For international experts health is a comprehensive concept closely linked to bodily, material, spiritual and social well-being. But what does health mean to women living in a poor neighborhood of an African city? Women in Dar es Salaam see health as primarily related to livelihood,hygiene and care. To stay healthy one has to fulfill basic needs for food, water and shelter, to keep the body and home clean and to take good care of the family. Since the state and newly privatized services hardly reach them and husbands often fail in their role as breadwinners, women bear a growing burden in daily health practice. They become increasingly vulnerable, unless they manage to create a new balance by improving their knowledge, becoming economically more independent and raising support within the household, in social networks and organizations. By shifting the focus from illness to local meanings of health and vulnerability, anthropology can make a unique contribution to the rapidly expanding field of urban health research. Such an actor-centered approach provides fascinating insights and fosters innovative theoretical debates for both scholars and practitioners. With regard to medical anthropology, this study opens new lines of inquiry which may eventually lead to an anthropology of health.