The nexus between health shocks and forest sustainability remains underexplored, with no studies jointly investigating communities' perceptions of the origins of health shocks and the role of actor constellations in shaping compliance with forest management institutions under health shocks. We addressed this gap using a directed content analysis of data derived from key informant interviews (n= 24), expert interviews (n= 4), and focus group discussions (n= 16). Our findings reveal that epidemics are perceived to have zoonotic origins compared with pandemics. Based on power attributes, we identified two types of eco-health actor constellations: coercion-driven and incentive-driven. The former relies on punitive measures to enforce forest management institutions. This risks communities' trust and external dominance perception. The latter encourages local participation through livelihood incentives but remains vulnerable due to reliance on external funding and jurisdictional ambiguities. Shaped by the actor constellations identified, compliance with forest management institutions shift significantly under different health shock typologies; epidemics induce deterrence-driven adherence, while pandemics trigger low or non-compliance. These findings underscore the importance of forest management models that integrate health risk communication and community-based incentives. However, we caution against the weaponization of zoonotic narratives for conservation goals. This study contributes to the actor-institutional framework by highlighting that actors do not act in isolation within forest management institutional frameworks during shocks. This theoretical lens highlights the adaptive roles of actors at the interface of health shocks and forest sustainability. Future studies should quantitatively and cross-culturally clarify the determinants of forest management institutional compliance.