp_7xKiJq9cNZH5 (16 January 2015, date last accessed).
Downloaded from http://occmed.oxfordjournals.org/ by guest on June 7, 2016
an e-bulletin to promote the initiatives that organizations, including HSE, are undertaking to tackle occupational disease. The community provides a focal point for promoting on-going stakeholder activity and a place where others can share learning about different types of initiatives that are being undertaken. Since its launch in April 2014, the e-bulletin has attracted almost 17 000 subscribers and the community site has had over 55 000 unique page requests. HSE’s strategic intervention plans help to target efforts in those areas where we will have the greatest impact. We use a variety of engagement methods, which are dependent on the nature, severity and extent of the risk to health. This has resulted in many industry-wide and workplace-specific initiatives. HSE, as required by the Act, continues to provide expert advice and guidance, inspect, investigate and prosecute those who flout the law and put people’s health at risk. We also continue with initiatives to raise awareness of health risks and to promote behaviour change, such as the recent Beware Asbestos campaign [10]. HSE has been working successfully with industry partnership groups to raise awareness of long latency disease. These partnerships are composed of large and small businesses, trade associations, trades unions, training organizations, suppliers and professional bodies. The groups who have been particularly effective in delivering key messages about the long-term health effects of inhaling dust and fumes include the Construction Dust Partnership [11]; the Welding Fume Team [12] and the Quarries Partnership Team who recently developed an award-winning online animated film [13]. For those priority topics where we need to develop a better understanding of the exposed populations, we are undertaking specific research to investigate current workplace exposure scenarios and explore the impact of new technology on workplace exposures now and into the future, working with industry partners where this is appropriate. In addition, HSE is proactively encouraging collaborative activity in Europe, proposing activity to reduce exposures to harmful substances through the respiratory route. Despite all these interventions, we cannot afford to be complacent and there are still many challenges ahead. HSE has to build on the achievements of the last 40 years, move forward as a regulator and work with others to embrace the principles set out in the Health and Safety at Work Act. We believe working in partnership is key to ensuring that the UK remains one of the healthiest and safest places in the world to work. We must continue to work together with others to identify issues and focus on solutions, share good practice, develop ideas and build networks to tackle the root causes of occupational disease. This requires a long-term commitment and effort from all in the health and safety system to ensure that
duty-holders perceive that health and safety regulation is of little importance. There is overwhelming evidence that there is a positive correlation between injury rates and enforcement [12] and the HSE itself has accepted that a ‘lower level of enforcement’ would mean ‘a consequent decrease in health and safety standards throughout Great Britain, with ensuing costs to society’ [13]. It now appears that the downward trend has not only stalled but may be in reverse. Given that we have over 2 million people living with injuries or illnesses caused or made worse by work, we still have a significant problem where work is making a considerable proportion of the population ill, and this deserves to be tackled through evidence-based interventions rather than short-termism or simplistic analysis. Hugh Robertson Senior Policy Officer, Trades Union Congress, London, UK e-mail: [email protected]
References 1. Hansard. 19 November 1968, vol. 773, cc1116-24. 2. Bonnell J. A. Br J Ind Med 1973;30:199–201. 3. HSE. 2004. Thirty Years on and Looking Forward. 4. Br J Ind Relat 1976;14:92–101. 5. HSE Annual Statistics. October 2014. 6. DWP. Good Health and Safety, Good for Everyone. March 2011. 7. Lofstedt. 2011. Reclaiming Health and Safety for All. 8. Young. 2010. Common Sense Common Safety. 9. Triennial Review Report: Health and Safety Executive, Temple January 2014. 10. HSE. 2014. Costs to Britain of Workplace Fatalities and SelfReported Injuries and Ill Health, 2012/13. 11. Daily Telegraph. Speech in Maidenhead. 5 January 2012. 12. http://www.tuc.org.uk/sites/default/files/HSinspection.pdf (12 November 2014, date last accessed). 13. HSE. 2011. Impact Assessment for the Proposed Replacement of the Health and Safety (Fees) Regulations 2010.
