The environment of East China Sea (ECS) has been faced by huge stresses from anthropogenic activities and population growth in the Yangtze River drainage basin and the areas along the coasts. Improper use of natural resources and short-term economic objectives have resulted in severe environmental degradation in a fairly short time frame and the degradation has now reached a level where the health and well being of the coastal populations are threatened. The main pollutants are inorganic nitrogen, phosphate, oil hydrocarbons, organic matters and heavy metals. Nutrients cause eutrophication of the coastal waters and the estuarine area and very often stimulate the occurrence of red tides. The environmental pollution of Yangtze River basin directly impact on the state of the marine environment in the ECS. The ecosystem stability is maintained by a steady water discharge from the river, that mixes with the marine salty water in the estuary, and the sediment loads from the river that balance ocean erosion in the delta and its adjacent coastal area. The large-scale water transfer and dam constructions in the Yangtze River basin will change this basis. For the ECS the challenge is to reverse the negative processes taking place and to restore ecosystem balance. The main challenge is to integrate socioeconomic and environmental decision making in order to promote sustainable development. A better understanding of the driving forces in society that cause these environmental pressures is required in order to overcome these obstacles. International cooperation may be an important contributor to the progress and in particular provide access to financial, technological, scientific and human resource assistance.