Little progress has been made in the past 30 years in closing the gap between Aboriginal and non-Aboriginal Australians in terms of their educational outcomes, rates of incarceration, risks for chronic illnesses and reduced life-expectancy. The Western Australian Aboriginal Child Health Survey is the first population based survey of its kind developed specifically to inform policy and planning to improve the developmental health of Aboriginal children and youth. A random representative sample of 5,289 Aboriginal children aged 0-17 years, including 1,480 adolescents aged 12-17 years was surveyed through household based interviews with carers and adolescents, questionnaire data from schools and consensual record linkage to health service and education system data. The findings describe the prevalence and relative impact of developmental and environmental factors associated with the health and mental outcomes of Aboriginal adolescents. The major portion of the overall burden of disorder is now evident in the more urbanised living settings of Aboriginal families. Some health risk behaviours such as poor dietary intake, smoking, unprotected sex and insufficient physical exercise are more common in Aboriginal adolescents. However, others such as alcohol and marijuana use and suicidal behaviour occur at similar levels to those seen in non-Aboriginal youth.