The temperate and boreal forests of Europe and North America have been subject to repeated pathogen (fungal disease and phytophagus insect) outbreaks over the last 100 years. Palaeoecology can, potentially, offer a long-term perspective on such disturbance episodes, providing information on their triggers, frequency and impact. Mid-Holocene declines in Tsuga and Ulmus pollen dominate the Quaternary literature on forest pathogens, yet the role of pathogens, and even the presence of pathogenic fungal diseases, during these events has yet to be established. Pathogen-focused research strategies, informed by the sequence of events documented in modern outbreaks, and undertaken at high temporal resolution using a multi-proxy approach, are required. It is argued that forest pathogens are likely to have been significant agents of past vegetation change, even in cases where climate change was the primary stress factor. Copyright © 2013 John Wiley & Sons, Ltd.