Sacrifice a Historic Downtown Neighborhood for a Hospital? There's a Better Option.

One of the top priorities for any community has got to be health care. After all, what is the point of housing, infrastructure or schools if people aren’t alive and healthy to use them? But the question of where a hospital should be located within a community is a different matter. Just last month, Daniel Herriges of Strong Towns wrote about Windsor, Ontario residents and businesses fighting to keep their hospital in town instead of seeing it relocate to a rural area at the edge of the city.

In Utica, New York, though, a photo negative of the Windsor story is playing out—demonstrating that there is no one-size-fits-all answer. Utica’s proposal for a new downtown hospital pits several desirable goals against each other: accessible health care, a revitalized downtown, and a healthy tax base to support city services.

But these goals don’t have to be at odds—if the city and the hospital in question are willing to reconsider their preferred location. And in doing so, they should start with our favored mantra: #DoTheMath.

Utica, NY

Lying in the center of Upstate New York, Utica is the biggest city between Albany and Syracuse, and it serves as the healthcare hub for three counties in the area: Oneida, Madison and Herkimer. The Mohawk Valley Health System (MVHS) and the City of Utica plan to meet the area’s increased healthcare needs with a new 373-bed hospital in downtown Utica. Central location and “revitalization of downtown Utica” are cited as top reasons for choosing the specific location.

The proposed site comprises over 1.2 million square feet (over 28 acres) in the Columbia Lafayette Neighborhood. Adjacent, and occupying an additional 1 million square feet, is a proposed entertainment district called the U District, with plans for a casino, beer museum, mini-farm of hops, and shooting range. The hospital plan and the U District have been linked Both plans feature generous surface parking and the demolition of several buildings the city has labeled “blighted.”

Nothing is particularly glamorous about the neighborhood as it stands. Multiple historic structures are sitting vacant—including buildings the city of Utica actually owns, whose value is depressed by the city’s own apparent decision to treat them as “blight” instead of renovating them. One might assume the area is not worth much—and that these mega-projects, which will create many jobs to grow the local economy, have got to be a boon to this location, right? Wrong.


A fiery organization called #NoHospitalDowntown has brought the flaws of this location to light. BetterUticaDowntown is another group with the same mission: to change existing hospital plans in order to give Downtown Utica a genuine chance at revitalization and save a valuable neighborhood. Both groups have reason to fight.

A self-contained hospital campus would punch a hole in this up-and-coming area, separate growing neighborhoods and significantly reduce the potential of downtown Utica as a whole.

For starters, the proposed site would wipe out over 40 business and property owners in an area worth saving—the historic Columbia Lafayette Neighborhood. Once gone, the hospital would be no real comparison to what exists in terms of the economic impact on the immediately adjacent neighborhood. It’s a popular belief that more downtown jobs will yield more traffic to local businesses by “activating” the surrounding streets, but Strong Towns member Arian Horbovetz, specifically addressing the Utica hospital issue, has written about how hospitals are not “activators” of this sort; they tend to be very self-contained and do not financially enrich the surrounding area.

Just considering the purpose and nature of a hospital supports both statements. Hospital employees are not likely to eat lunch or dinner at a local restaurant near the hospital: their high-stress jobs result in a different lifestyle. Also, sick patients and visitors are probably not looking to go shopping or have a beer at a local brewery after their hospital visit. Hospital users are not likely to spend money in the surrounding community. The notion that this hospital is a slam-dunk bet to revitalize downtown is simply false.

Building a hospital in the proposed location also comes at a high opportunity cost. The areas surrounding the Columbia Lafayette Neighborhood have recently begun to blossom, promising even higher future values for the chosen site. To the east, Genesee Street is one of the city’s most exciting places with local restaurants, cafes and pubs. A couple blocks north on Genesse is Handshake.City. Also called the “Backyard of Downtown Utica,” this grassroots effort builds community and revitalizes the city through incremental development on unused property. Lastly, a few blocks west of the neighborhood is Varick Street. With FX Matt Brewing Company and Adirondack Distilling Company, this street is full of life, especially in the evening. A self-contained hospital campus would punch a hole in this up-and-coming area, separate growing neighborhoods and significantly reduce the potential of downtown Utica as a whole.

#NoHospitalDowntown realized that an alternative location is a better financial decision and better for the downtown atmosphere. They asked geoaccounting firm Urban3 to run the numbers and allow math to make an unbiased case for the best hospital location.


Urban3 specializes in telling an impartial story with data in situations such as Utica’s. Ironically, Joe Minicozzi, AICP, principal at Urban3, relates to the #NoHospitalDowntown cause on a personal level.

