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Introduction: Many of the health problems faced by rural and remote Aboriginal people have been attributed to a poor living environment. In the mid 1980s we began a process of defining problems with the immediate living environment that would affect health. These related particularly to safety, washing and hygiene practice., Methods: Between January 1999 and November 2006 we undertook a standardised and detailed assessment of housing in Aboriginal communities. This involved an initial assessment of 250 items in each house and living area, focusing on performance and their impact on these healthy living practices. At the first survey-fix we implemented a limited cost repair of non-functioning health hardware and then six months later returned to the communities for a repeat assessment to examine improvement in performance., Results: Between January 1999 and November 2006 we assessed 4,343 houses in 132 communities in four States and the Northern Territory during survey-fix 1 (SF1) and have repeated that survey-fix assessment (SF2) in 3,448 houses in 112 of those communities. This survey demonstrates extraordinarily poor performance of Aboriginal houses. In the survey period, 71,869 items referred for repair by survey teams were inspected by licensed electricians or plumbers and 49,499 of these have so far been fixed. Only 10% of these house items requiring repair were due to vandalism or misuse., Conclusion: Improvements in the living environment for Aboriginal people will require a sustained commitment to the planning, funding and implementation of maintenance programs in addition to adherence to the design, construction and supervision detail outlined in the National Indigenous Housing Guide.