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Background: As knowledge advances in the detail of the toxicology to understand the adverse outcome pathways, the translation form hazard to risk is greatly advanced by the epidemiologic contributions. In SAICM epidemiology is mainly considered in biologic and research surveillance, but somewhat in the risk assessment. Significance: For most of the developing countries, the population distribution of exposures and disease is the key consideration for acting on the management of chemicals; still, the mainstream methods and implementation neglects this area of implementation, directly related to management (regulatory and not), and communication. Content: We will present what is SAICM and where is epidemiology currently considered in the approach, highlighting the contribution to stakeholders understanding of the dimension of the problem especially considering the context of developing countries. Then we review of the contributions of epidemiology to advance chemical regulatory action to protect population’s health and assess how it is included in the SAICM. A special emphasis will be done on the contribution of epidemiology to the “risk characterization” that each country must do adequate to their environment and socio-demographic situation of their population when deciding on their acceptable risk and health impact. For this we will touch on the need for monitoring the exposure and health impact from toxicants and regulations in developing countries. We end up with calling for stronger epidemiologic methods contribution to the international management of chemicals.