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Purpose: For over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a "Model of Health and Well-being" (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada., Design/methodology/approach: The MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice., Findings: The MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes., Originality/value: As comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.

This study evaluated road traffic noise annoyance in Canada in relation to activity interference, subject concerns about noise and self-reported distance to a major road. Random digit dialing was employed to survey a representative sample of 2565 Canadians 15 years of age and older. Respondents highly annoyed by traffic noise were significantly more likely to perceive annoyance to negatively impact health, live closer to a heavily traveled road and report that traffic noise often interfered with daily activities. Sex, age, education level, community size and province had statistically significant associations with traffic noise annoyance. High noise annoyance consistently correlated with frequent interference of activities. Reducing noise at night (10 pm-7 am) was more important than during the rest of the day.

The present paper provides the results from two nation-wide telephone surveys conducted in Canada on a representative sample of 5,232 individuals, 15 years of age and older. The goals of this study were to gauge Canadians' annoyance towards environmental noise, identify the source of noise that is viewed as most annoying and quantify annoyance toward this principal noise source according to internationally accepted specifications. The first survey revealed that nearly 8% of Canadians in this age group were either very or extremely bothered, disturbed or annoyed by noise in general and traffic noise was identified as being the most annoying source. A follow-up survey was conducted to further assess Canadians' annoyance towards traffic noise using both a five-item verbal scale and a ten-point numerical scale. It was shown that 6.7% of respondents indicated they were either very or extremely annoyed by traffic noise on the verbal scale. On the numerical scale, where 10 was equivalent to "extremely annoyed" and 0 was equivalent to "not at all annoyed", 5.0% and 9.1% of respondents rated traffic noise as 8 and above and 7 and above, respectively. The national margin of error for these findings is plus or minus 1.9 percentage points, 19 times out of 20. The results are consistent with an approximate value of 7% for the percentage of Canadians, in the age group studied, highly annoyed by road traffic noise (i.e. about 1.8 million people). We found that age, education level and community size had a statistically significant association with noise annoyance ratings in general and annoyance specifically attributed to traffic noise. The use of the International Organization for Standardization/Technical Specification (ISO/TS)-15666 questions for assessing noise annoyance makes it possible to compare our results to other national surveys that have used the same questions.