This year marks the 20th anniversary of the Construction Research Program at the National Institute for Occupational Safety and Health (NIOSH). The Program started in 1990 through a $1 million appropriation and a Congressional mandate to "develop a comprehensive prevention program directed at health problems affecting construction workers by expanding existing NIOSH activities in areas of surveillance, research, and intervention." The United States Congress provided additional direction and funding over the next five years, adding new focus areas such as traumatic injury, musculoskeletal disorders, surveillance, and intervention research. Support was provided for a cooperative agreement for an external National Construction Center with the aim to develop prevention-oriented strategies and programs, to provide linkages to the construction community, and to coordinate applied research. Before 1990, construction safety and health was a relatively obscure topic with few researchers specializing in this area of research. Information describing safety and health conditions in the industry was difficult to find. The fatality rate for the U.S. construction industry as a whole was estimated to be 25 per 100,000 full time equivalent (FTE) employees, the fatality rate for structural iron workers in 1992 was 143.3 deaths per 100,000 FTE, and the rate for electric power line installers was 149.3 deaths per 100,000 FTE. Yet, there were few regular conferences for both researchers and construction industry practitioners to share problems and solutions. When the NIOSH Construction Program was started, most decisions in safety and health were based on anecdotal information, occasionally using fatality data. There was, for instance, little awareness about non-fatal, but potentially disabling, conditions like musculoskeletal disorders or even of ergonomic interventions that would prevent these troubling conditions. Apart from confined space entry risks and hazardous waste operations, including asbestos management, there was no significant awareness of health hazards. That has changed substantially by characterizing outcomes using new data such as non-fatal injury and illness surveys, workers compensation claims, and health care utilization. Today there is a much more balanced, evidence-based perspective on the occupational safety and health needs of the construction industry. There is a rapidly expanding body of applied research that is steadily improving in scientific quality and in ease of practical application. The collaboration between NIOSH and the National Construction Center is a model of public-private partnership in the industry. The collaboration has created a strong foundation for construction partnerships, especially as the program is poised to work with industry partners to move research to practice (r2p) in the coming years.