This study explores the gap between perceived and actual waterborne health risks in rocky-hill settlements of Southwestern Nigeria. Using household surveys, interviews, and field observations in Ilawe-Ekiti and Aramoko-Ekiti, we assessed how communities judge water quality and respond to illness.

Findings show strong reliance on sensory cues like taste, odour, clarity, as indicators of safety, while hidden risks such as fluoride, iron, manganese, and microbial pathogens remain overlooked. Despite widespread reporting of diarrheal and related illnesses, only a small fraction of households practiced effective water treatment.

This perceptual disconnect, combined with limited trust in government interventions, deepens environmental health vulnerabilities. By linking local narratives with scientific risk evidence, this research offers a novel framework to advance SDG 6 (Clean Water and Sanitation), the Nigerian National Water Policy, and African Union Agenda 2063 for rural health equity.

Keywords: Environmental justice, rural health, waterborne diseases, perception, SDGs, policy, equity, clean water, community perception.