Abstract Background This study explores how socioeconomic factors and the availability of medicinal plant resources influence the perception of disease risk in a local medical system. It addresses the role of traditional knowledge and the care and prevention practices used by the community, highlighting the interactions between cultural, social and environmental aspects. Methods The research was conducted in the community of Serra Grande, Lagoa do Ouro, Pernambuco, with 95 participants. Semi-structured interviews were conducted to collect data on socioeconomic factors, perceived risk of disease (using ranking and Likert scale), and perceived availability of medicinal plants. The data were analyzed with Generalized Linear Models using R software. Results Age was the only socioeconomic factor with a significant influence on the perception of risk of disease, being higher among individuals aged between 51 and 70. In addition, the results indicated that the perception of risk of disease is negatively influenced by the availability of medicinal plant resources, i.e., a lower availability of plants is associated with a higher perception of risk. 117 species of medicinal plants used by the community were identified, with the Fabaceae and Lamiacae families standing out. Conclusions The study highlights the complexity of risk perception in rural communities, influenced by social, cultural and environmental factors. Effective public health policies must integrate these dynamics, creating adaptive strategies that strengthen community resilience and preserve traditional knowledge and resources essential for health.