Abstract Plate tectonic theory accounts for the steady subsidence of mid-plate oceanic islands by cooling of the lithosphere and so provides a sound basis for Darwin's theory of atoll formation. Now it is evident that because the lithosphere behaves elastically in response to loads such as islands, more localized subsidence and uplift patterns can also be explained. Tectonically active areas, where one plate is subducted beneath another, are also likely to contain regions of marked uplift, but are less amenable to modelling. These processes together provide a background motion framework for most reef settings with rates of vertical movement of the order of a few millimetres per year. Reef forms are greatly influenced by the configuration of their foundations. Holocene reef foundations were essentially moulded by processes of deposition and erosion during the Pleistocene when global sea level changes were often greater than 1 cm year −1. We are now developing a sufficient understanding of the rates and nature of reef processes of growth and destruction to be able to see the manner in which the structural development of reefs responds to the complex interplay of tectonic uplift and subsidence plus changes of sea level and climate.