Abstract: Based on the sustainable livelihood analysis framework, this paper analyzed the impact and mechanism of health shocks on the livelihood strategy choices of middle-aged and elderly farmers by using CHARLS data and multi-period double difference method. The results showed that, middle-aged and elderly farmers were more likely to choose agricultural livelihood strategies rather than part-time agricultural and non-farm livelihood strategies after suffering health shocks. The heterogeneity analysis showed that, health shocks more significantly encouraged male farmers to choose agro-based livelihood strategies rather than part-farm livelihood strategies. The health shock, on the other hand, discouraged female farmers from engaging in off-farm livelihood activities. Moreover, the health impact on low-educated farmers was more pronounced, causing them to choose agricultural livelihood strategies and abandon agricultural part-time and non-agricultural livelihood activities. The mechanism test proved that, the lower the level of livelihood capital of middle-aged and elderly farmers, the more likely their livelihood strategy choices were to change due to health shocks. Accordingly, this paper put forward suggestions that, the government should strengthen health poverty alleviation, which provided a theoretical reference for promoting the diversified development of livelihood strategies of middle-aged and elderly farmers.