Promptly grasping the process of runoff change and the mechanism of hydrological health (H) variation in inland river basins is essential for the optimal use of water resources in the arid area of Northwest China. In this study, the upper Shule River (USR) was selected as the research area. The Budyko equation and the slope changing ratio of cumulative quantity method (SCRCQ) were used to analyze the response of environmental changes to the evolution of runoff and hydrological health during 1956–2022. The findings showed that the streamflow at various time scales in the USR showed a significantly increased trend from 1956 to 2022. The change rate of annual maximum runoff (Rmax) was 3.3 times that of annual runoff (R), the change rate of R in the flood period was 2.4 times that in the non-flood period, and the change rate in summer was 5 times that in winter. The H of the USR indicated a downtrend during 1956–2022, and the H in the Ta period was better than that in the Tb period. June and August were the main periods of runoff increase and hydrological health evolution, and precipitation (P) was the main driving factor. The response of Rmax increased to climate variability and anthropogenic stressors was 50.42 % and 49.58 %, respectively. The response degrees of H to climate variability and anthropogenic stressors were 62.89 % and 37.11 %, respectively. In general, climate variation was the major factor in the increase of R and the decrease of H in the USR. The findings are useful for getting the streamflow evolution process and hydrologic cycle mechanism and playing a supporting role in the sustainable management of water resources in the future.
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