28 Distillation Guidebook Co-Lab • 9.18–9.19 2025 Booklet 4: This booklet examines the role that "meds and eds," universities and medical institutions, play as economic anchors in small cities. It traces how these institutions grew to prominence in the mid-to-late 20th century and became primary employers and stabilizing forces in many small cities, while also considering the risks of over-reliance on them, particularly when they falter or close. It looks at how these institutions' large, tax-exempt landholdings strain municipal budgets and intensify housing pressures as enrollment and workforces continue to grow. The booklet also explores the frequently strained "town-gown" relationship between these institutions and surrounding neighborhoods, shaped by class and cultural divides, transient populations, and institutional footprints that can feel disconnected from community priorities. It follows questions raised in the convening about governance and partnership: how universities and hospitals might engage more genuinely with local decision-making and better balance their national/global missions with responsibilities to the small cities that host them. "Meds & Eds"
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