The future of coastal wetlands will depend on the combined effects of climate change and human impacts from urbanization and coastal management. Disentangling the effects of these factors is difficult, but satellite imagery archives provide a way to track biological and physical changes in wetlands over recent decades to reveal how coastal wetlands have been changing in response to climate and human drivers. In this study, we used Landsat to monitor the conditions of 32 coastal wetlands in southern California from 1984 to 2019 and identify environmental and human drivers of these trends. Wetland conditions were characterized by vegetation greenness, using the normalized difference vegetation index (NDVI), and by habitat composition, derived from areal estimates of wetland and subtidal habitats. Overall, wetlands displayed three types of long‐term response: greening and gaining wetland (10), greening and losing wetland (16), and browning and losing wetland (6). Regional environmental drivers with overall positive effects on wetland NDVI were sea level, wave height, and precipitation, whereas stream discharge, vapor pressure deficit, and air temperature had negative or nonlinear effects. Wetland area change was primarily correlated with sea level, but response was highly contextual among sites. Negative trends in wetland NDVI and area were more common in larger sites with low elevations and in sites with open inlets. Restoration had mixed effects, with only half of the restored sites showing positive changes in NDVI and wetland area post‐restoration. The important work of managing and restoring urban coastal wetlands is complicated by variability and context and requires us to account for the influence of humans and climate as we build a regional understanding of historic, present, and future wetland health.