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The past two decades have seen vast changes in the world of health science journals, including greater awareness of the role of journals in reporting research, advancing patient treatment and care, educating health professionals, and helping to bridge the communication gap between researchers and policy-makers. There is global recognition of the need for better quality evidence-informed information to improve patient care and health systems. At the same time, the way in which information is delivered and knowledge shared has been revolutionized. One thing that has not changed is the role of editors in steering a journal on its course and selecting content that best meets the needs of the community it serves. How editors accomplish these goals while maintaining high standards and controlling quality is subject to increasing challenges.