Coastal and adjacent shelf waters are generally highly productive ecosystems harboring important ecological processes and exposed to a range of anthropogenic pressures from land-based and marine sectors. Ensuring that the cumulative pressures from human activities do not cause unacceptable, permanent harm to the ecosystem is challenging but crucial for sustainable management of these regions. Linkage frameworks and ecological risk assessments have proven to be useful tools for holistic evaluations of cumulative human pressures as a guide to managers and policy makers for prioritization of risk factors. Here, we present the first holistic assessment of ecosystem risk from human activities along the Norwegian coast. Pressures from coastal sectors are identified and weighted by the exposure to and potential impact on ecosystem components following the ODEMM (Options for Delivering Ecosystem-based Marine Management) framework. We focus on four coastal regions with contrasting scales of human activities. Two southern regions with multiple anthropogenic activities are associated with higher cumulative risk of negative impacts compared to northern areas where less extensive activities have a lower potential of harming the coastal ecosystems. Despite latitudinal differences in human use of the coastline, the pressures and ecosystem components associated with the greatest risk of cumulative impacts are relatively similar between the regions. Contaminants and underwater noise stand out as high-risk pressures, associated with multiple sectors with a high spatiotemporal footprint and with the potential to negatively impact a range of ecosystem components. Nevertheless, a confidence assessment also highlights the need for more in-depth analysis on the input, spread and effect of these pressures on coastal ecosystems. We discuss strengths and weaknesses of the risk assessment framework and suggest new directions which may enhance the utility and uptake of such assessments for sustainable management of coastal ecosystems.