As described in Stephen Roberts' and colleagues Research letter in today's Lancet, commercial fishermen work in the most hazardous occupation in the UK, followed closely by other mariners. This result is similar to the findings of Rafnsson and Gunnarsdottir's landmark 1994 study of Icelandic fishermen and mariners. The hazard is probably similar worldwide. [2 and 3] Although many of the hazards inherent to fishing (weather, waves, risk of capsising and drowning) were known and described in classic texts (eg, the Bible, Moby Dick), these hazards have been greatly complicated during the past century, as fishing decks have become increasingly complex industrial environments. The deck of a modern fishing vessel is a pitching slippery surface with many winches, lines, booms, and pulleys, all with their hazards of injury. The worldwide realisation that something could be done to mitigate these hazards has only gained momentum during the past few decades. There have recently been productive scientific, technological, social, and regulatory approaches to the many hazards of work on the seas. Although the physiology of drowning has been well-understood for centuries, that of immersion hypothermia only became well-described in the mid-20th century. This new knowledge led to the development of immersion suits, neoprene garments which can be donned by fishermen abandoning ship in cold waters and which can keep them relatively warm and buoyant, optimally for a few hours, until rescue. Development of synthetic fabrics has made self-inflating life-rafts a practical option for many vessels, and their use in open seas is codified by the international Safety of Life at Sea convention. Wide deployment of communications satellites has permitted the development of emergency position-indicating radio beacons, which greatly facilitate the location of sinking vessels,  and satellite-based weather surveillance, which has increased the precision of weather forecasts for much of the earth. Telemedicine services delivered by satellite telephone are now commercially available for fishing and merchant vessels. There are, however, two other areas which have not been well exploited yet. Vessel stability is well understood and measurable. However, many of the vessels that sink have had their stability compromised by retrofitting and/or overloading, often by the addition of heavy machinery above deck. Another growing area is the study of human fatigue and its role in transportation incidents. Problematically, most scheduling of work time for fishing vessels still revolves around fishing seasons and long transport-times between port and the fishing grounds. Thus the performance of fishermen may often be below par because they are tired. This fatigue can lead to reduced vigilance in operating hazardous machinery and impaired judgment in deciding when to start or terminate a voyage.  Although many developed nations (including the Nordic nations, the UK, Iceland, Canada, the USA, Spain, Russia, New Zealand, and Chile) maintain large and active search-and-rescue operations or coast guards, and have improved their surveillance for these events, international agencies the International Labour Organization and, increasingly, the Food and Agriculture Organization have taken on the organising of progress for many other developing nations. [2 and 10] The industrial-scale high-seas fisheries using vessels over 24 m in length have been widely codified for safety by consensus among many nations in the 1993 Torremolinos Protocol, although formal adoption of these standards as national requirements (eg, the Commercial Fishing Vessel Safety Act of 1988 in the USA) has been variable. Where adopted, more vigorous safety regulations have already helped to prevent many deaths-well documented in Alaska -as has the implementation of rigorous training programmes by non-governmental organisations.  Organisation and regulation of fishing-vessel use, equipment, and training of personnel in the developed nations should continue to yield progress in reducing the mortality among fishermen and seafarers. However, most of the world's estimated 36 million fishermen reside in developing nations and have hardly been touched by any of these developments, often going to sea in small marginally seaworthy craft with little or no safety equipment and limited access to reliable weather predictions. This situation may now be changing: the smaller artisanal (family-operated) fisheries that are common in developing nations are also being progressively organised. A large regional meeting, including official delegations from Bangladesh, India, Indonesia, the Maldives, Sri Lanka, and Thailand, was held last year in India to address this issue and resulted in the Chennai Declaration,  which sets the stage for the application of appropriate technology, community-based training, and regulations to be implemented in these settings. Some of these approaches, imaginatively applied, may make for better lives as well as safer work-eg, by developing local fabrication of inexpensive personal flotation-devices or internet interfaces in village kiosks to provide basic health information in addition to current weather predictions and safe-fishing tips. Real progress in the developed nations' efforts to prevent fishing fatalities are just beginning. Much more work will be needed to make this occupation acceptably safe. Even more effort will be needed to spread the full benefits of new technology to the artisanal and subsistence fishermen and boats so numerous in maritime developing nations. These benefits, which include access to satellite weather prediction and simple, inexpensive measures such as flotation vests, and amendments to improve vessel buoyancy, are all within reach, provided there is sufficient international commitment.