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Statutory medical examinations (SME) are practiced worldwide to promote workers' health. We reviewed SME legislation and enforcement in the rapidly industrializing Asia-Pacific, compared these with laws in Europe and America, and identified areas for further development.Information on SME in 13 Asian-Pacific countries was collected by a questionnaire survey of occupational health (OH) experts from each country, supplemented by a literature and Internet search.SME laws were diverse throughout the Asia-Pacific, and were either selective or comprehensive, depending on the countries' legal systems. Common problems included manpower shortage, high costs and lack of awareness of SME. This resulted in poor compliance, which was broadly associated with the level of socio-economic development.Educating the public on OH issues would address compliance problems, as would the training and efficient deployment of OH professionals. The development of management systems and regional standards would encourage a harmonized approach towards SME. Am. J. Ind. Med. 54:78-88, 2011. © 2010 Wiley-Liss, Inc.