An epidemiologist who sees a cluster of asthma cases in one neighborhood does not start by handing out inhalers. She asks what is in the air, what is in the housing stock, what changed in the local environment. The intervention targets the cause, not the symptom. Nicholas Mukhtar carries that exact instinct into his work with companies, and it traces back to where he was trained.
Mukhtar enrolled at Johns Hopkins University as a Bloomberg Fellow while still running the nonprofit he had founded. He completed dual master’s degrees in public policy and public health by 2017. The fellowship, funded through Bloomberg Philanthropies, embeds professionals in their organizations during training rather than pulling them out to study. The coursework was demanding, he has said, but the real education was learning how epidemiologists think: map how upstream conditions create downstream outcomes, then act on the upstream.
That framework now drives his consulting at Tera Strategies in Fort Lauderdale. The problems wear different clothes in a corporate setting, but the failure pattern holds. Organizations react to what is visible while ignoring what produced it.
Mukhtar describes the reflex bluntly. A department goes over budget, so leadership cuts staff. Revenue softens, so marketing gets reorganized. An executive resigns, and the whole org chart shifts overnight. “In public health, we call that treating the acute case rather than addressing the exposure,” he wrote. The business equivalent rarely asks whether decision rights were documented, whether communication norms were set before the team grew, or whether the numbers were reviewed often enough to catch trouble early.
He sorts companies into two buckets. One is the large, established firm that behaves like a city bureaucracy, unable to get out of its own way. The other is the startup, a handful of people covering 20 roles while trying to become a real business. Both make the same mistake. They prescribe inhalers.
The cost of that habit shows up in the research. A 2025 paper in Frontiers in Health Services described systems thinking as a way to “anticipate the potential consequences of policy implementation,” which is the analytical move most struggling companies skip. They treat the missed quarter or the lost client as the disease, when each is closer to a fever.
Mukhtar’s advice reverses the order of operations. Trace the cause before designing the cure. A broken company and a broken public health system fail for similar reasons, he argues: upstream decisions, or the absence of them, create downstream dysfunction that compounds over time. Find the exposure, and the symptoms usually take care of themselves.
