Objective: To investigate the current situation and related factors of the ecological environment and health literacy level of medical college students in Shiyan City, so as to propose relevant countermeasures and suggestions for improvement in these domains. Methods: From May to June 2023, 1 312 medical students from Hubei University of Medicine in Shiyan City were selected by accidental sampling to investigate the level and influencing factors of the ecological environment and health literacy among this population. The Chi square test and binary multivariate Logistic regression analysis were performed to analyze the different characteristics and main influencing factors of the ecological environment and health literacy levels in this population. Results: The level of the ecological environment and health literacy level among medical students in Shiyan City was 24.3%. Different levels of ecological environmental and health literacy were observed among medical students by gender, grade, major and ethnicity ( χ 2=5.13, 54.87 , 64.71, 5.99, P <0.05). Higher rates were also observed among public health major students than among students of other majors. The first three classification literacy levels consisting of basic literacy, basic knowledge, and basic skills were 4.6%, 49.5 % and 50.4%, respectively. The possession rates of six secondary classification indicators were as follows:basic cognition ( 53.2 %), basic attitudes (34.5%), scientific knowledge (3.0%), behavioral knowledge (22.5%), cognitive skills (59.5%) and operational skills (48.6%). The results of multivariate Logistic regression showed that ethnic minorities and biomedical majors were negatively correlated with medical students ecological environment and health literacy ( OR =0.61,0.52), while female students, public health majors, sophomores and seniors were positively correlated with medical students ecological environment and health literacy ( OR=1.44, 1.95, 2.16, 2.24, P <0.05). Conclusions The overall level of ecological environment and health literacy among medical students in Shiyan City is low. Schools should popularize environmental health knowledge from different perspectives in order to improve the overall literacy level of environmental health literacy among medical students.