The world’s marine and coastal ecosystems are under threat and single-sector management efforts have failed to address those threats. Scientific consensus suggests that management should evolve to focus on ecosystems and their human, ecological, and physical components. Estuaries are recognized globally as one of the world’s most productive and most threatened ecosystems and many estuarine areas in British Columbia (BC) have been lost or degraded. To help prioritize activities and areas for regional management efforts, spatial information on human activities that adversely affect BC’s estuaries was compiled. Using statistical analyses, estuaries were assigned to groups facing related threats that could benefit from similar management. The results show that estuaries in the most populated marine ecosections have the highest biological importance but also the highest impacts and the lowest levels of protection. This research is timely, as it will inform ongoing marine planning, land acquisition, and stewardship efforts in BC.