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The changes of wetland ecosystem health and its driving factors in China. • Nationwide health changes and driving factors in wetland ecosystems were analyzed. • China's wetland ecosystem health increased by 7.2% and showed spatial differences. • Conservation and restoration policies improved wetland ecosystem health. • Proactive conservation strategies should be forcefully implemented. To counter widespread wetland loss and deterioration due to rapid socioeconomic development, China implemented a series of wetland conservation and restoration policies that have resulted in an increase in wetland area since 2000. Although wetland loss has been contained, changes in wetland ecosystem health are poorly quantified across China. We report on China's first nationwide assessment of the spatial-temporal dynamics of wetland ecosystem health based on physical, biological, and chemical indicators from the first wetland inventory (1995–2003) to the second wetland inventory (2009–2013), and identify the potential effects of wetland ecosystem health changes to provide guidance for future wetland conservation management. We found that the wetland ecosystem health comprehensive index increased by 7.2%, indicating that China's wetland conservation and restoration policies significantly promoted an improvement in wetland ecosystem health. These improvements were concentrated in the middle reaches of the Yangtze River and in the eastern and northern Qinghai-Tibetan Plateau. Deteriorations in wetland ecosystem health were focused in southern provinces and Heilongjiang, which were mainly attributed to population increase and conversion of wetland to cropland, respectively. Although wetland protection and restoration policies have improved wetland ecosystem health without affecting agricultural production, wetland conservation did not prevent the reduction in natural wetland area and the decline in biodiversity throughout China. This analysis demonstrated that a more proactive conservation strategy is required to greatly strengthen wetland conservation management, by expanding the wetland protected area network, strictly obeying wetland ecological redlines, strengthening degraded wetland restoration, and raising population awareness of wetland protection. This study provides a proactive wetland conservation strategy, and indicates that assessment of wetland ecosystem health changes and their driving factors could contribute to a better understanding and further coordination of the relationship between wetland ecological conditions and socioeconomic development. [ABSTRACT FROM AUTHOR]