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Abstract The well-being of Indigenous communities in Alaska is inextricably linked to traditional harvest practices (THPs) such as hunting, fishing, and gathering local wild foods. Regional trends in the health of THPs have not been quantitatively evaluated in Alaska. Therefore, we surveyed Indigenous residents in the Western Coastal (n = 623) and Interior (n = 437) Regions of Alaska to estimate perceptions of the extent and cause of change in the health of THPs over the last ten years. We found that THPs improved in Western Coastal and declined in Interior Alaska. The best predictors of improvement or decline in the health of THPs were 1) change in the ability to share the harvest, 2) change in participation in hunting and fishing activities, and 3) extent of challenges caused by climate change. The odds of a decline in the health of THPs were 8 to 13 times higher for households that reported a decrease in sharing of traditional foods.