A REPORT produced this week by North Yorkshire's health chiefs highlights a recurring problem for any organisation seeking to provide services in the county.

On average, North Yorkshire is wealthier, healthier and brighter than most areas of Britain. It comes near the top of government tables detailing educational achievement and wealth generation per head of population. This statistical evidence is backed by most people's perceptions of the county as an affluent, better-than-average place to live.

Yet the figures, and the perceptions, tend to paper over the cracks in this superficial layer of prosperity. Underneath there are pockets of deprivation which tend to be hard to find because of the widespread physical nature of the county. Unlike the inner city, where a particular estate or district can be targeted for extra help, problems in rural areas rarely present themselves in such a neat package.

Prof Mark Baker, North Yorkshire's director of public health, says in his annual report that addressing widening inequalities in health in the county is the most difficult challenge the county's health authority faces.

While some easily defined areas, such as Colburn, can be marked out for special help or measures, the rural nature of most of the county makes it difficult to deploy resources in an effective way to improve the health of the disadvantaged.

Access is a key problem, not helped by branch surgery closures and the withdrawal of NHS hospital services at the Duchess of Kent hospital at Catterick. The North Yorkshire health authority is attempting to address the issue by using village halls and even pubs as part-time health clinics - innovative ideas which should be applauded.

The county council too is trying to improve access to health facilities through the re-establishment of some public transport services, particularly buses.

Sadly, these initiatives will only go some way to addressing the inequality problem. Both health authority and county council are hampered by central funding arrangements which do not take full account of that strange but nevertheless real concept of "rurality" - the inherent difficulty of providing services in country areas.

The long-awaited rural White Paper could prove to be really worth waiting for if it tackled this most fundamental of countryside issues