Arable land health (ALH) and arable land productivity (ALP) are crucial indicators of agricultural ecological functionality and sustainability. The shift of grain‐producing regions in Northwest China has led to arable land degradation, which endangers both food production and sustainable development. Several studies have focused on arable land quantity, distribution, and regional features, but ALH and sustainable ALP have received little attention. For the first time, we investigated the spatio‐temporal distribution and coupling connection between ALH and ALP in Northwest China (NC) using soil health indicators. Our study revealed the following key findings: (1) A minimal dataset of 12 indicators can efficiently replace the total dataset to evaluate the arable land health index in NC. (2) Over the last 20 years, the high and sub‐high grades of ALH increased by 536.8% and 222.6%, respectively, with a shift toward the northwest. During the specified period, ALH with low health and underutilized grade decreased by 46.01% and 69.4%, respectively, primarily in Xinjiang and Inner Mongolia. At the county level, ALP increased by 26%, primarily in northern Xinjiang and southern Gansu. 71% of counties remained stable, while only 3% experienced a decline. (4) The relationship between ALH and ALP were divided into six coupled groups that form an inverted “U” shape. High‐production areas were generally strongly linked, while low‐production areas were weakly coupled. Over the last 20 years, NC has seen significant improvements in ALH, coinciding with an increase in ALP. However, in most cases, the relationship between ALH and ALP were negative or weak.