doi:10.1093/occmed/kqv016
Working for a healthier future The Health and Safety at Work Act received royal assent 40 years ago and provided a new ‘goal setting’ regulatory framework for occupational health and safety in Great Britain. The Act implemented the recommendations of the 1972 Robens Report and introduced a new non-prescriptive model, based on the view that ‘those that create risk are best placed to manage it’ [1], an enduring © Crown copyright 2015
principle that remains relevant today. Two recent reviews of the Health & Safety Executive (HSE) and health and safety regulation have supported this view. The 2013 triennial review of HSE found that ‘the Act has stood the test of time’ [2] and endorsed the risk-based approach to regulation. An earlier review by Prof. Löfstedt [3] sought views from a wide range of organizations and found
Downloaded from http://occmed.oxfordjournals.org/ by guest on June 7, 2016
that of Professor Lofstedt [7] in 2011 which proposed no changes to the Act itself, beyond one on self-employment which was rejected by the government who came up with their own, very different, proposal. However, the broad conclusion that the HSWA was still relevant today was also made by Lord Young [8] and also Martin Temple [9] in their reviews, where they also reported general support for the Act from stakeholders such as employers, unions and safety professionals. So why have the changes happened? In part, it is simply that modern politicians have little direct knowledge of the world of work and are likely to be influenced by the sensationalist reporting of ‘health and safety’ by the media. However, there is also an ideological basis for it. This government is committed to cutting regulation and reducing what it perceives as ‘burdens’. The emphasis has therefore moved away from protection as the government has been swayed by arguments of the business benefits of reducing regulation over the advantages to the individual worker, despite the economic evidence for deregulation never having been demonstrated. The HSE estimates that the cost of health and safety failings, excluding cancers, is £14.2 billion [10]. Another factor is that government ministers, of any party, are likely to prioritize those issues which have an immediate effect. These are the high-injury or high-profile safety issues rather than long-term effects which will not be known about (or reported) for some years. The average health and safety minister lasts less than 2 years whilst occupational cancers are unlikely to show up until decades after exposure. Hence the priority given to process safety over occupational health issues. The unanswered question is whether the changes are likely to lead to an increase in injury and illness. Is occupational health and safety more about workplace culture rather than legislation or does one drive the other? When the government attacks the ‘health and safety culture’ itself, as the prime minister has done [11], and introduces reductions in both the funding of the regulator and their ability to inspect, that helps create a culture where
178 OCCUPATIONAL MEDICINE
example in workers manufacturing asbestos sheeting or pipes, for others the cause is less clear. We know that this is exacerbated by the difficulties in reporting and capturing information on occupational disease. Latency periods of up to 30 years between exposure and development of ill-health and/or disease make the links even more difficult to establish. We also need to consider situations where exposed populations are changing. There has been significant change in Great Britain’s industrial structure, labour market and working population since 1974. Trades people like plumbers and demolition workers working with legacy products are now considered to be most at risk from asbestos; a much more challenging problem where the risks are sometimes less obvious to those exposed. Current estimates suggest there are at least 13 000 [7] deaths from occupational lung diseases and cancers each year caused by past exposures, primarily to dust and chemicals at work. More than half of the 8000 cancer deaths were caused by past exposures to asbestos (mesothelioma or asbestos-related lung cancer). A significant number of deaths from occupational cancer are due to lung cancers attributable to past exposure to respirable crystalline silica, diesel engine exhaust emissions and mineral oils [8]. Tackling occupational disease, including cancers and respiratory diseases, is high on HSE’s agenda. Just as with every other aspect of driving up health and safety performance, HSE cannot tackle things alone. We need a mix of employers and trade unions, and occupational medicine and occupational hygiene professionals to work together to tackle these issues. We need to ensure that we have a range of activities in place if we are to make progress—with all of us doing what we