Air pollution, as the foremost environmental health risk to global sustainable development, continues to exacerbate the associated disease burden amid population aging and rapid urbanization. This paper systematically examines the spatiotemporal evolution patterns, the transformation characteristics of health risks, and the governance paradigm shift required as China’s air pollution control transitions from "rapid improvement" to a "challenging phase". The study finds that since the implementation of the Air Pollution Prevention and Control Action Plan, although the annual average PM_2.5 concentrations in key regions have significantly declined, governance now faces new challenges such as the exacerbation of combined PM_2.5 and ozone pollution, and the limitations of traditional monitoring methods in capturing precise individual exposure. Mechanistic research indicates that ultrafine particles (UFPs) can cross multiple biological barriers and, by activating the hypothalamic−pituitary−adrenal (HPA) axis, induce systemic inflammation and neuroendocrine disorders, leading to a shift in health risks toward more "insidious" and "systemic" forms. Confronted with these challenges, China's governance system urgently needs to transition from the 1.0 stage centered on "pollutant concentration control" to a 2.0 stage centered on "population health risk prevention and control". To this end, this paper proposes the establishment of an Intelligent Health Risk Governance framework (IHRG) integrating "pollution−exposure−disease" early warning and collaborative governance. By incorporating holistic sensing networks, exposomics big data, and AI−driven digital twin mapping technologies, a multi−level smart governance pathway covering "national−regional−individual" dimensions can be established. This aims to provide scientific support for the systematic prevention and control of environment−related diseases, and for the coordinated advancement of the "Beautiful China" and "Healthy China" initiatives, while also offering insights for other countries facing similar challenges.