Malaria and poverty are intimately connected. Controlling for factors such as tropical location, colonial history, and geographical isolation, countries with intensive malaria had income levels in 1995 only 33% of countries without malaria, whether or not the countries were in Africa. The high levels of malaria in poor countries are not mainly a consequence of poverty. Malaria is very geographically specific. The ecological conditions that support the more efficient malaria mosquito vectors primarily determine the distribution and intensity of the disease. Intensive efforts to eliminate malaria in the most severely affected countries in the tropics have been largely ineffective. Countries that have eliminated malaria in the past half century have all been either subtropical or islands. These countries’ economic growth in the five years after eliminating malaria has usually been substantially higher than growth in the neighboring countries. Regressions using cross-country data for the 1965-90 period confirm the relationship between malaria and economic growth. Taking into account initial poverty, economic policy, tropical location, and life expectancy among other factors, countries with intensive malaria grew 1.3% less per person per year, and a 10% reduction in malaria was associated with 0.3% higher growth. Controlling for many other tropical diseases does not change the correlation of malaria with economic growth, and these diseases are not themselves significantly negatively correlated with economic growth. A second independent measure of malaria has a slightly higher correlation with economic growth in the 1980-1996 period. The paper concludes with speculation about the mechanisms that could cause malaria to have such a large impact on the economy, such as foreign investment and economic networks within the country.