What Nicholas Mukhtar learned about systems thinking from public health
I was 22 years old, driving through Detroit, when I saw a group of kids playing basketball with a deflated ball and two construction barrels for hoops. They lived in a major American city and didn’t even have a park. I had ten parks to choose from growing up. They didn’t choose their zip code. That image stayed with me, not as a charity case but as a systems failure. Somewhere between city budgets, federal health priorities, and decades of disinvestment, an entire neighborhood had been designed out of basic recreation. The kids weren’t failing. The infrastructure around them had failed a long time ago.
That was 2011. Within two years, I’d founded Healthy Detroit, a nonprofit built around a simple premise: if you want to change health outcomes at the population level, you have to change the systems that produce those outcomes. We didn’t open clinics. We partnered with the Detroit Parks & Recreation Department to turn public parks into one-stop wellness centers offering free fitness classes, biometric screenings, immunizations, nutritional programs, and connections to social services. We chose city parks as our delivery mechanism because they were the one piece of community infrastructure with no barriers to entry. No appointments. No insurance cards. No co-pays.
By 2017, the organization had an annual operating budget of roughly $15 million. The American Public Health Association named Healthy Detroit the National Public Health Organization of the Year. Our work appeared in the U.S. Surgeon General’s 2014 Report to the President and Congress. None of that happened because I was a better fundraiser than the next person. It happened because the model was built as a system, one that could be replicated, measured, and run without me standing in every park.
What Hopkins Taught Me About Tracing Causes Upstream
I enrolled at Johns Hopkins University as a Bloomberg Fellow while still running Healthy Detroit. The fellowship is funded through Bloomberg Philanthropies and provides full-tuition scholarships to professionals working on public health challenges. Fellows are embedded in their organizations during training. You don’t leave the work to study it. You study it while you’re doing it.
I earned dual master’s degrees in Public Policy and Public Health by 2017. The coursework was demanding, but the real education was in how epidemiologists think. Public health practitioners don’t treat individual patients. They’re trained to map how upstream conditions create downstream outcomes across populations. An epidemiologist looking at a cluster of asthma cases in a neighborhood doesn’t start by prescribing inhalers. She starts by asking what’s in the air, what’s in the housing stock, what changed in the local environment. The intervention targets the cause, not the symptom.
A 2025 paper in Frontiers in Health Services described systems thinking in public health as a methodology that “enables policymakers to comprehend the interconnections within public health systems and anticipate the potential consequences of policy implementation.” That’s an academic way of saying what I learned on the ground in Detroit: you can’t fix a problem you haven’t traced to its origin.
At Healthy Detroit, we applied this instinct to program design. Each HealthPark site followed a standardized model. Residents received biometric assessments, connected with partner services through an on-site virtual network, and carried a “Healthy Detroit Passport” that tracked their participation. The passport collected aggregate data while giving individuals a way to monitor their own progress. If a site was underperforming, we could trace the issue to a specific breakdown (staffing, scheduling, partner coordination) rather than assuming the whole concept was flawed.
Replicability mattered as much as initial impact. A program that worked in one park but couldn’t be duplicated across the city would have limited reach. I designed the infrastructure with scale in mind from day one. That habit followed me into everything I’ve done since.
Applying the Same Logic to Companies
When I transitioned into private-sector consulting, first through Healthy Communities in Washington, D.C., then through Tera Strategies in Fort Lauderdale, I carried that diagnostic framework with me. The problems look different in a corporate setting. Nobody’s talking about immunization rates or park infrastructure. But the underlying pattern holds: organizations treat symptoms because they haven’t mapped the system producing those symptoms.
I look at companies in two buckets. One is the large, established company that functions much like a big city government, a bureaucratic machine that sometimes can’t get out of its own way. The other is the startup, a group of people doing 20 different roles and trying to turn it into a real functioning business. Both types tend to make the same mistake. They react to what’s visible (a missed quarter, a departing employee, a failed product launch) without asking what created the conditions for that failure in the first place.
In public health, we call that treating the acute case rather than addressing the exposure. In business, I see it constantly. A department is over budget, so leadership cuts headcount. Revenue dips, so marketing gets restructured. Someone in the C-suite leaves and the whole reporting chain gets reshuffled overnight. None of those responses touch the actual cause. The question nobody asks is whether decision-making authority was ever documented. Whether communication expectations were codified before the team scaled or just left to improvisation. Whether financial reporting was frequent enough to catch the problem before it became a crisis.
I’ve written that a lot of business owners treat systems as something to construct after growth occurs. My advice runs the other direction. Build the infrastructure before you need it, because by the time you need it, you can’t afford the downtime.
The Communication Problem Hidden Inside Every Other Problem
Across the organizations I advise, whether in healthcare, wealth management, family offices, or startups, the single most common root cause of dysfunction is communication failure. I’ve said this publicly and I’ll say it again: that seems to be 90% of the problems across the board. People just need to talk.
Grammarly’s workplace research estimated that poor communication costs U.S. businesses $1.2 trillion annually. McKinsey found that even high-performing companies carry a 30 percent gap between a strategy’s full potential and what their operating model actually delivers. Those numbers describe the same phenomenon I saw in public health: the distance between a plan and its execution is where outcomes are determined.
In a hospital or a medical director’s office, that gap is felt most acutely as delayed care decisions and chronic misalignment between clinical teams and administrative leadership. Family offices have their own version: an inheritance plan that nobody in the family understands, drafted years ago by somebody who’s no longer around to explain it. Startups tend to surface it differently. The founder is doing everything personally because the team was never given enough clarity to operate on their own.
Systems thinking gives me a way to see these patterns across industries rather than treating each one as a unique situation. The specifics change. The structure of the problem rarely does.
What I’d Tell Anyone Entering This Work
Public health trained me to think about problems at the population level. My graduate work at Hopkins gave formal structure to what I’d been doing intuitively at Healthy Detroit: tracing root causes, finding the right pressure points, and measuring whether interventions actually worked. The transition to corporate consulting was less of a leap than people assume. A broken organization and a broken public health system fail for similar reasons: upstream decisions (or the absence of them) create downstream dysfunction that compounds over time.
I’m not anti-regulation. I’m pro-simplification. The more complex we make systems, in healthcare, in government, in business, the people at the bottom are the ones who end up paying for it. That conviction was shaped by years of watching Detroit residents navigate a healthcare system designed for somebody else. It stayed with me because the same dynamic is repeated in boardrooms, where complexity serves nobody and clarity is the rarest resource.
If there’s one thing the Bloomberg Fellowship taught me, it’s that you can’t separate the design of a system from the outcomes it produces. The system is the outcome. Every organizational problem I’ve encountered since then has confirmed that principle. When someone calls and says their company is struggling, I don’t start by asking what went wrong. I start by asking how the company was built. What was designed deliberately. What was improvised. And what was never discussed at all. The answer to that last question is usually where the real work begins.
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