Abstract: Intensive human activities have led to significant changes in land use types, which will have an impact on the landscape and ecosystem health of the basin. By using the land use map data of 2000, 2010 and 2020, the changes of land use, landscape pattern index and ecosystem service value in Fen River Basin are modeled and calculated, and the ecosystem health assessment of Fen River Basin is carried out at the county scale based on PSR model. The results show that in the past 20 years, the construction land in Fen River Basin has increased sharply by 3.64%, while the cultivated land area has decreased significantly by 4.51%. The decrease of cultivated land is mainly transferred to construction land, forest land and grassland, and the increase of construction land mainly comes from cultivated land and grassland. The PD of construction land and cultivated land in the basin has increased by about 23%, indicating that the degree of landscape fragmentation of these two land types has increased in recent 20 years. SHDI of the overall landscape level of the basin shows an upward trend, while PD and LSI first increase and then decrease, which reflects that the degree of land use has increased, the impact of human activities has intensified, and the landscape in the basin has a fragmentation trend. There are certain differences in the ecosystem health status of the river basin in different time and space. The regions with good ecosystem health status showed an increasing trend from 2000 to 2020, but with the development of urbanization, the ecosystem health pressure of population gathering areas such as the surrounding areas of Taiyuan and the lower reaches of Fen River is still large. The results of this study can provide a theoretical basis for environmental protection and ecological management of the basin.