travel costs from siberia and the far east could exceed average monthly wage levels in these regions by several times in addition an increase in the permanent population in areas with extraction industries operating in extreme climatic conditions also poses particular problems because health care services are often lacking in such localities diet is poor and pollution is extensive this may reflect differences in the organisation of primarycare provision between rural and urban areas see chapter persons living in rural areas may not have doctors who they can consult and patients have to be satisfied with paramedical services which are limited in the care that they are allowed to provide surveys show that the access to health care in rural areas is worse than in urban areas both in terms of the presence of medical facilities and in the quality of health care provision bremzen et al