Minicozzi’s Uncle Joe owned and operated Roman’s Pastry Shop before it was obtained through eminent domain and leveled for construction of the fort.

Minicozzi’s Uncle Joe owned and operated Roman’s Pastry Shop before it was obtained through eminent domain and leveled for construction of the fort.

Growing up just 12 miles away in Rome, New York, Minicozzi saw a similar situation play out in his hometown and is all too familiar with the damaging end results. In 1973, the city chose to rebuild Fort Stanwix as a national monument on roughly 15 acres in the middle of Downtown Rome. 

Minicozzi’s uncle lost his pastry shop in a two-story, mixed-use building to eminent domain in order to construct the fort. Other valuable buildings shared the same fate. Minicozzi said this event left a lasting impact on him which affects his work today.

While this is a relevant and valuable lesson for MVHS and Utica, it would take more than a story to convince them to relocate the hospital. Urban3 allowed the data to find a new site using the most important factor: a central location.

The hospital will serve three distinct areas: Utica, Oneida County and the three surrounding counties previously mentioned. Urban3 found the population centers of each area. Figure 1 shows each center on a map along with the center of these three points. The figure also displays existing hospitals St. Luke’s and St. Elizabeth’s.


Figure 1. (Source: Urban3)


If the hospital must serve and be easily accessible by all areas, St. Luke’s is situated in an advantageous position: closest to the population center of Utica yet in the direction of the other two centers.

St. Luke’s Hospital

A redesign of St. Luke’s tweeted on June 7, 2019. (Source: #NoHospitalDowntown)

St. Luke’s Hospital has the space to grow into a bigger hospital as well. There are roughly 10 acres of surface parking, much of which could be condensed into a parking garage. Vacant land to the west and north both provide additional avenues for growth. #NoHospitalDowntown shared a redesign concept of how the St. Luke’s campus might be redesigned to accommodate the new growth.

At just three miles and 10 minutes from downtown by car, St. Luke’s seems to be the ideal location for the MVHS to grow. However, Urban3 did not stop there. They provided another alternative.

Alternative In-Town Location

If proximity to the Utica population center and a downtown location are musts, Urban3 found an alternative that fits both criteria.

Figure 2 shows the Utica population center with a circle around it using the distance to the proposed site as its radius. This means anything inside the circle is then closer to the population center of Utica. A hospital needs a large piece of land; is there one available within this circle? Urban3 found that the Hannaford Plaza shopping center is an 18 acre area lying within the circle.

Figure 2. Click to view large image. (Source: Urban3)

The shopping plaza, which may be considered a financial hotspot to the city, pales in comparison to several buildings in the proposed site in terms of value per acre (VPA). According to Urban3, Hannaford Plaza has a VPA of under $600,000. Meanwhile, in the Columbia Lafayette Neighborhood, just two buildings sit at $770,000 and nearly $4 million. What’s more: these two buildings are widely unmaintained and underutilized. No fancy retail stores or big investments provide aid. Imagine what small scale, incremental developmental could add to Columbia Lafayette.

The Math Doesn’t Lie

MVHS and Utica unfortunately have not taken action on the points brought up by #NoHospitalDowntown, BetterUticaDowntown or Urban3, but one thing is for sure: the math doesn’t lie. And it is crucial to understand exactly what the math says and what it does not say.

The math does not say we must always build a hospital outside of the downtown. That may be the specific solution in Utica, but this is no one-size-fits-all solution, nor should it be the take-away. Again, our profile of Windsor, Ontario drew a very different conclusion—also based on some hard data. Hospital location relative to downtown is less important than understanding the value of existing land and knowing the opportunity cost of constructing a hospital.

What the math reminds us, though, is that traditional development is the key to strong towns. Multistory, mixed-use buildings are gold. Even the unmaintained, underutilized buildings along Columbia Street beat out a shiny shopping mall when it comes to value per acre. Traditional development that utilizes flexible spaces and incremental growth is what built these places. Now that they have been abandoned, we have the opportunity to take them back and return to traditional development patterns.

Additionally, historic districts are gold. It would be ideal if we didn’t need to discuss “revitalizing” a downtown because it is already in top condition, but the opposite is true in many American cities. With this existing circumstance, we need to salvage the greatest asset that exists in many towns and cities: our historic neighborhoods. 

In Utica, using an alternative hospital location keeps alive the possibility of salvaging a historic neighborhood with amazing potential. Does anything threaten the historic parts of your town or city? If so, #dothemath and see if you can’t demonstrate the area’s current and potential value. It could help you fight to keep the history—and financial well-being— of your home alive.