Abstract: Scientific assessment of river health status contributes to a better understanding and management of river ecosystems.We review recent advances in river ecosystem health assessment from theoretical, methodological, and standardization perspectives.We comprehensively summarize and discuss the evolution of assessment methodologies across spatiotemporal scales, including development, indicator systems, applicability, and accuracy.Current multi-level river health assessment standards in China are systematically analyzed to identify discrepancies and propose optimization pathways.To address existing methodological constraints, we recommend integrating emerging data sources (e.g., microbial genomics and ecotoxicology) with advanced technologies like multi-source data fusion, dynamic modeling, and IoT, gradually achieving more accurate real-time monitoring to enhance scientific decision-making capabilities for ecosystem protection.This study provides reference for advancing research and practice in river conservation.