ABSTRACT Urbanization has significant impacts on ecosystem health (ESH) by affecting land-use patterns. The evaluation of the ESH and the spatial correlations between human interference provides an insight into sustainable development as a response to potential ecological degradation if ESH is threatened by further urbanization. We applied the Vigor-Organization-Resilience-Services (VORS) modelto detect the responses of ESH of Shannan Prefecture in the Tibet to urbanization from 1990 to 2015, based on different levels of terrain gradients. The results show that the ESH of the most areas in Shannan reaches the levels of highest health and average health during the study period. By 2015, the area proportion at the highest health level increased by 0.68%, while that of degraded level decreased by 1.51%. Overall, the ESH of areas tends to shrink at higher-level TGs, and urban sprawl with ESH shrinking existed in middle-level TGs in Shannan. Furthermore, a significant spatial aggregation effect was found concerning that low ESH–high CUL type is mainly distributed on the middle-level TGs with dense human population. The results highlight the needs to rationally organize urbanization process in plateau regions based on different TGs, which contribute to maintain ESH advancing people livelihood improvement.