A jurisdictional risk assessment for the whole community: A new, systematic approach to participatory decision-making in public health emergency preparedness using the analytic hierarchy process

In 2018, the New York City (NYC) Department of Health and Mental Hygiene piloted a novel jurisdictional risk assessment (JRA) for public health disasters using the analytic hierarchy process (2018 JRA-AHP). This new approach offers a replicable and equitable model for consensus decision-making that incorporates the complexities of disaster preparedness. Its main contribution to the field is to offer a practical manifestation of emergency management's Whole Community Approach. The 2018 JRA-AHP applied this principle by expanding traditional definitions of ‘expertise’ to include lived experience of disaster and facilitating direct participation in the risk decision by a variety of individuals with diverse backgrounds, expertise and knowledge of public health disasters. This paper describes the theory, methods and results behind the JRA-AHP. The paper also presents a critical analysis of public health disaster risk assessments; contextualizes the Whole Community Approach using models of the relationship between democratic governments and communities; and addresses the practical applications of the 2018 JRA-AHP in NYC while exploring the potential challenges that other jurisdictions may face in attempted adaptation.