While these programs are diverse, there are factors that many of them have in common. The first is that the majority could be described as Ôbottom up' rather than Ôtop down.' Most of them originated at the local level, driven by priorities decided by individual Indigenous communities. Some employed methodologies pioneered elsewhere, but these were adapted so they have local relevance. Most of the programs depend on the knowledge, authority and support of community Elders for their success. They show that improved health outcomes are less likely to come from miracle cures or imposed new treatment regimes than from the ability of Indigenous people to determine their own futures and be accountable for decisions impacting on their own communities" (from the Introduction).