The world of work is changing rapidly. Occupational health and safety and environmental health increasingly are seen as a joint product with goods and services, requiring line-management responsibility. This new specialty is encouraged to be strategic rather than tactical to optimize its value in the core business of industry-related medical needs. Because employers, governments, and workers bear major costs, they have a strategic interest in outcomes. Strategic opportunities exist for reduction of the impact of occupational injury and disease; stewardship of the environment, product, and process; the reduction of non-occupational health care costs; for having occupational and environmental health and safety follow best business practices and be prominent in the leadership of change; for optimizing human relations/labor policies and practices; and for meeting regulatory requirements. The strategic position of the specialty can be strengthened through discussion, dialogue and vision development, role definition, establishment and use of performance indicators, improved career structures and training, and a proactive approach to quality initiatives, research, marketing, and strategic alliances.