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Despite the growing awareness of the important ecological functions and values provided by coastal and estuarine wetlands, wetland degradation continues worldwide due to increasing anthropogenic disturbances. Chongming Dongtan wetlands, adjacent to Shanghai, the largest city and industrial and trading port in China in rapid urban expansion and socioeconomic development are currently threatened with biodiversity reduction, wetland loss, contamination, and invasion of exotic plant. Sustainable protection and management of Dongtan Nature Reserve necessitate research to develop diagnostic tools and indicators for a comprehensive and objective assessment of wetland ecosystem health condition. Based on the pressure-state-response framework and ecological and environmental surveys at the Dongtan wetlands, an indicator system was established for evaluating the coastal wetlands ecosystem health, using indicators detected from satellite imagery and current field surveys. Through the establishment of health assessment units and spatial quantification of the indicators, the spatial clustering analysis, integrated with remote sensing and geographic information system technique was applied to make an accurate diagnosis of ecosystem health for Chongming Dongtan wetlands and highlight the areas in subhealthy and unhealthy condition and urgent need of conservation and management. The results from this research indicated that the ecosystem health condition at the Dongtan wetlands showed spatial variation, to a certain extent, corresponding to the distributions of elevation and land cover types. More than 75� % of the total study area was at a relatively healthy level, with 34.19� km² for the very healthy zone and 41.08� km² for the healthy zone, while the subhealthy and unhealthy zones covered 18.23 and 4.76� km², respectively. This study demonstrated the potential for this integrated approach to give objective and effective evaluation of ecosystem health for the dynamic coastal and estuarine wetlands and provide up-to-date information to assist with early warning for ecological security and management decisions for Chongming Dongtan Nature Reserve.