This commentary examines the history of occupational disease and injury surveillance. The authors discuss the early days of federal surveillance efforts, examine barriers to reporting, and assess the current state of federal and state oversight. Understanding the history of occupational health surveillance is important because the current surveillance system has serious flaws. The Government Accountability Office estimates that under the current system, up to 80 percent of worker illnesses and injury are missed.

Key Findings:

• Initial calls for surveillance of workplace injuries and diseases began in the 1910s by labor activists, who were also involved in wage and work hour reforms.
• By the mid-1910s, several states and the federal government had surveillance mechanisms in place, but efforts to improve surveillance stalled in the ensuing decades.
• The 1970s saw increased workplace surveillance with the passage of the Occupational Health and Safety Act, which implemented improved reporting from employers and new governmental powers to evaluate health hazards. However, an effective surveillance system never materialized from these efforts.
• The United States is the only developed country without an effective national system to report occupational disease and injury.

The Unites States lags behind other industrialized countries in monitoring workplace disease and injury. Its history of workplace health surveillance efforts has not resulted in an effective, fair and systematic process to protect the well-being of workers.