This article seeks to develop a conceptual and policy framework for understanding China's role in the global economic imbalances. China's contribution to these imbalances via recurrent trade and financial surpluses corresponds with a phase of deepening structural risks to China's economic growth and development. These structural challenges include: the composition of growth resulting from China's dynamic internal transformation, China's trade orientation, the trajectory of resource use and CO2 emissions, welfare problems relating to distribution and international constraints. This article develops a conceptual framework for examining the relationship between the processes of long-run structural transformation in China, its economic imbalances, and the role of institutional reform in dealing with these structural challenges. As such, economic policy should extend beyond short-term macro management to pursue an institutional reform agenda to facilitate broader structural change to mitigate constraints to future growth and to improve economic welfare.