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Organized efforts to reduce the burden of malaria are as old as human societies. Understanding the historical relationships between humankind and malaria is important for natural and social scientists studying the disease, as well as policy makers trying to control it. Malaria once extended widely throughout the old world, reaching as far north as 64ºN latitude and as far south as 32ºS latitude. Today, however, malaria is almost exclusively a problem of the geographical tropics. Analysis of historical changes in malaria prevalence suggests a number of factors which help to determine the likelihood and sustainability of success in malaria control. Among these are geography, evolutionary history of flora and fauna, infrastructure, and land use. It is due to these factors, much more than socio-economic ones, that attempts to control or interrupt transmission of the disease have historically been most successful on islands, in temperate climates, or at high elevations.