The introduced pathogen Cronartium ribicola, cause of white pine blister rust, has spread across much of western North America and established known infestations within all but one species of white pine endemic to western Canada and the United States. Blister rust damage to severely diseased trees reduces reproduction and survival. Severe losses in white pine populations have resulted in site conversions to other species and seriously impacted resource values for timber, wildlife, watershed, recreation, aesthetic and other ecosystem services. In addition to blister rust, other major forest health threats and challenges to sustaining or restoring white pine populations are infestations of other pathogens, insects, fire, management practices that favour other tree species, and climatic change. Recent, large-scale outbreaks of mountain pine beetle have raised concerns for the viability of some white pine populations. In the 1960s, forest disease management for western white pine and sugar pine shifted from Ribes eradication to planting seedlings selected for better survival and resistance to blister rust. Seed orchards for producing improved white pines have been established, but deployment of that improved stock is hampered by a lack of planting opportunities. The inheritance and mechanisms of resistance are best known for western white pine and sugar pine; but new work is extending an understanding of genetics to all the western species of white pine. Current management efforts are focused on locating and protecting individual trees resistant to blister rust and assessing their disease resistance and other adaptive traits. In response to the threats from blister rust, the strategic goal is to sustain or restore viable white pine populations in western forest ecosystems. The four action components of the strategy are: (1) conserve genetic resistance to C. ribicola; (2) reduce the risk of adverse impact in stands currently uninfested; (3) restore and maintain white pines where blister rust is causing impacts and (4) assess and monitor the health and management of white pines. Successful implementation requires long-term support for coordinated efforts of management and research agencies, forest industry and an informed public.