Internationally, NGOs (service organizations more than constituent groups) have been increasingly vocal in international policy debates and in health-related international conventions.

Their contribution has been particularly strong in establishing health conventions and standards. For example, trade unions have campaigned on hazardous chemicals. The International Baby Food Action Network - established in 1979 by five NGOs - played an important role in developing the International Code on the Marketing of Breastmilk Substitutes. Trade unions in southern Africa promoted and participated in a tripartite dialogue in the Southern African Development Community to adopt a regional code of practice on HIV/AIDS and Employment.

These civic actions have taken a number of forms, including:

• urging governments to support conventions and standards
• monitoring and exposing industry abuses before and after their adoption
• sharing information on the issues involved in developing the codes
• garnering international media attention and public support
• applying direct pressure, such as through boycotts
• providing a critical counterweight to industry lobbies.

Internationally, this 'watchdog' and advocacy role has led to a proposal to form a Global Health Watch. This collaborative NGO structure aims to stimulate the political will to develop improved health policies and to monitor how well governments implement them.