Abstract: This study conducted an evaluation of the ecosystem health of 57 districts or counties in the Gansu section of the Yellow River basin from 2010 to 2020 based on a driving force-pressure-state-response (DPSR) model and an entropy weigh-coefficient of variation weighting method. The temporal and spatial evolution of the ecosystem health levels and the ecosystem threats in each district or county in the basin were analyzed, which helped identify ecosystem problems and propose reasonable management and restoration strategies. The results show that the overall ecosystem health of the Gansu section of the Yellow River basin improved significantly from 2010 to 2020; more specifically, the general ecosystem health was poor from 2013 to 2016, and improved significantly after 2016. The ecosystem health of the main basin of the Yellow River, basin No. 1, was the highest, and its change in health status was the largest. Moreover, the ecosystem health of the Taohe River basin also improved greatly, whereas the health of the other basins was low and only saw small improvements. At the overall level, the driving force and pressure indices of the Gansu section of the Yellow River basin fluctuated but mainly increased, and the state and response indices continued to rise, indicating that the ecosystem health and stability of the Gansu section of the Yellow River basin steadily improved from 2010 to 2020. Population growth, per capita water resources, the proportion of land used for construction, and the comprehensive utilization rate of industrial solid waste are the main factors affecting the changes in ecosystem health in the study area. Optimizing land use, promoting a more balanced distribution of the population and water resources, and strengthening environmental protection and restoration efforts are put forth as effective measures to promote green development and the construction of ecological barriers in the Gansu section of the Yellow River basin.