Workers in the building, renovation, and demolition of roads and commercial structures in the U.S. suffer a disproportionate share of occupational fatalities and lost-time injuries. Nearly all of the injuries and deaths are preventable. The fatality rate from work-related ailments, such as cancers and silicosis, is believed to be excessive, but is not generally computed. The safety and health problems are tied largely to the construction industry's organization and how the work is performed. Many hazardous exposures result from inadequacies in access to information, measurement technology, and personal protective equipment. Potential solutions are in labor-management site safety and health planning and management, education and training of workers and supervisors, new technologies, federal regulation, workers' compensation law, medical monitoring, and occupational health delivery. Public health opportunities involve health care delivery systems, improved preventive medicine, disability determination and rehabilitation programs, and research, beginning with the standardization of data to monitor these problems.