Abstract
This article is a comparative-historical study of ILO action on occupational safety and health (OSH) as fundamental rights. In the two decades following the adoption of the International Covenant on Economic, Social and Cultural Rights, the ILO used a realist lens and prioritized the idea that OSH were dependent upon economic preconditions for their protection. This history is revisited in the light of the new complex of global health uncertainty and the addition of OSH to the framework of fundamental principles and rights at work. The analysis highlights the applicability of a realistic vigilance approach to the ILO's current work on OSH.