An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources.

Affordable access to safe drinking water is essential to community health, yet there is limited understanding of water insecurity among Native Americans. Therefore, the focus of this paper is to describe Apsáalooke (Crow Indian) tribal members’ experiences with water insecurity. For Apsáalooke people, local rivers and springs are still vitally important for traditional cultural activities. We interviewed 30 Native American adults living on the Crow Reservation in Southeastern Montana. Participants answered six open-ended interview questions about their water access, costs of obtaining water and changes in their domestic and traditional water uses. Participants emphasized how the use of water has changed over time and described the complex challenges associated with addressing water insecurity in their community, including the importance of considering the spiritual and cultural impacts of water insecurity on health. Water insecurity is a growing global problem and more attention and efforts are needed to find appropriate and affordable solutions.

It is well established that climate change is already causing a wide variety of human health impacts in the United States and globally, and that for many reasons Native Americans are particularly vulnerable. Tribal water security is particularly threatened; the ways in which climate changes are damaging community health and well‐being through impacts on water resources have been addressed more thoroughly for Tribes in coastal, arid, and sub‐arctic/arctic regions of the United States. In this article, Crow Tribal members from the Northern Plains describe the impacts of climate and environmental change on local water resources and ecosystems, and thereby on Tribal community health and well‐being. Formal, qualitative research methodology was employed drawing on interviews with 26 Crow Tribal Elders. Multiple determinants of health are addressed, including cultural, social, economic, and environmental factors. The sense of environmental‐cultural‐health loss and despair at the inability to address the root causes of climate change are widespread. Yet the co‐authors and many other Tribal members are actively prioritizing, addressing, and coping with some of the local impacts of these changes, and are carrying on Apsáalooke [Crow] lifeways and values.