Several Grand Challenges are faced by the contemporary occupational health strategies in both the industrialized and the developing world. The globalisation of economies, introduction of new technologies, new enterprise structures, new forms of work, new work organizations, demographic changes of the workforce, particularly ageing, growing mobility of working people, new schedules for working hours and high productivity and quality demands set high challenges to safety and health management, safety practices, and for safety and health services. Also climate change is going to affect conditions of work through several mechanisms. There is need to provide and modify occupational health and safety services to meet the challenges of the globalizing work life. Many of such services are outsourced and often downsized to the minimum. This is paradoxical as the scientific evidence from both the industrialized countries and from developing world show increasing needs for closer contacts between the workplaces and occupational health and safety services. The most advanced countries and highly developed companies have found high-quality work environment conducive to health and safety, work ability and wellbeing of workers, but also to productivity and quality of products and services. They also have started to address to the new challenges by broadening the scope of occupational health and safety. Unfortunately those most in need, such as small enterprises, self-employed and informal sector are least served by these services, although there is likely that the highest benefits from services are found where the needs and risks are the highest. The new approach proposed by joint action of the ILO, WHO and ICOH on basic occupational health services, BOHS, provides a new approach for meeting the needs of the most underserved sectors.