The future of occupational disease surveillance was discussed. Challenges for the future were described in terms of state based surveillance, collaboration of federal agencies, exposure surveillance, standardizing data collection, and employer reporting of occupational illness and injury. State health departments have been encouraged in recent years to improve their ability to perform surveillance and to direct their surveillance efforts in ways that will result in effective worksite intervention. The future success of state based surveillance efforts will be determined in part by the extent to which occupational diseases are prevented as a result of the surveillance. A pilot program of state based surveillance has been successful and will probably be expanded. NIOSH, the Bureau of Labor Statistics (BLS), and the National Center for Health Statistics were engaged in a joint effort to improve national estimates of the true incidence of occupational diseases. Utilizing existing data sources such as those of OSHA and the Mine Safety and Health Administration was considered to be essential, since having to perform large scale national surveys is very expensive. The most difficult challenge in the area of surveillance was considered to be employer underreporting of illness and injury. Parallel data systems will have to be maintained in order to assess the degree of underreporting. It was noted that although underreporting limits the usefulness of employer generated data, the data should still be useful, especially for monitoring acute injuries. The author concludes that continued cooperation between state and federal agencies is essential to maintain the progress of recent years and achieve new gains in occupational disease surveillance.