Over 60% of the world's reefs experience damage from local activities such as overfishing, coastal development, and watershed pollution. Land-based sources of pollution are a critical threat to coral reefs, and understanding "ridge-to-reef" changes is urgently needed to improve management and coral survival in the Anthropocene. We review existing literature on spatial-ecological connections between land use and coral health, specifically examining vegetative, agricultural, urban, and other land-use types. In general, forested land use is positively related to metrics of coral condition, while anthropogenic land uses like urban development and agriculture drive a decline in coral cover, diversity, colony size, and structural complexity. However, land-use and land-cover impacts vary across time and space, and small portions of the landscape (e.g., discrete segments of unpaved roads, grazed and scalded hillsides) may have an outsized effect on reef pollution, presenting opportunities for targeted conservation. Some coral species show resilience under land-use and land-cover change, and the impact of land use on coral recovery from bleaching remains an active area of research. Finally, a spatial bibliography of existing literature reveals that most ridge-to-reef studies focus on a handful of regional hotspots, surface water, and watershed-scale dynamics; more research is needed to address groundwater connectivity and to compare land-use impacts across multiple regions and scales. Approaches from landscape ecology that assess spatial patterns of, and synergies between, interlocking land cover may assist conservation managers in designing more resilient reefscapes.