Health and Safety (H&S) regulation has been one of the most successful public health interventions of the twentieth century, dramatically reducing fatal workplace injuries in high-income countries. However, while H&S has been effective in preventing death and acute injury, it has been far less effective in addressing the dominant occupational health problem of the contemporary workforce: work-related disability. This commentary argues that traditional H&S frameworks – designed for external, acute, measurable hazards – are ill-suited to chronic, multifactorial, context-dependent conditions such as musculoskeletal pain, burnout, and common mental disorders. It examines the limitations of ergonomics when applied through a narrow biomechanical lens, critiques the conflation of compliance with health outcomes, and identifies the medicalization of a systems problem. The commentary then proposes a modern H&S paradigm focused on sustaining work capacity, integrating psychosocial hazards, prioritizing autonomy and recovery, and accepting the uncertainty inherent in chronic health problems. Saving lives was the first chapter. Preventing disability must be the next.

Occupational health, Work disability, Health and safety, Ergonomics, Psychosocial hazards, Prevention