Tropical coastal ecosystems such as coral reefs have provided food, income and resources to humans for millennia. The first interactions that people had with coral reef ecosystems left little signature or impact, most probably due to the restricted access, as well as the challenges and ephemeral technologies that people used to exploit these important ecosystems. As human populations expanded along tropical coastal areas, however, the influence of coastal people on coral reefs grew rapidly. Deforestation and coastal agriculture reduced coastal water quality, with many fringing coral reefs disappearing as impacts grew. Increasing numbers of fishers with increasingly advanced technologies exploited tropical coastal fisheries so that many marine species declined dramatically. These activities have removed some functional groups to the point where ecological transformations away from coral-dominated communities increasingly occurred. Shipping and marine pollution, as well as ocean warming and acidification from the burning of fossil fuels, have added further stress on tropical marine ecosystems. The latter represents a major threat with even small amounts of change potentially driving the ecological extinction of coral reefs and other marine ecosystems. Given inaction on the core drivers of these changes, the future does not look bright for coral reef ecosystems as we move into the critical phase of the Anthropocene Epoch.