This paper explains the options available for Australian governments to articulate and allocate responsibilities for the health and health care of Aboriginal and Torres Strait Islander people in an enduring, reliable form. It was commissioned by the Lowitja Institute – Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research in response to widespread recognition of problems in the policy and administrative arrangements for health and health care for Australia’s First Peoples, including lack of clarity about the responsibilities of governments at various levels.