Mountains have long been admired and protected on the grounds of their wilderness, character and landscape beauty. But despite their remoteness and low human population density, many mountain ecosystems are strongly affected by drivers of global change. Mountain ecosystems in the tropical and sub-tropical regions have attracted the attention of a number of scientists, policy makers and natural resource managers because of their critical role in the supply of ecosystem services, and their vulnerability to environmental changes induced by anthropogenic and climatic factors. Adapting to and mitigating the effects of environmental change and sustaining ecosystem services in the context of a burgeoning human population is a major challenge. The Convention on Biological Diversity, Millennium Development Goals, and other international agreements explicitly connect conservation to poverty alleviation. It has become clear that nature conservation only works in practice if people’s needs are also taken into account; while conservation efforts based on community participation and ownership tend to be more effective. A concerted effort is needed to develop a better scientific understanding of ecosystem structure and functioning and drivers of change as a basis for formulating comprehensive ecosystem management approaches and strategies that link to human wellbeing and poverty alleviation. This paper reviews the state of knowledge on five principle pressures, driving biodiversity loss in the HKH region, and describes evolving processes that highlight reconciliation of the conservation and development perspectives.