“Medicine has imperceptibly led us into the social field and placed us in a position of confronting directly the great problems of our time.” -Rudolf Virchow, Report on the Typhus Epidemic in Upper Silesia, 1848 This short note, adapted from a document drafted in the context of the launch of the Public Health Foundation of India, attempts a brief overview of certain key public health challenges and issues in India, some of which are not always widely recognized. While delineating these challenges, an attempt has been made to move beyond a purely bio-medical approach, towards a social medicine perspective, which gives central importance to social processes underpinning public health. Many of the statements are at a level of broad generalization, and of course may need to be refined and qualified in specific situations. Epidemiological Transition or Epidemiological Polarization? “This epidemiological polarization is characterized by a prolonged coexistence of two mortality patterns, one typical of the developed societies (chronic and degenerative), and the other of poor societal living conditions (infectious and parasitic) combined with high mortality from accidents and violence. … This profile indicates the persistence of large health gaps between different social groups and areas within countries. … Increasing gaps in income and social inequalities still raise concerns because of theireffect on the widening of mortality differentials in the Region.” - Carlos Castillo-Salgado, Health