What are the essential services and institutions a city can't function without? Police and fire protection. Schools. And, without a doubt, health care. These things are non-negotiable.
We've been observers for years of the trend of cities hollowing out—in function if not in form—as these essential services decamp to the outskirts. The situation is especially dire in small and mid-size cities. Time to build a new high school? More often than not it's a massive campus on the edge of town—completely inaccessible to the community by walking, even as we pay lip service to "safe routes to school."
Other cities have sought to relocate government offices to the fringe. Or they've brought the suburban campus model into the heart of town, as is happening in Brainerd, Minnesota, where the school district plans to raze multiple blocks of a traditional urban neighborhood to provide—can you guess it?—parking.
These decisions are often motivated by a short-sighted concern for efficiency: acquiring land is often both cheaper and easier on the urban-rural fringe than in the heart of town, and such a location affords more design flexibility. But these decisions reinforce the destructive dynamic of the Growth Ponzi Scheme, in which a community chases short-term growth at the cost of assuming the long-term liability of maintaining all the brand new infrastructure required to serve a spread-out development pattern. Meanwhile, older neighborhoods languish and fall into decline.
One of the more dramatic ongoing stories of this sort is taking place in Windsor, Ontario, where a group of activists are engaged in a David-and-Goliath struggle to prevent the city's only hospital from being relocated to an essentially rural area outside of the city.
Their situation illustrates that building a strong town can't always just be about the feel-good work of supporting local businesses, rehabbing old homes and revitalizing neighborhood streets. Not when decision-makers, elected and unelected alike, can so easily undermine the integrity of your community with short-sighted actions whose effects will last decades. Sometimes it's going to take a political fight on the part of those who understand the importance of not abandoning a city's heart—especially when it comes to the institutions that keep its blood pumping.
The Story of the Hospital and the Beanfield
Windsor, Ontario is a city of 217,000 in a region of 400,000. It has been called "the end of Canada"—it's the country's southernmost city of any size, located across the Detroit River from Detroit, Michigan. Like Detroit, Windsor has a substantial automobile industry, and like Detroit, it's core neighborhoods have experienced disinvestment and population and job losses in recent decades. Even as recently as 2000, Windsor was at a record high number of 28,100 automotive jobs—but by 2007, the city had been buffeted by recession and that number had fallen to 18,200.
Windsor's population is aging, and growth is expected to be flat or declining after 2031. Given this situation, the smartest planning approach for the city would be to double down on its core strengths and prioritize essential maintenance of existing infrastructure and levels of service.
Instead, Windsor is short-sightedly chasing growth on its far suburban fringe—and a $2 billion new hospital is the wedge it's using to try to kick-start this growth.
Windsor has two acute-care hospitals, one downtown and one about 4 kilometers outside the core. They are run by the same entity, Windsor Regional Hospital (WRH), which is the region's second-largest employer, with about 4,000 employees. (In Canada, hospitals are funded by the provincial government, and an elected board runs each individual hospital much like a private business, with a CEO and administrative team.)
In 2012, WRH conducted a review of the two aging hospitals and determined it would be better to close them and consolidate their services into one new, state-of-the-art facility. In a series of town hall meetings, WRH went out to the community and talked up the benefits of a brand new hospital. Private rooms, the latest technology—what city wouldn't want that?
The catch, though? With little apparent public input or debate, the hospital's 2012 review had determined that the new hospital would be built on "60 acres of greenfield land." The site ultimately selected was an area near Windsor's international airport, but far from the developed core of the city. Residents have taken to referring to the would-be hospital site as "the beanfield."
The rural road leading to the proposed location currently has no public transit service and will require major infrastructure upgrades to handle the anticipated traffic. The new location is closer to some suburban communities, but far from Windsor's most densely-populated and poorest neighborhoods. The plan replaces all hospital services in Windsor's urban core with only a proposed Urgent Care Center and mental health services. The resulting facilities will be unable to handle many life-saving procedures and will not be not open 24-7. The city's aging residents and those without ready access to a car will find their ability to access care greatly reduced.
