This research explored the perception of elderly citizens in Shanghai about negative health impacts of environmental issues. A soft systems methodology (SSM) framework was employed with methodological tools including rich pictures, workshops, social system model building and comparison of models. We found that among our elderly participants, recent government and media campaigns have created the perception that environmental conditions have improved due to government initiatives. The exception to this view is among the educated participants of the study. This suggests that powers of nested social hierarchies and governmental media control still have a dominant influence on public opinion in Shanghai, creating barriers for citizen recognition and understanding of environmental health issues. Education and open access to information are potential areas for intervention to improve understanding and empowerment in this area.