Direct consequences of the human role, where human activity affects river channels through engineering works including channelization, dam construction, diversion and culverting, have been long recognised [Marsh, G.P., 1864. Man and Nature or Physical Geography as Modified by Human Action. Charles Scribner, New York; Thomas Jr., W.L., (ed.) 1956. Man's Role in Changing the Face of the Earth. Chicago, University of Chicago Press, Chicago.]. The less obvious indirect effects of point and reach changes occurring downstream and throughout the basin, however, are much more recently appreciated, dating from key contributions by Strahler [Strahler, A.N., 1956. The nature of induced erosion and aggradation. In W. L. Thomas (Ed.), Man's Role in Changing the Face of the Earth. University of Chicago Press, Chicago, 621–638.], Wolman [Wolman, M.G., 1967. A cycle of sedimentation and erosion in urban river channels. Geografiska Annaler 49A, 385–95.], Schumm [Schumm, S.A., 1969. River metamorphosis. Proceedings American Society of Civil Engineers, Journal Hydraulics Division 95, 255–73.], and Graf [Graf, W.L., 1977. The rate law in fluvial geomorphology. American Journal of Science, 277, 178–191.]. These are complemented by effects of alterations of land use, such as deforestation, intensive agriculture and incidence of fire, with the most extreme effects produced by building activity and urbanisation. Changing river channels are most evident in the channel cross-section where changes of size, shape and composition are now well-established, with up to tenfold increases or decreases illustrated by results from more than 200 world studies. In addition the overall channel planform, the network and the ecology have changed. Specific terms have become associated with changing river channels including enlargement, shrinkage and metamorphosis. Although the scope of adjustment has been established, it has not always been possible to predict what will happen in a particular location, because of complex response and contingency. The ways in which changes in cross-section relate to reach and network changes are less clear, despite investigations showing the distribution of changes along segmented channels. When considering the human role in relation to changing river channels, at least five challenges persist. First, because prediction of the nature and amount of likely change at a particular location is not certain, and because the contrasting responses of humid and arid systems needs to be considered, modelling is required to reduce uncertainty, as was first emphasised by Burkham [Burkham, D.E., 1981. Uncertainties resulting from changes in river form. American Society Civil Engineers Proceedings, Journal Hydraulics Division 107, 593–610.]. Second, feedback effects incorporated within the relationship between changes at channel, reach and network scales can have considerable implications, especially because changes now evident may have occurred, or have been initiated, under different environmental conditions. Third, consideration of global climate change is imperative when considering channel sensitivity and responses to threshold conditions. Fourth, channel design involving geomorphology should now be an integral part of restoration procedures. This requires, fifthly, greater awareness of different cultures as a basis for understanding constraints imposed by legislative frameworks. Better understanding of the ways in which the perception of the human role in changing river channels varies with culture as well as varying over time should enhance application of design for river channel landscapes.