People in the Northeast United States have a long history of benefitting from the ocean in many ways, exemplified by the region’s important cod and lobster fisheries, coastal tourism and recent expansion of offshore energy. Over the past few decades, the region has become one of the fastest warming spots on the planet, has seen significant growth in coastal populations, and expansion of new sectors into the marine environment, resulting in ecosystem shifts and changes to the supply and distribution of these benefits. With these changes comes a need for measuring ocean health to understand how engagement with the ocean may be affected, and how regional management may need to adapt. To address this need, we tailored the Ocean Health Index framework to the U.S. Northeast region, scoring eight distinct goals for ocean health on a scale of 0 to 100 for 11 sub-regions over 13 years (2005–2017). All goal scores were averaged resulting in an Ocean Health Index score of 83 for the Northeast in 2017. This score fluctuated by 1 point in either direction (82–84) in the previous 12 years. The lowest scoring goals in 2017 also exhibited the highest volatility since 2005, Food Provision (64) and Resource Access Opportunities (71). The region’s highest goal scores came from Livelihoods & Economies (99) and Biodiversity (90) and remained stable during the study period. Clean Waters scores had a steady, significant downward trend since 2005, while Resource Access Opportunities and Aquaculture show the largest improvements. This synthesis of over 50 datasets to create annual aggregate scores provides the public, government and non-government agencies with an easily digestible summary of how the region is faring in regards to ocean health. Perhaps even more importantly, this synthesis allows for the tracking of trends over time and the ability to quickly identify and prioritize low-scoring components of ocean health that could benefit from dedicated resources for improvement. As managers plan for the future in a changing Northeast marine region, the ability to track annual changes in ocean health and its respective components is key to making decisions that benefit the entire social-ecological system.