Marine ecosystem is a complex nonlinear system. However, ecosystem health assessment conventionally builds on a linear superposition of changes in ecosystem components and probably fails to evaluate nonlinear interactions among various components. To better reflect the intrinsic interactions and their impacts on ecosystem health, an ecosystem coordination index, defined as the matching level of ecosystem structure/services, is proposed and incorporated into the ecosystem health index for a systematic diagnosis in the Pearl River Estuary, China. The analysis results show that the ecosystem health index over the last three decades decreased from 0.91 to 0.50, indicating deteriorating from healthy to unhealthy status. The health index is 3-16% lower than that calculated using the common method without considering ecosystem coordination. Ecosystem health degradation in the Pearl River Estuary manifested as significant decreases in structure/services and somewhat mismatching among them. Overall, the introduction of coordination in ecosystem health assessment could improve the understanding of the mechanism of marine ecosystem change and facilitate effective restoration of ecosystem health.