The efforts to develop a public health cadre have not seen much progress in most of the Indian states, despite the recommendations of several committees appointed by the union government, and the 2022 guidelines issued for establishing them. This paper, by drawing on the views of experts in the field, examines the epistemic, structural, systemic, and administrative barriers to the establishment of such a cadre in the south Indian states. It notes that the dominance and perpetuation of biomedical view of health, poor understanding of what public health is, privatisation of healthcare, the vested interests of clinicians, consultancy firms, international funding institutions and the existing hierarchies and binaries within the system, act as major barriers to the establishment of the cadre. The paper suggests that the proposed public health management cadre needs a critical revisit in light of these impediments and concerns.