The evolution of cocoa farming was quickly confronted with the development of pests and diseases. These sanitary constraints have shaped the geographical distribution of production over the centuries. Current climate change adds an additional constraint to the plant health constraints, making the future of cocoa farming more uncertain. Climate change is not only affecting the areas where cocoa is grown for physiological reasons, particularly in relation to changes in water regimes, but also affects the distribution of pests and diseases affecting this crop. These different points are discussed in the light of the trajectories observed in the different cocoa-growing areas. The breeding programs of cocoa trees for sustainable resistance to plant health constraints and climate change are therefore particularly important challenges for cocoa farming, with the other management practices of plantations.