Abstract This article examines local perceptions of health risks in a mountain community in the Karakoram of Northern Pakistan. Specifically, it aims to show how the tremendous social and economic transformations taking place in this region are experienced and understood by the people most affected by them. The case study draws from ethnographic data collected through a range of methods, including personal narratives, focus groups, interviews, household surveys, conversations, and participant observations. Central to this analysis is the role that social change plays in mediating and shaping residents' worries, and perceived vulnerabilities within this particular economic and cultural context. Furthermore, the effects of the global economy on how people assess their dependency on external factors and processes are explored, including attention to the ways in which newly introduced products and technologies raise concerns about product safety, health security, and community cohesiveness. This analysis of local narratives of health risks illustrates these points and demonstrates how residents' constructions of risk provide a basis for understanding local debates and doubts about how “development” and modernity are being approached in this mountainous region.