Rationale: To identify the possible savings in the cost of primary health care of chronic disease associated with the participation by Aboriginal people in land management. In so-doing we investigate the connection of health of Aboriginal people and the extent of their involvement in land management in remote-very remote Australia. Methods: Possible savings in primary care costs for hypertension, renal disease and diabetes were estimated using multivariate regression to examine associations between Aboriginal involvement in land management and Northern Territory Government-defined chronic disease outcomes, controlling for socio-demographics and health behaviours. Participants were 298 Aboriginal adults aged 15-54 from a remote Aboriginal community, classified by their chronic disease status and a previously validated measure of self-reported participation in land management activities. Results: Land management participants were significantly less likely to have diabetes, renal disease or hypertension. Using the sampled mean value of engagement in land management, we found the expected net annual savings for the community from involvement in land management of $268,000. This equates to a net present value of primary health care savings in chronic disease care for the sampled community over 25 years of $4.08 million. This estimate does not include further savings in other primary health conditions nor costs anticipated in referred and hospital-based health care for chronic disease. Conclusion: While the association between involvement in land management and better health requires further clarification, our findings indicate that significant and substantial primary health care cost savings may be associated with greater participation in land management activities. These estimated savings are in addition to the market and non-market economic benefits of a healthier population and environmental benefits.