Considerable progress has been made in recent years in improving health and safety at work. For many people work does not take place in a fixed location but involves a large number of tasks associated with the control of a vehicle and exposed to all the hazards of a heavily trafficked environment. For those who drive lorries and buses there has been a deterioration over the last 20 years in work conditions. This deterioration is largely the result of traffic congestion and its associated air and noise pollution but also with the pressures of maintaining a demanding schedule in circumstances that make that task almost impossible. A lorry or bus driver is at the sharp end of the failure of our transport system. Buses find it almost impossible to maintain schedules and the pressure on lorry drivers to meet demanding schedules is intense. The driver in both circumstances has to absorb the failures of the transport system in the form of increased stress levels, conflict with customers and the intensification of a wide range of work pressures in a hostile environment. These circumstances damage the health of drivers in a way that is unacceptable. The objectives of this report are to review the evidence on the work related health problems of drivers and to make recommendations for a significant improvement in the working environment of this neglected group of professionals.