Environmental pollution has had a negative impact on the population’s well-being, impeding the pursuit of a better standard of living. This study seeks to investigate the impact of environmental decentralization in China on the health burden, thereby expanding research on environmental federalism, health, and welfare. Using panel data from 30 Chinese provinces, the empirical findings show that good environmental performance and moderate economic development significantly reduce the environmental health burden. Notably, as environmental decentralization increases, the impact of environmental performance becomes more pronounced, particularly in terms of environmental administration and monitoring. The effect of environmental performance in reducing health burdens is more visible in the northern and western regions with relatively severe pollution, as well as in the subsample with higher health burdens. Overall, this paper emphasizes the importance of political institutional factors in reducing the health burden.