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India is the second highest most populous country in the world after China. It is also becoming an economic powerhouse having already achieved fourth position globally (purchase power parity). In spite of technological advances, the health scenario in India presents a paradoxical situation with lack of basic occupational health services for the majority of working population.India’s population crossed 1.21 billion according to the census carried out in 2011, 833 million reside in rural area and 377 million reside in urban area. Current population estimates exceed 1.3 billion. Those in working age group are estimated to be 63.6%. More than 90% work in the informal economy, mainly agriculture and services (60% self-employed and 30% without regular jobs). Less than 10% have jobs in the organised sector; mainly industry, mining and some services. The proportion of workers engaged in agriculture is steadily declining and that in services is increasing.Leading occupational risks are accidents, pneumoconiosis (especially silicosis) and lung diseases, musculoskeletal injuries, pesticide poisoning, asbestosis, noise induced hearing loss and workplace stress. Women are subjected to the dual burden of home work and occupation. Statistics on accidents and occupational illnesses is not easily available. Typical employer employee relationship cannot be established in self-employed, home based work and much of the unorganised sector. There are no fixed wages, leave or social security for this population for occupational injuries and diseases. Further, the focus on health and safety is lacking in the expanding service sector.Important OSH needs include legislation to extend OSH coverage to all sectors of working life, spreading stakeholder awareness about occupational health, development of OSH infrastructure and professionals, integration of occupational health with primary health care.Equity in health system cannot be achieved in India unless the lack of basic occupational health services for all working population is addressed.