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The contamination of ground water with arsenic is a great public health concern. This paper discusses the possible formation mechanism of high As groundwater; identify the main influences of natural and anthropogenic factors on As occurrence in groundwater; and finally estimates As-induced potential health hazards in an intensive agricultural region, Datong Basin (Northern China). Our findings indicate that the predominant controlling factors of As in groundwater can be divided into natural factors and anthropogenic activities. Natural factors can be classified as natural potential source of As, environmental geological characteristics and hydrochemical conditions; anthropogenic activities are manifested in industrial coal mining, domestic coal burning, agricultural irrigation return flow and excessive application of fertilizers, and groundwater exploitation. Microbial and/or chemical reduction desorption of arsenate from Fe-oxide/hydroxide and/or clay minerals, As-bearing Fe-oxide/hydroxide reduction coupled with sulfate reduction, and competition with phosphorus are postulated to be the major process dominating As enrichment in the alkaline and anoxic groundwater. In addition, age-dependent human health risk assessment (HHRS) was performed, and high risk values reveal a high toxic and carcinogenic risk of As contaminate for population who is subject to the continuous and chronic exposure to elevated As. Image 1 • Arsenic occurrence mechanism interpretation from natural and anthropogenic factors. • Arsenic pollution sources identification. • Human health risk assessment (HHRS) for age-dependent population. [ABSTRACT FROM AUTHOR]