Over the past two centuries, effective building and land use regulation have dramatically reduced incidences of urban conflagration and epidemic disease. In the developed world, such regulation has resulted in successful risk reduction and hazard response adaptation. However, disaster risk reduction strategies for low- and middle-income countries have largely ignored building and land use regulation. Furthermore, experience has demonstrated that the simple transfer of building codes from highly developed to developing countries is often counterproductive. A review and analysis of regulatory experience must be better applied to the creation of regulatory capacity in developing countries. Knowledge must be appropriately adapted to local conditions and incorporated into methods of sustainable regulatory implementation. This publication provides an analysis of available evidence to identify practical measures for increasing the effectiveness of building code implementation. Focusing on low- and middle-income countries, the authors argue for increased investment in functional building regulatory and governance systems for disaster risk reduction, while advocating a practical reform agenda for global collaboration.