New Zealand workers die from exposure to harmful substances 10 times more often than from accidents, Worksafe says.
About 60 people die each year from accidents at work, but research carried out for Worksafe in 2012 showed that between 600 and 900 die each year from work-related illnesses, the watchdog organisation said.
Chief executive Nicole Rosie told a conference in Nelson this week the number one killer was cancer linked to exposure from asbestos.
"Second in there is silicosis, then exposure to [other] hazardous substances and fertilisers fit into this category.
"Also in this area is shift work, and hours of work which are highly co-related with both cancer and heart disease."
The Ministry of Health said asbestos exposure was mainly the result of breathing in air that contained asbestos fibres, including from windblown soil from hazardous waste sites.
Ms Rosie said Worksafe had been set three key targets since it was established, including a 25 percent reduction in workplace fatalities, serious harm and time away from work.
She said at the moment New Zealand averaged 2.6 deaths per 100,000 workers annually in workplace incidents compared with with 0.5 to 0.8 deaths per 100,000 workers in the UK and 1.5 deaths per 100,000 in Australia.
Ms Rosie said it was not correct that New Zealand had higher risk industries than others.
"All countries that have put a focus on health and safety have seen reductions in statistics. There is a method to improving health and safety and there's no reason why New Zealand can't be world class."
Statistics showed workers in the agricultural sector were between seven and nine times more likely to die than the average for New Zealand workers. The predominant cause of death was exposure to harmful substances such as the chemicals in fertilisers.
Automation had led to a drop in forestry and construction deaths, but exposure to harmful substances remained the predominant cause of death in the agricultural sector.
Ms Rosie said foremost of the three elements that made health and safety effective were leadership.
"The leader at the top who thinks it's all compliance, a waste of time and all about paperwork, then we know we will not get a change in health and safety performance.
"Best Practice organisations, without a doubt the first thing they need to attend to is their leaders, and the focus of their leaders, and those at the forefront will invariably say, the first person they had to change was themselves."
Ms Rosie said work-fit employees, which was linked to fatigue, was a critical issue that was going to need better management.
"People must have sufficient time between rosters to sleep. The traditional eight-hour day has changed and the way we manage things like fatigue has to change for us to be able to cope with a rapidly changing world."
She said a risk-based rather than rules-based approach was important.
"We will not be able to create the rules fast enough to deal with the changing dynamics and environment we're now living in."
Employee engagement in the health and safety process was also important, Ms Rosie said.