are best placed to do to improve occupational health in Great Britain. By developing a common understanding of the challenges we face, we can identify a realistic picture of what we are able to achieve. We see HSE as a catalyst on this—one part of the solution in tackling the challenge of occupational disease. In 2013, HSE brought together professionals from across the health and safety community to discuss new and innovative ways to help prevent occupational disease. Since then, we have been working with others to develop programmes of activity to raise awareness and promote behavioural change; we are also undertaking focused research in priority areas. Tackling health issues also forms part of HSE’s inspection and enforcement activities; a national targeted inspection focusing on health risks for construction workers saw enforcement action taken at one in six of the hundreds of sites visited. HSE has set out the importance it places on tackling occupational disease. Our dedicated webpages [9] provide an overview of the problems and the industries most affected by respiratory diseases and cancer. We have also established an online community and
Downloaded from http://occmed.oxfordjournals.org/ by guest on June 7, 2016
health and safety regulation is overall broadly supported and that proportionate risk management can make good business sense. The Act replaced detailed, industry-specific regulations, bringing an additional 8 million workers into its scope and, for the first time offered protection to others affected by work activities. It created a flexible system based on a goal setting approach, introducing codes of practice and guidance to support employers. The new regime was based on the principles of consultation and engagement, and was designed to deliver a proportionate, targeted and risk-based approach. When HSE was established in 1975, its first director general, John Locke, described the Act as ‘a bold and far-reaching piece of legislation’ [4]. The introduction of the Act was an acknowledgement that the piecemeal approach of earlier legislation had failed to keep up with industrial and technological developments. The Act imposed a range of duties on employers and employees, designers, manufacturers and suppliers of articles and substances for use at work. The reduction in the number of workplace fatalities since the introduction of the Act, from 651 in 1974 to 133 in 2013–14, is a remarkable achievement. Statistics also show a downward trend in occupational ill-health. In 2001–02, 33 million working days were lost due to ill-health [5]; by 2013–14, this figure had reduced to 23.5 million working days. Although this indicates that some progress is being made, an estimated 1.2 million people are still suffering from an illness that they believe was caused, or made worse, by their current or past work. We cannot afford to be complacent—the number of people being made ill or dying prematurely each year because of occupational disease is still too high. Chronic illness has a huge impact on both the individual and their families. Many find their life permanently affected; they may be unable to return to work, or suffer financial consequences, such as loss of income or extra expenditure associated with illness. Dr Charles Thackrah, a Leeds surgeon and occupational medicine pioneer, writing in 1831, suggested that dusts should be removed from factories by the use of exhaust ventilation, and following the introduction of the Factories Act (1844), the first ‘certifying factory surgeons’ were appointed. The Factories Act (1864) stated that; ‘every factory shall be ventilated in such a manner as to render harmless, so far as is practicable, any gases, dust or other impurities generated in the course of manufacture, that may be injurious to health’ [6]. Even though some of the risks associated with working with hazardous substances were known long before the Act came into force, occupational diseases—particularly those with long latency— remain challenging to address. Although some cases of ill-health, such as mesothelioma, can be clearly related to past work activities, for
Editorials 179
40 years from now long latency diseases have become a thing of the past. Kären Clayton Long Latency Health Risks Division, Policy and Operational Strategy Directorate, Health and Safety Executive, Bootle, Merseyside, UK e-mail: [email protected]
