This project focuses on water-related health challenges in Arctic and Sub-Arctic communities. A key event associated with the project was a two-day circumpolar conference held in Anchorage, Alaska during the fall of 2016. Additionally, prior to the conference, the project delivered an informational summary of the status of household running water and sewer service together with a comparison of water-associated illness rates across Arctic and Sub-Arctic communities. The circumpolar conference brought together researchers, engineers, manufacturers and vendors, and health experts to discuss health benefits, challenges and solutions associated with making running water and sewer in small Arctic and Sub-Arctic communities safe, affordable and sustainable. A comparison of technical approaches and the different governance and regulatory frameworks and approaches utilized by Arctic nations was discussed together with problems and solutions regarding the potential impact of climate change on sanitation infrastructure in the Arctic and Sub-Arctic. The State of Alaska presented information about The Alaska Water and Sewer Challenge Project, a multi-year research and development effort started in 2012. The project focuses on decentralized water and wastewater treatment, recycling, and water minimization in cold climates.