Shopping on the internet has become routine for many people and covers a wide range of products and services. It is therefore unsurprising that, in some countries, medical and pharmaceutical services can also be bought. This has clear advantages in countries such as Australia, where some communities are isolated by huge distances (or other geographical circumstances) but are able to access the internet. However, shopping for psychotropic substances is not quite the same as shopping for toothpaste or televisions. These drugs are subject to strict controls, including the requirement for prescription by a qualified medical practitioner. It is possible to implement systems so that internet shopping for and mail delivery of psychotropic substances conform to regulatory requirements; if this is done, internet pharmacies can be valuable in ensuring an adequate supply of medical provisions to all citizens, wherever they live (US General Accounting Office, 2000). However, these same sales opportunities can easily be exploited by unlicensed internet pharmacies and it is the problems caused by these illicit ‘cyber-pharmacies’ that are now the cause of grave concern.

The association between mental illness and poor physical health has been known for decades (Philips, 1934). This is not a trivial relationship between mental ill health and minor physical problems but an association with such poor physical health that it results in premature death. For example, a study in the USA showed that the life expectancy of those with schizophrenia or other serious mental illness was 9 years shorter than for the general population (Dembling et al, 1999). Similarly, those with learning disabilities have an increased risk of early death, and this increase is greater in those with severe disability.

Suicide, especially among young people, appears to be increasing in prevalence in diverse countries and cultures. The reasons for this worrying trend remain obscure. Here we present commentaries on suicidal trends in three countries.

Recently, the UK government expressed concern about the rising tide of antisocial behaviour among young people who, in certain areas of the country, were habitually engaging in acts of minor delinquency – often fuelled by drink. On the other hand, legislation was introduced to make it legal for premises that sell alcohol to remain open longer, up to 24 hours a day. This latter arrangement has courted considerable controversy. For example, the British Medical Association commented that any extension to licensing hours requires a programme of research, after its introduction, to look at its health consequences - both acute and chronic.

In recent years, the number of suicides in Japan has increased dramatically, particularly among middle-aged men. According to the Brief Report on Suicides in 2001 by the National Police Agency of Japan (NPA, 2002), the number of suicides in Japan was 31 042, and the national suicide rate was 24.4/100 000. Akita is an agricultural prefecture with a population of approximately 1 200 000. According to the Akita Prefectural Police (APP), the number of suicides in Akita Prefecture was 457 (299 males, 158 females) in 2001. Akita Prefecture currently has the highest rate of suicide in Japan. The identification of strategies for suicide prevention is therefore imperative.

Developing psychiatric services for disaster-affected populations in a place with meagre resources is a challenge, especially if the place is remote and offers limited access, and the weather conditions are harsh. The earthquake in October 2005 posed just such a challenge (Makhdum & Javed, 2005). Massive damage was reported from Pakistan, as the epicentre was in Muzaffarabad, in Pakistani-controlled Kashmir. There was also extensive damage to life and property in some areas of Kashmir in India. The road and communication network had been completely destroyed in many of the affected areas.

On 10 January 2006, ITV2, a UK television channel, ran a 90-minute programme called Britain's Youngest Boozers. It claimed that one in three younger people are binge drinkers and that one in six is dependent on alcohol. The comments in interviews with adolescents and families were stark and worrying. Although the age parameters were not clear at the start of the programme, it focused on those aged up to 25 years and presented enormously serious concerns about the changed patterns of drinking among Britain's younger people.

Demographic ageing proceeds apace in all world regions (United Nations, 2003). The proportion of older people increases as mortality falls and life expectancy increases. Population growth slows as fertility declines to replacement levels. Latin America, China and India are experiencing unprecedentedly rapid demographic ageing (Figs 1 and 2).

Demographic ageing is proceeding especially rapidly in Latin America. Those aged 65 years and over will increase from 33.3 million (6% of the total population) in 2005 to 56.3 million (8.5%) in 2020 and 110.2 million (14.7%) in 2040. A recent review drew attention to the relatively small number of population-based studies of dementia in Latin American countries (Ferri et al, 2005). Estimates based on the literature suggested 1.8 million people with dementia in 2001 increasing to 4.1 million by 2020 and 9.1 million by 2040. The increase, more than a doubling of the number of people with dementia between 2000 and 2020, was the most marked for any world region. Arguably, health and social finance systems are not well placed to meet the needs of the growing numbers of frail and dependent elderly people.

