Offshore fishing is a sizeable industry in the UK and it is one of the most dangerous occupations. Long hours, extreme weather and working with heavy machinery contribute to a high mortality rate in fishermen. Despite a long-standing acknowledgement of the dangers and high mortality associated with fishing, there has been little research in this field. Although there have been developments within the industry in terms of safety, there has been little emphasis on the relationship between health, the environment and performance at work. This paper reviews the international literature on the health of fishermen, and describes the main findings and highlights gaps in current evidence. Areas for further research that would inform the future development of an evidence-based occupational health service for the offshore fishing industry are discussed.