Abstract: The thesis is a study of a single community, its health, expectations and aspirations. It is a study of understand in g and responsibility in the context of dependence. The primarily ethnographic work for this thesis was undertaken in Ngukurr over thirteen months between 1999 and 2002. Ngukurr is a remote town on the south east border of Arnhem Land in Australia’s Northern Territory. Its long term residents are Aboriginal people. The thesis presented here examines these people’s understanding of health and illness in their community and their attainment of a good life. My study focuses on issues around people’s engagement with and disengagement from, the management of their health and health service delivery. My thesis is guided by the following questions: • how do people assess their health status? • how a republic health services perceived? • what expectations does the community have about the type and quality of the services provided? • do people seek an active role in the management of their health? People’s attitudes to and expectations for their health are examined in the context of a history of direct welfare dependence till the mid nineteen seventies; followed by local self government in which fiscal and administrative responsibility were held by Government or outside individuals. The evidence for health status, morbidity, and mortality among the remote indigenous population is significantly worse than non indigenous Australians and h a s been the subject of extensive Commonwealth and State health programs to little obvious effect. The literature I survey shows that people in poor communities rate their health more highly than the objective data suggests. Ngukurr residents rate their health in a similar way, b u t their apparent satisfaction masks complex beliefs about illness and concerns about health. I demonstrate that the community believes that outside influences are more important than personal actions as a cause of poor health, that there is little respect for the community’s view of health or health services, and in consequence there is little point in taking personal or collective responsibility. Ngukurr residents are not disinterested in health. They are acutely aware of the patterns of morbidity and mortality in their community and consider these to have a negative impact on their quality of life. Their ability to bring about changes in these patterns is limited by different paradigms of health and illness which sometimes appear as fatalism, powerlessness in the non-Aboriginal domain, loss of confidence due to poor communication with non indigenous providers, and consequent low expectations with regard to personal and community health. This creates a challenge for current policies to devolve management responsibility for health services to local communities. Policy makers should make considerable efforts to understand local health beliefs and value systems and ensure that changes are appropriate, rather than making changes in health systems based on non-indigenous understandings of needs.