NIOSH's successful work with commercial fishermen demonstrates that by merging injury epidemiology with engineering interventions and industry input, effective safety programs can be designed and implemented. The public health approach of using data and research to drive collaborative programs to address occupational safety and health issues has proven effective. The working relationships that NIOSH staff developed with other federal and state agencies, nonprofit groups, and the industry, took time. NIOSH had to prove that it had something to offer and that it would treat the other groups as collaborators. The results have been impressive. The number of all occupational fatalities in Alaska has decreased by 67 percent from 1990 to 2005, the number of occupational fatalities in fishing events declined by 73 percent. The Alaskan annual occupational fatality rate has dropped from more than five times the national rate in the 1980s, to three times the national rate in 2004. The public health approach to occupational injury prevention has proven successful in Alaska and serves as an example for application to other industries and areas of the country.