CENTER FOR GLOBAL HEALTH ACCOUNTABILITY

Measuring outcomes,
not intentions.

Every year governments, international organizations, charities and foundations devote enormous effort and resources to improving global health. These efforts are usually judged by the quality of their intentions or the scale of their ambition. Far less attention is paid to a more fundamental question.

Did they actually achieve the outcomes they promised?

The Center for Global Health Accountability exists to answer that question.

Explore the evidenceWhat we measure
Books
All books →

Books bring together years of empirical research into broader narratives. They represent the judgement of individual authors while remaining grounded in the evidence developed through CGHA's wider research programme.

House Always Wins cover
Acceptable Addiction cover
Tobacco Trap cover
Decolonizing Public Health cover
AVAILABLE NOW
The House Always Wins
The Business, Politics, and Human Cost of Sports Betting

An investigative narrative revealing how smartphones, deregulation, and pandemic isolation turned America’s pastime into its newest addiction — and the book behind CGHA’s gambling research programme.

Paperback · $19.99Kindle · $14.99Audiobook · $20.57Audio CD · $35.95
Buy on AmazonAbout the bookUnderlying evidence
The books tell the larger story. The evidence remains available for everyone to examine.
OUR WORK BEGINS WHERE MANY POLICY DISCUSSIONS END
Rather than asking whether a proposal sounds persuasive, we examine what happened after it was implemented.
Did smoking decline?
Did disease decline?
Did patients benefit?
Did consumers change their behaviour?
Did illicit markets emerge?
Did international organizations improve health?
Did regulations achieve the improvements they promised?
These are empirical questions. They require evidence rather than assumption.
DATA
The data are the foundation of everything we do.

Every project undertaken by CGHA begins with evidence. We collect field data, undertake surveys, analyse markets, study institutions and measure outcomes before drawing conclusions. Reports, books and commentary are all built upon that evidence.

One thing that distinguishes CGHA from many organizations is that we do not see the reports as the primary product.

The evidence is the primary product.
Reports interpret the evidence.
Books synthesize the evidence.
Commentary discusses its implications.
The data remain the foundation.

That is also why much of the work published here appears under the name of the Center rather than individual authors. Individual researchers make essential contributions, and books and journal articles are properly attributed. The underlying evidence, however, is intended to become part of a permanent institutional resource that others can examine, challenge, refine and build upon.

The objective is not to create a collection of individual opinions. The objective is to build an enduring body of empirical evidence.
Field research or survey work in progress
654
survey respondents, Montgomery County, PA
18
adult consumers in the nicotine field study
7
published papers and reports
Surveys, methodology & full tables →
What the evidence shows
All surveys & data →

Original CGHA measurements. Every chart links to the survey or paper that produced it.

GAMBLING SURVEY
Low trust, high participation
Montgomery County, PA · n = 654
695933<33
Support legal
betting (Rep)
Support legal
betting (Ind)
Participate
(Rep)
Trust
operators
FIELD PAPER
The market among friends
Primary supply route · n = 18
Reliable friend supplier · 8Casual order through a friend · 4Friend who travels frequently · 3Online-to-local friend route · 1Off-menu retailer · 1Open-air multiproduct seller · 1
16 of 18 sourced through a social relationship.
VACCINE SURVEY
Distrust is uniform. Uptake is not.
Distrust of pharmaceutical companies, by party · n = 654
72.3%74.8%76.6%DemIndRep
COVID booster uptake nevertheless varies by roughly 3× across these same groups.
What we measure
All research areas →

Five programmes, each organized around the questions it exists to answer.

Tobacco and Nicotine
Do tobacco-control policies reduce disease?
Do they help smokers?
4 questions →
Global Health Governance
Are international institutions accountable for results?
Do international agreements improve health?
3 questions →
Pandemic Policy
Did pandemic interventions improve health outcomes?
Which policies worked?
4 questions →
Medicines
Do regulatory systems protect patients?
How common are counterfeit and substandard medicines?
3 questions →
Markets and Behaviour
How do consumers actually respond to regulation?
How do markets adapt?
3 questions →
FLAGSHIP PROJECTPANDEMIC POLICY
The Great Avoidance
What Covid inquiries investigated — and what they did not.

Governments have conducted dozens of inquiries into the pandemic. This project measures what those inquiries investigated, what they overlooked, and the gap between a policy's significance and the scrutiny it received.

Explore the project
Inquiry timeline, map, or diagram — no virus imagery
Research
All research →

CGHA research evaluates public-health policies using empirical evidence rather than assumption — combining economics, epidemiology, behavioural science, field research and institutional analysis.

Lead article image
MARKETS & BEHAVIOUR · COMMENTARY
Sports Betting Doesn't Sell Bets. It Sells Relief.

Lessons from America and Britain on gambling, loneliness, and the new economy of engagement. The emotional reward often comes not from winning — but from no longer losing.

July 2026 · 8 min read
FIELD PAPER
The Market Among Friends

When a product is excluded from the lawful market, prohibition may change the supplier without ending the demand.

August 2026
RESEARCH REPORT
Vaccine Uptake, System Legitimacy, and Institutional Exit

Distrust is nearly uniform across political groups. Uptake varies by roughly three times.

May 2026
Commentary
Full archive →
podcast still
PODCASTJuly 2026
Why gambling sells relief, not excitement
The Relief–Engagement Model explained, drawing on the Pennsylvania and UK survey data behind The House Always Wins.
CGHA Research Series
opinion still
OPINIONJune 2026
From public health to behavioral governance
Real problems affecting some people are increasingly used to justify far broader systems of behavioral management.
Op-ed
presentation still
PRESENTATIONMay 2026
What Covid inquiries left unexamined
Findings from The Great Avoidance on the gap between a policy’s significance and the scrutiny it received.
International Health Reform Panel
© 2026 Center for Global Health Accountability · Research. Evidence. Accountability.AboutPartnershipsMedia