The objective of the research was through key actors to identify the contamination by hydrocarbons and heavy metals in water and the main sources of contamination in the municipality of Macuspana, Tabasco. Methodology: A diagnosis was made, by applying questionnaires through interviews directed to the inhabitants of the municipality of Macuspana and workers in the oil sector. The data were processed with frequency analysis, Kruskal Wallis, analysis of variance, and multivariate with two factors. Results: It was shown that there has been historical contamination, for 30 years, there is evidence of dead organisms in the water bodies, and the presence of various diseases in the population due to exposure to contaminants from hydrocarbons and heavy metals that derive from the oil activity. There is evidence of a negative impact due to the presence of spills from disabled wells due to a lack of maintenance programs. Implications: The economy in most of the Gulf of Mexico is based on the extraction, processing, and distribution of hydrocarbons. This industry´s growth increased the number of exploration and production of oil wells, generating a direct impact on aquatic environments. The state of Tabasco is one of the largest oil producers, as well as fishing resources of commercial and environmental importance, which are directly affected by oil activity. Findings: The study found cases of diseases in the population correlated with exposure to hydrocarbons. Conclusions: There is little interest from the oil sector about public health problems in the population and environmental damage to the ecosystems in the municipality of Macuspana, Tabasco.