This study examined the effect of psychosocial factors and environmental perceptions on self-rated health in the environmentally devastated Aral Sea area of Karakalpakstan. Self-rated health was assessed using a questionnaire on 881 randomly selected individuals from three communities. Communities were chosen based on relative differences with regards to economic and ethnic characteristics, and distance from the sea coast. Consistent with mortality rates in the area, the prevalence of 'poor' self-rated health was high. Factors negatively associated with self-rated health include psychosocial impacts and reported environmental concern, as well as community of residence and age. These results demonstrate that the population has a poor perception of their own health, a significant finding given that self-rated health is a strong predictor of morbidity and mortality. It is also clear that psychosocial health is strongly associated with health perceptions. Thus, to improve the overall health of this population, health remediation measures must address physical as well as psychosocial health problems.