In the opening chapter I documented the failure of America's system of occupational safety and health regulation to achieve its objective of a safe workplace. The rate of injuries has increased during the 1980s, while occupational disease silently takes, in all probability, an even larger toll. The burden falls most heavily on those who can least afford it: minorities and those with the lowest pay and fewest opportunities for advancement. Above all, the cost of this intensifying injury, disease, and death is unnecessary; other countries facing the same economic constraints do achieve higher levels of safety.

What then should we do to bring about reform? How far-reaching must the changes be, and in what direction? Before investigating these questions, we need to know just what it is we want to accomplish and how we will measure our progress. This is more difficult than one might think. The naive approach would be to aim for minimum risk; this, after all, would have the virtues of simplicity, ease of assessment, and apparent fairness. Unfortunately, it does not stand up to scrutiny: (1) The simple minimization of risk fails to recognize that risk often has rewards. If a small reduction in risk requires a substantial loss in the quality or affordability of the products labor is producing, it may not be worth it. Building an urban subway system, for example, may be inherently dangerous, but not to build it, or to set such high standards for workers' safety that the subway becomes too expensive, may impose a higher cost in air pollution, increased traffic accidents, and so on.