As the most populous democracy in the world and an aspiring global superpower, India needs to nurture its human capital through continually improving occupational safety and health (OSH). At present, measuring and improving India’s workforce OSH is challenging because only 10% are employed in the organized formal sector, mainly in industry, mining and some services, and all Indian workers are confronted with the following conditions: oversupply of cheap labor, paltry public spending on OSH, stakeholder resignation to unsafe OSH conditions, inadequate implementation of existing legislation, multiple infrastructure problems including unenforced traffic management, lack of reliable OSH data and measurement, and a shortage of OSH expertise and professionalization institutions. The four most important needs for improving Indian OSH are: (1) legislation and enforcement to extend OSH coverage to both the informal and formal economic sectors; (2) dissemination of and appropriate scaling of model OSH programs along with stiffer financial and nonfinancial penalties for violations of Indian OSH laws; (3) increased public expenditures for adequate staffing of OSH agencies and their integration with primary health care in India; and (4) development of OSH infrastructure and professionalization processes and institutions.