Abstract Outlining the economic significance of the role of global supply chains (GSCs) in the organisation of the global economy, this paper initially presents some indications of health and safety outcomes in low- and middle-income counties (LMICs) where GSCs source much of the production destined for use in advanced economies. It goes on to discuss the operational dynamics of these chains and the corporate priorities that they reflect, which, it argues, do little to improve the poor work health and safety (WHS) outcomes in LMICs. It then examines evidence for the effectiveness of various private and public regulatory strategies that are claimed to bring about improved health and safety practices and outcomes among GSC suppliers in these countries. The paper critically evaluates this evidence and argues that, while there may be some examples of effective strategies and regulatory practices in particular contexts, their overall influence remains limited. It identifies and discusses the principal reasons for these limitations and concludes that the global regulation of conditions of labour – including WHS – at the end of GSCs falls well short of universal best practice and is, more generally, insufficient to counter the economic forces working against the maintenance of adequate standards of worker protection.