References 1. Robens A. Safety and Health atWork – Report of the Committee 1970–72 (Robens Report). London, UK: H.M. Stationery Office, 1972. 2. Temple M. An Independent Review of the Function, Form and Governance of the Health and Safety Executive (HSE) Martin Temple. https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/275233/hse-function-form-governancetriennial-review.pdf (16 January 2015, date last accessed). 3. Löfstedt RE. Reclaiming Health and Safety for All: An Independent Review of Health and Safety Legislation. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/66790/ lofstedt-report.pdf (16 January 2015, date last accessed). 4. Health and Safety Executive. The History of HSE. http:// www.hse.gov.uk/aboutus/timeline/ (16 January 2015, date last accessed). 5. Health and Safety Executive. Historical Picture: Trends in Work-Related Injuries and Ill Health in Great Britain Since the Introduction of the Health and Safety at Work Act (HSWA) 1974. http://www.hse.gov.uk/statistics/history/historicalpicture.pdf (16 January 2015, date last accessed). 6. Eves D. Two Steps Forward, One Step Back: A Brief History of the Origins, Development and Implementation of Health and Safety Law in the United Kingdom, 1802–2014. http://www. historyofosh.org.uk/brief/index.html (16 January 2015, date last accessed). 7. Health and Safety Executive. Health and Safety Statistics 2013/14. http://www.hse.gov.uk/statistics/overall/hssh1314. pdf (16 January 2015, date last accessed). 8. Rushton L. Occupational Cancer Burden Research. http:// www.hse.gov.uk/cancer/research.htm (16 January 2015, date last accessed). 9. Health and Safety Executive. Tackling Occupational Disease. http://www.hse.gov.uk/aboutus/occupational-disease/ (16 January 2015, date last accessed). 10. Health and Safety Executive. Beware Asbestos Campaign. http://www.hse.gov.uk/asbestos/tradesperson.htm (20 January 2015, date last accessed). 11. Construction Dust Partnership. http://www.citb.co.uk/ health-safety-and-other-topics/health-safety/constructiondust-partnership/ (20 January 2015, date last accessed). 12. Welding Fume Team. Bad Air Day—Safe Welding, Healthy People. http://www.badairday.info/home.asp (20 January 2015, date last accessed). 13. Quarries Partnership Team. Stop Dust Before It Stops You. https://www.youtube.com/watch?v=sWLPMgpMQCU& list=PLUgskOJdB41AmQcu-cPp_7xKiJq9cNZH5 (16 January 2015, date last accessed).
Downloaded from http://occmed.oxfordjournals.org/ by guest on June 7, 2016
an e-bulletin to promote the initiatives that organizations, including HSE, are undertaking to tackle occupational disease. The community provides a focal point for promoting on-going stakeholder activity and a place where others can share learning about different types of initiatives that are being undertaken. Since its launch in April 2014, the e-bulletin has attracted almost 17 000 subscribers and the community site has had over 55 000 unique page requests. HSE’s strategic intervention plans help to target efforts in those areas where we will have the greatest impact. We use a variety of engagement methods, which are dependent on the nature, severity and extent of the risk to health. This has resulted in many industry-wide and workplace-specific initiatives. HSE, as required by the Act, continues to provide expert advice and guidance, inspect, investigate and prosecute those who flout the law and put people’s health at risk. We also continue with initiatives to raise awareness of health risks and to promote behaviour change, such as the recent Beware Asbestos campaign [10]. HSE has been working successfully with industry partnership groups to raise awareness of long latency disease. These partnerships are composed of large and small businesses, trade associations, trades unions, training organizations, suppliers and professional bodies. The groups who have been particularly effective in delivering key messages about the long-term health effects of inhaling dust and fumes include the Construction Dust Partnership [11]; the Welding Fume Team [12] and the Quarries Partnership Team who recently developed an award-winning online animated film [13]. For those priority topics where we need to develop a better understanding of the exposed populations, we are undertaking specific research to investigate current workplace exposure scenarios and explore the impact of new technology on workplace exposures now and into the future, working with industry partners where this is appropriate. In addition, HSE is proactively encouraging collaborative activity in Europe, proposing activity to reduce exposures to harmful substances through the respiratory route. Despite all these interventions, we cannot afford to be complacent and there are still many challenges ahead. HSE has to build on the achievements of the last 40 years, move forward as a regulator and work with others to embrace the principles set out in the Health and Safety at Work Act. We believe working in partnership is key to ensuring that the UK remains one of the healthiest and safest places in the world to work. We must continue to work together with others to identify issues and focus on solutions, share good practice, develop ideas and build networks to tackle the root causes of occupational disease. This requires a long-term commitment and effort from all in the health and safety system to ensure that
