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Ecosystem degradation caused by Land use/cover change (LUCC) in the process of rapid urbanization has attracted extensive attentions. However, the spatiotemporal dynamics of future ecosystem health (EH) and its coupling relationship with land use has not been well analyzed. In this study, based on future land use scenarios, we used the vigor-organization-resilience-services assessment framework to measure the ecosystem health level in Southwest China and analyzed its spatial-temporal characteristics under the four scenarios in 2010, 2050 and 2100. The results showed that areas with high health level (i.e., well and relatively well) accounted for the largest proportion across all the scenarios, indicating the ecosystem in Southwest China was in a good state. However, higher population and higher urban expansion scenarios will lead to a significant decline in EH in most counties, especially in rapidly urbanization areas. The ecological sensitivity method was applied to explore the response of ecosystem health to change in land use intensity. The results found that about 80% counties were at moderate sensitivity level under the four scenarios, as only counties with high ecological sensitivity were concentrated in western Sichuan, southwest Yunnan and the periphery of large cities. The coupling coordination analysis between ecosystem health and land use intensity was employed to discern the counties with low-level coordination in EH and land use management. Results showed that the degree of coordination in western Sichuan was low and its change remained stable across all the scenarios, while the coordination degree was high and its change relatively intense in Sichuan basin and western Guizhou from 2010 to 2100. This study can provide effective guidance for ecosystem management and the formulation and implementation of land use policies. [ABSTRACT FROM AUTHOR]