Riparian vegetation establishment and improvement are two large interventions that are undertaken to improve stream ecological health. While there is empirical evidence demonstrating riparian vegetation presence is important for stream ecological health, we currently lack evidence linking riparian vegetation condition to variation in stream ecological health. We help answer this knowledge gap by relating assessments of riparian vegetation condition with an extensive (30+ years), site-based (n = 132) dataset of stream ecological health as represented by two indices of the aquatic macroinvertebrate community. We utilised recently modelled (and region-wide) riparian vegetation condition data, derived from 425 site-based observations in conjunction with imagery from the Sentinel-2 satellite. A variety of other reach and catchment parameters commonly used to predict stream health, such as vegetation cover, catchment imperviousness and temperature, were included, alongside riparian vegetation condition, as predictor variables in Random Forest Models predicting indices of the aquatic macroinvertebrate community. Using Gini Index to identify predictor variable importance, vegetation cover emerged as the strongest predictor of spatial variation in macroinvertebrate indices. Importantly, riparian vegetation condition ranked as the second or third most important predictor in both models. Our results provide empirical evidence that riparian vegetation condition significantly predicts stream macroinvertebrate community health across large spatial regions. Management interventions targeting both improved riparian vegetation condition and vegetation cover may directly benefit stream ecological health.