If recordable injuries and occupational diseases are declining, why is it that disability is rising, not just among those reaching retirement age but far earlier in life? Workers compensation schemes, once largely focused on treatment and compensation of workplace injuries, have been besieged by claims for stress and chronic musculo-skeletal disorders, arising not just from the sectors of previous concern but increasingly from the rapidly expanding service sector -- finance and health care, education and entertainment -- previously imagined as "safe work." Perhaps most worrisome, few in the workforce appear fit enough to continue work much beyond traditional retirement age despite lengthening life expectancy and active discussions of raising the Social Security age. Admittedly many of these phenomena represent not just health consequences of work but also changes in social expectations and preferences, as was evident when claims for disability rose rapidly during the Great Recession in response to job scarcity. But underlying it all is a very large burden of sub-optimal health.