With its unique geographical location, the coastal zone has concentrated great advantages in resources, population and economy. However, with the deepening of marine resources development activities, a series of problems have emerged in the coastal zone, such as the gradual shortage of resources, the decline of environmental quality and the increase of ecological risks. The coastal zone ecosystem has shown a certain degradation trend. Maintaining the health of the coastal zone ecosystem has become the primary task of the sustainable development of the marine economy. Monitoring the coastal ecosystem carrying capacity, diagnosing the health status of the coastal ecosystem, effectively planning and managing the development and utilization of natural resources in the coastal zone, and controlling human activities related to the sea within the ecological carrying capacity and health limits of the coastal zone are of great significance to the sustainable development of society and economy in the coastal zone. In this study, the ecosystem health model, state space model and ecological health early warning principle were comprehensively applied to construct the coastal ecosystem health diagnosis framework of “Carrying type →Early warning degree →Health level;” The evaluation index system of coastal ecosystem carrying capacity was established; Taking Shandong Province as the empirical research object, the health status of the coastal ecosystem in Shandong Province was diagnosed by using the relevant data from 2007 to 2019. The empirical results show that: (1) From 2007 to 2013, the carrying capacity of the coastal ecosystem in Shandong Province was relatively good, in the state of “loadable” or “critical overload,” while from 2014 to 2019, the carrying capacity was poor, in the state of “overload;” (2) From 2007 to 2013, the early warning degree of coastal ecosystem health in Shandong Province was in the state of “no alarm,” “light alarm,” and “medium alarm,” and the health level was in the state of “very healthy,” “healthy,” and “sub-health;” from 2014 to 2019, the health warning level of the coastal ecosystem in Shandong Province was in the state of “serious alarm” and “extremely serious alarm,” and the health level was in the state of “unhealthy” and “Morbid,” and the health status was worrying; (3) The key influencing factors affecting the carrying capacity of the coastal ecosystem mainly included the output of marine mining, marine GDP, per capita marine production, total amount of main pollutants directly discharged into the sea, domestic tourist arrivals in coastal cities, area of marine nature reserves, proportion of class IV and inferior class IV seawater, average density of beach garbage in the monitoring area, number of medical and health institutions; Finally, some policy suggestions were put forward to improve the health of coastal ecosystem in Shandong Province. In the “discussion” part of this study, the consistency between the research results of this paper and the actual situation of the marine ecosystem in Shandong Province and the existing research results of the same kind is compared, and the applicability and limitations of the research methods in this paper are put forward, indicating that the research methods in this paper are more applicable to the comparative analysis under the same ideal value determination criteria.