The majority of Malawians live in the rural areas. The peri-urban areas of Blantyre and Lilongwe have witnessed enormous changes due to the political and social challenges faced immediately prior to and after Malawi's political transition in the early 1900s. Political and other social changes have been associated with the growth of urban zones, removal of some of the regulations and sanctions that governed the status of urban and peri-urban areas in the post-independence era to 1992/94. These changes have implications for health in both urban and peri-urban areas. The problems and opportunities raised by political change are discussed and possible research areas and solutions are suggested. There is need to regulate the growth of 'urban' and peri-urban areas if the poverty reduction aspirations of Malawi are to be realized.