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The Russian Federation faces multiple challenges for its health and welfare systems and for the development of social policy responses. This article provides a review of some of the key challenges for social policy in Russia and assesses the adequacy of the responses to date. The author surveys recent developments in health and social welfare and makes recommendations on priorities for Russia's policy-makers and international funders. A range of public health challenges including drug and alcohol misuse, health in prisons and mental health is discussed; HIV/AIDS is singled out for particular attention. While Russia is increasingly attracting the attention of social scientists in the West, there is uncertainty about models and concepts suitable for the analysis of this complexsociety. Although empirical trends are largely discussed in this article, it is argued that theoretical development is required and some suggestions are made about concepts of the 'middle range' to assist in future analyses. Intermediate theories, such as those relating to the management of personal welfare, and development of resilience in a formerly collectivized context, are identified as having explanatory potential for this task.