The tsunami which affected South Asia on 26 December 2004 caused over 41 000 deaths in Sri Lanka, representing 0.2% of the total population, and displaced over 880 000 people from their homes and livelihoods (World Health Organization, 2004). Kilinochchi, Jaffna and Mullativu districts in the Northern Province of Sri Lanka were affected by the tsunami and, as of April 2005, in the whole province, 6200 people had lost their lives, 961 were still missing, 19 618 were still housed in welfare centres and 45 548 were housed with relatives and friends (Government of Sri Lanka, 2005).

Brazil is the largest and most populous country in South America (in 2002 the population was approximately 175 million). Although life expectancy in Brazil has increased, suicide and other forms of injury-related mortality, such as homicide and accident, have increased as a proportion of overall mortality (Oswaldo Cruz Foundation, 1984; Brazil Ministry of Health, 2001). The suicide rate in Brazil (3.0–4.0 per 100 000 inhabitants) is not considered high in global terms (World Health Organization, 1999). Nevertheless, it has followed the world tendency towards growth: during 1980–2000, the suicide rate in Brazil increased by 21%. Elderly people present the highest suicide rates in absolute numbers, but the alarming finding in the Brazilian data is that the youth population is increasingly dying by suicide (Mello-Santos et al, 2005). This statistic partially confirms a forecast by Diekstra & Guilbinat (1993) that the number of deaths by suicide would dramatically increase over the next decades, mainly in developing countries, including Latin America. In these regions, socio-economic factors (such as an increase in divorce and unemployment and a decrease in religiosity) increase the risk of self-harm. We discuss the reasons for the low suicide rate in Brazil and highlight the socio-economic factors affecting its increase among the youth population in particular.

The population of Taiwan is 98% Han and 2% indigenous. Taiwanese Hans are, ethnically, an immigrant Chinese population. Traditionally, indigenous families make wine and, just like tea to the Hans or coffee in Western social settings, wine is served to entertain the guests in the indigenous culture. Alcohol drinking is a way of delivering a message of their conviviality. It also has a central role in traditional harvest festivals, ancestor worship and wedding ceremonies (Historical Research Commission of Taiwan Province, 1996).

According to the 2001 census, India is home to more than 76 million people aged 60 years and over. This age-group, currently only 7.4% of the population, is expected to grow dramatically in the coming few decades. Analysis of the census data shows substantial variation in the rate of demographic ageing across India: at present, 10.5% of Kerala's population is older than 60 years, while in Dadra and Nagarhaveli this proportion is only 4%. Regions with more favourable health indicators seem to be ageing faster and the demand for specialist services will soon be evident in such places. There is a growing realisation that the care of older people with disabilities makes enormous demands on their carers. Terms such as ‘dementia’ and ‘Alzheimer's disease’ are now better understood. This was not the case when the Alzheimer's and Related Disorders Society of India (ARDSI) initiated awareness programmes. However, dementia remains a largely hidden problem in those disadvantaged parts of India where poverty and illiteracy remain prevalent.

Different kinds of disaster create dissimilar conditions for survivors, and the specific realities associated with each must guide our helping responses. This in no way negates the importance of having general principles to follow in responding to major disasters (Sphere Project, 2004; van Ommeren et al, 2005).

Suicide is a serious worldwide health problem, particularly among youths. It is defined as the intentional act of killing oneself. Analytically, the suicidal act entails: the wish to kill, the wish to be killed and the wish to die. People who die by suicide know what they are doing and are aware of the consequences of their actions. A completed suicidal act is a complex phenomenon associated with psychological, biological and social factors. It follows severe exhaustion under a continuing assault of stressors when the suicidal individual is no longer able to cope with and to restore homeostasis. In order to categorise a case as a suicide, legal authorities demand unequivocal evidence of intent.

Alcohol use and misuse among young people continue to be a major public health concern, despite decades of initiatives aimed at educating young people about the hazards of alcohol. Yet where do young people learn about alcohol use? How do they form attitudes about the effects and risks of drinking? Increasing evidence suggests that young people learn not only from real people (e.g. peers and parents) in their everyday lives but also from characters whose lives they witness through the media. In fact, the mass media have been recognised as significant sources of information about substance use that can influence young people's beliefs and expectations (Bahk, 2001; Sargent et al, 2002).