10 Distillation Guidebook Co-Lab • 9.18–9.19 2025 reopen the hospital after a few months. This raises a broader concern about external companies operating hospitals and institutions from the outside – increasingly this includes private equity involvement. As one participant mentioned, this “leads to floundering systems” or a “failure of systems.” External companies may lack direction and do not have the same investment in the community. If an institution struggles financially, an outside operator may be more willing to accept downsizing or closure despite the high stakes for local residents. Hospital networks may face similar risks if their primary campus is in a different region, and similarly for educational institutions and state colleges with satellite campuses. The main institution can contract or move their satellite campuses to other places or close them outright. Large, Tax-Exempt Footprint Meds and Eds institutions occupy a large share of their cities’ physical footprints. In many small cities, they are the largest property owners, acquiring vast amounts of land over time. These land and building acquisitions manifest new “satellite” or “innovation” campuses on a city’s fringe while expanding university footprints in central locations and historic cores. As their enrollment and workforces continue to expand, there is compounding pressure on already constrained housing markets. Participants from Ann Arbor, Bethlehem, Erie, and Stamford cited their “meds and eds” as “eating up land” or “eating local real estate,” referring both to property acquisition and how their large footprints limit space for new development. When discussing geographic footprints, participants referred mainly to “eds”. Eds’ footprints grew largely from urban renewal projects in the 60s and 70s, as they expanded their campuses to keep pace with growing enrollments and employment bases. Urban renewal laws initially focused on residential redevelopment, allowing municipalities to designate areas as “blighted” and seize private property, often through eminent domain. These laws were later amended to include universities, enabling campus expansion on renewal land. Universities frequently partnered with cities to acquire land and carry out redevelopment projects that displaced existing residents to add academic buildings and even expand universityaffiliated medical centers. In Bethlehem, the development of Lehigh University’s Farrington Square displaced a predominantly black neighborhood on the Southside. That pattern of acquisition has continued in smaller ways. Lehigh has since purchased local
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