The Yangtze River Economic Belt (YREB) is China’s golden tourism belt, while also serving as a demonstration model for the construction of an ecological civilization. Therefore, tourism ecosystem health (TEH) is a key consideration for the promotion of sustainable development in the YREB. In this study, we explored the meaning and application of the TEH concept and developed a fivedimensional TEH evaluation index system based on a framework encompassing “vigor-organizational structure-resilience-ecological service functions-residents’ health and education level” (VORSH). Taking the YREB as an illustrative case study, we used a coupling-coordination model and the geographic detector method to analyze the spatiotemporal evolution and driving forces of TEH in this region. Key results of the analysis were as follows: (1) Overall, TEH and its five dimensions in the YREB showed steady improvement during the period 2000-2019. (2) The spatial distribution of TEH was high in the eastern part of YREB and low in the western part, with a gradual transference of TEH grades. From 2000 to 2019, transfers of TEH states occurred mainly in two directions. The first entailed transference to a higher-level neighboring state, and the second entailed retention of the original health state. (3) From 2000 to 2019, the coupling-coordination types associated with the five dimensions of TEH in the YREB gradually evolved from a state of being uncoordinated to one of coordination, and the degree of coupling-coordination revealed spatial distribution pattern of east > center > west. (4) The leading factors driving the spatial differentiation of TEH in the YREB were identified as development of the tourism industry and regional economy, urbanization, residents’ health conditions, and urban greening. The interactive relationships among these factors indicated a trend of nonlinear enhancement and bi-factor enhancement. In addition, differences in the main driving factors of TEH were found for particular years. This study provides useful inputs for promoting the development of a high-quality tourism economy and a high level of protection of the tourism ecology that can guide coordinated and sustainable development of TEH.