Abstract
Background: Zoonotic and environmentally driven health threats increasingly emerge at the human–animal–environment interface, highlighting the need for prevention-oriented and community-centered One Health approaches. This study adapted the OHZDP tool developed by the United States Centers for Disease Control and Prevention (U.S. CDC) for subnational use in Thailand, integrating environmental and social science perspectives and expanding community participation to ensure context-specific and operationally relevant prioritization. Methods: A comparative mixed-methods case study was conducted in two Thai provinces—Ubon Ratchathani and Nan—using multisectoral, four-day participatory workshops in 2025. Approximately seventy participants per province represented human, animal, environmental health, local governance, and civil society sectors. Health hazards were identified using an all-hazards approach. Six decision criteria were weighted through multisectoral consensus, and hazards were scored using a structured multi-criteria framework, complemented by qualitative deliberation to generate consensus-based prioritization. Results: Prioritization outcomes differed between provinces due to variations in criteria weighting. Ubon Ratchathani emphasized biomedical severity and cross-sectoral impact, prioritizing emerging infectious diseases, rabies, non-communicable diseases, and other high-mortality infections, reflecting a catastrophic risk preparedness profile. In contrast, Nan prioritized governance capacity and policy feasibility, resulting in rankings dominated by environmental and governance-dependent hazards, including PM2.5 air pollution, open waste burning, stray dog management, agricultural chemical exposure, and climate-related disasters. Conclusions: Community-led adaptation of prioritization tools strengthens subnational One Health action. Integrating governance, environmental, and social determinants into biomedical frameworks enhances multisectoral engagement, supports prevention-focused implementation, strengthens early warning systems, and builds community resilience against zoonotic disease emergence.