This paper examines connections between sustainable livelihoods and the ability to deal with
health risks. In the Kilombero Valley in Tanzania rates of mortality and morbidity from malaria
remain high. Application of the Sustainable Livelihoods Approach (SLA) to a narrative of daily
lives demonstrates that villagers have experienced a reduction in human, social, natural, physical
and financial capitals, which limits their ability to follow health promotion advice. The focus on
livelihoods highlights local developmental interventions that could have a significant impact on
improving the health and wellbeing of the villagers, with potential relevance to other places in the
Global South.