The study findings reported in this issue by Dr. Harriet L. MacMillan and associates (see pages 1569 to 1578) demonstrate that aboriginal people in Canada bear a disproportionate burden of illness compared with the general population. In this editorial the author examines some of the factors that have contributed to this situation, such as poverty, cultural barriers and jurisdictional problems. The way forward lies in supporting the aspirations of aboriginal people for self-determination. Aboriginal people in Canada need to recognize and use their own professional human resources and to adopt more responsibility for improving the health status of their communities. At the same time, there is a need for greater acceptance by aboriginal people of existing initiatives for health promotion and disease prevention.