Five key factors that will impact on Maori health over the next twenty-five years are examined: demographic change, participation in society, environmental adaptation, access to te ao Maori, and policies for health. Arising from these determinants a number of implications are discussed including changes in the demographic dependency ratio as the balance between those who are either too young or to old to work alters; the extent of Maori participation in the wider society; tools for improved adaptation to modern environments; access to culture and heritage; recognition of the health impacts of government policies as well as policies and programmes developed by Maori authorities. The importance of Maori leadership and a capacity for long term planning is emphasized.