In this article I present a political-ecological approach for biocultural analyses that attempts to synthesize perspectives from anthropological political economy and those from ecological anthropology and human adaptability approaches. The approach is used to examine contexts and consequences of vulnerability among Andean peoples in southern Peru, and specifically the ongoing and dialectical relationships between poverty, illness, and household production. Household demographic composition, class position, economic status, and interpersonal relations are all important in shaping their experience with illness, and coping capacity in dealing with the consequences of illness on household livelihood. I suggest that the contexts and consequences of vulnerability among rural producers in southern Peru contributed in part to the spread of the Sendero Luminoso revolutionary movement into the region in the late 1980s and early 1990s.