Amid rapid urbanization, the confl ict between accelerated construction land expansion and ecological conservation in the southern Jiangsu water-network region has become more pronounced. Ecological health assessment provides an objective measure of the structural stability, functional integrity, and service capacity of ecosystems within water network areas. Utilizing Wujiang District in Suzhou City as a case study, this research evaluates the spatiotemporal diff erentiation characteristics of ecosystem health in 2003, 2013, and 2023 based on the VORS model. The PLUS model is further applied to simulate the dynamic evolution of ecosystem health under various scenarios in 2033. Considering the current conditions and the outcomes of the multi-scenario simulation, spatial management zones are delineated, and relevant management strategies are proposed. The results indicate that: (1) From 2003 to 2023, the mean ecosystem health index of Wujiang District exhibited a declining trend, decreasing from 0.393 to 0.347, suggesting that urbanization has exerted increasing pressure on the regional ecosystem. Areas such as the Wujiang Economic Development Zone showed relatively low health levels, indicating weaker resistance to external disturbances in highly urbanized regions. In contrast, areas including East Taihu Lake, Yuandang, and Beimayang exhibited relatively high health values, with the dense distribution of lakes and wetlands contributing to stable ecosystem structures and well-maintained ecological functions. (2) Under the multi-scenario simulation for 2033, the mean ecosystem health value under the urban development scenario decreases signifi cantly, indicating that urban expansion imposes pressure on the regional ecosystem. In the ecological protection scenario, the mean health value is highest, indicating that ecological conservation measures eff ectively alleviate ecosystem pressure and maintain ecological stability. By overlaying the ecosystem health grade distributions under current conditions and across multiple scenarios, spatial zoning and management strategies based on the spatiotemporal evolution of ecosystem health dynamics are proposed, providing a theoretical reference for ecological protection and ecosystem health improvement in water network areas.