Penny Wise But Pound Foolish
I spoke with Shane Mitchell, a Strong Towns member who is a founding member of CAMPP, Citizens for an Accountable Mega-Hospital Planning Process, the group of Windsor residents and businesses challenging the proposed hospital location. Mitchell explains that part of the problem is the conflicting priorities of different agencies:
"The #1 site according to a ranking in the RFP [Request for Proposals], was in the city, but it would have cost of approximately $2 million more than the selected site. The committee instead moved on to the 2nd choice site because of a $2 million difference.
The infrastructure cost to serve the greenfield site is quoted at upwards of $200 million plus 2 million annually just to extend transit service to the area, but because the hospital is working in a silo separate from the city, they’re effectively saying, 'We can save $2 million. Sure, the city has to spend $200 million, but it's not coming from our pot.'
The proposed hospital site lies in a designated “floodplain development control area,” with official floodplain mapping yet to be done. The land development, including additional road construction and many acres of surface parking, will require an elaborate stormwater management system. This system is necessary to reduce flood risk to low-lying residential neighbourhoods to the north—an area that, in both 2016 and 2017, experienced 100-year rain events that resulted in extensive flood damage. Because of the site’s proximity to Windsor Airport, specialized engineering will also be needed to prevent open pools of standing water that will otherwise attract waterfowl, an obvious danger to aircraft.”
Why would the city go along with such a plan? One possible motivation is to lay the ground for suburban development. Specifically, a proposed 400 hectare (roughly 1.5 square mile) residential and commercial subdivision, which would lie south of Windsor Airport, near the proposed hospital, is contingent on the rezoning of the land and would seemingly need the mega-hospital project in order to kick-start the development. It would include room for 3,280 homes—roughly half of the total number of new homes Windsor anticipates needing in the next two decades, just in this one currently-agricultural area.
This is a costly, self-defeating way to grow—and all the more so for a city like Windsor that is far from booming. The city could easily accommodate its modest population increase in already built-up areas where no new infrastructure is required—and Windsor would be more prosperous and resilient for it.
Windsor Residents & Businesses Fight Back
In the summer of 2013, CAMPP was formed. Composed of mostly urban residents, the group began to meet on a regular basis with a goal of staving off the loss of the city’s accessible hospital services. CAMPP began writing to officials and holding meetings with residents, hospital planners and politicians.
CAMPP argued that if WRH is going to close both existing campuses in favor of a new single site hospital, then it should be located on an urban brownfield site. There are 500 acres within the city of Windsor that could be developed tomorrow according to the city’s own Brownfield Redevelopment Strategy, and such a site would be better for Windsor residents and for the city's financial future.
Unfortunately, there was never a robust public debate about the site selection, despite CAMPP's efforts. In 2014, WRH assembled a site selection committee comprised of hospital board members and select community representatives. In 2015, they announced the beanfield site. CAMPP has appealed the site selection through a process in Ontario, the Local Planning Appeal Tribunal (LPAT), that allows citizens to appeal land rezoning if it is inconsistent with existing long-range plans.
The effort has received significant support from a number of prominent figures, including Toronto planner Ken Greenberg and the former CEO of Maple Leaf Sports, Richard Peddie, as well as media coverage including a favorable editorial in the Globe & Mail, Canada's premier newspaper. Jennifer Keesmaat, former Toronto chief planner, is the independent expert witness for the legal challenge.
In April of 2019, CAMPP was granted an oral hearing for its legal challenge. The group anticipates a long battle and more than $100,000 in legal fees. (You can learn more and donate to their effort here.)
Mitchell views CAMPP's underdog fight as part of a broader battle against local governments throughout Ontario still wedded to a discredited, 20th-century approach to growth: costly horizontal expansion at the expense of existing neighborhoods and residents.
"If we’re doing these things, maybe we won’t just change the decision happening in Windsor, but we can overturn this habit of building suburban shopping mall style hospitals and schools.
The city of Windsor has a billion-dollar infrastructure deficit. People complain every day that their own street is like the surface of Mars. But they don’t see the connection with expanding our city onto farmland, when we don't have enough money to maintain what we already have.
We’re really hoping we’ll be able to overturn this. It could have a very positive effect on planning policy throughout the province.”
We hope so too.
(Cover photo via Wikimedia Commons)