GREELEY, Colo.—As transportation officials finalize plans and budgets for an aggressive road-widening project around Grand Rapid's booming medical campus, public officials in some other U.S. cities with major health hubs are struggling with the problems that similar projects have brought to their own communities.

Spurred by fatal pedestrian accidents, some of these officials seek innovative ways to protect walkers from the heavy traffic now flowing around and through their medical campuses. Others, seeing how the widened roads have disrupted the quality of life in their campuses and adjacent neighborhoods, are looking for ways to restore the attractiveness and urban vitality that road projects have inadvertently paved over.

And officials in another city are now moving as far away as possible from heavy dependence on autos, and instead are using streetcars, aerial trams, and other alternatives to help keep two medical centers—and the city itself—thriving.

The difficulty this Rocky Mountain town is having with traffic around its medical facility illustrates a challenge facing America’s urban revitalization movement: Many major, popular civic institutions, including hospitals, have dealt with the heavy traffic they generate by surrounding themselves with wide, busy roads that make them extraordinarily difficult to reach except by car—and downright dangerous to get to on foot. These traditional traffic-handling designs also interfere with quality urban life by disrupting networks of inviting public spaces and transportation corridors that allow for travel by foot, bike, and public transit.

The question is whether the City of Grand Rapids can buck that tradition. Experiences here, and at similar medical campuses in Pensacola, Fla., St. Louis, Mo., and particularly Portland, Ore., where trolleys are running and tram will soon roll, suggest that the question is an important one for Grand Rapids and the State of Michigan, which together intend to invest approximately $400 million on widening roads around its medical center, known as Health Hill.

A Sometimes Fatal Problem
Here in Greeley, it took a tragedy to persuade officials to do something about traffic around the North Colorado Medical Center. Dr. David Manning—a husband, father of two, devoted churchgoer, and highly regarded orthopedic surgeon—was struck and killed by a pickup truck while crossing 16^th Street on his way from the medical center to his parked car. The city then decided to install an $80,000, 150-ft.-long, raised-concrete median down the middle of the busy five-lane road. The median—with blinking signals, improved street lighting, and clearly defined crosswalks—would be a "refuge" for traffic-dodging pedestrians, according to City Engineer Steve Bagley.

A similar tragedy—involving two nurses hit last year while crossing fast-moving Davis Highway on their way from a parking deck to work—inspired a less permanent solution in Pensacola. State transportation planners and officials at West Florida University Hospital stationed police cars in the middle of the four-lane highway at peak travel times.

"It reminds everybody to slow down," said hospital spokesman Kendrick Doidge

A different, less dramatic concern drove efforts by St. Louis’ Washington University Medical Center to modify traffic patterns surrounding its campus. As Walt Davis, Washington University’s assistant dean for facility operations puts it, when arriving at his world-class hospital and medical school, "you didn’t know that you arrived anywhere special."

The university responded with a 10-year, nearly $11 million Public Realm Initiative that is just wrapping up. It is transforming several "nondescript" city blocks into a vibrant urban hub with decorative street lights, hanging flower baskets, brick sidewalks, and a leafy median down the middle of Kings Highway. Mr. Davis hopes the initiative gives the campus a unique identity and improves conditions for both pedestrians and motorists.

Officials in Portland, however, are using a strikingly different approach to largely avoiding the problems these other cities are having. Instead of widening or building new roads around two medical campuses, the city is providing residents with a broad range of transit choices. A streetcar line that opened in 2001 serves the Legacy Good Samaritan Hospital and Medical Center on the city's north side. This fall, on the south side, an aerial tram will link the Oregon Health & Science University with the booming South Waterfront District along the Willamette River—a crucial link in a development plan that is leveraging $2 billion in private investment and an estimated 10,000 jobs.

"It's about improving accessibility and convenience," said Rick Gustafson, executive director of Portland Streetcar Inc. 

Paving Over a Master Plan
According to Fred Kent, president of the Project for Public Spaces, a New York-based nonprofit group founded in 1975, safety and image problems typically follow road expansion projects in urban areas. He said the move by city and state officials in Grand Rapids to embrace such an expansion was discouraging, since the city is viewed nationally as a leader in the urban revitalization movement.

“We’ve seen a lot of hospitals and other public institutions in this country defined by parking lots and cars," Mr. Kent said. "What happens is they lose their connection and relationship to the community. What we’ve learned is that you want to define them by a network of inviting public spaces that connects the buildings to the community and becomes a place that people respect and revere.”

“You never want to build a road that is more than two lanes in either direction around public institutions," he said. "That’s because you don’t want to define your city and buildings around traffic. We see a lot of that in Grand Rapids.”

The principal roads serving Grand Rapids’ rapidly expanding Health Hill are four- and five-lane city streets and a major, four-lane, interstate highway. The Michigan Department of Transportation’s new plans for Health Hill will add still more concrete. The agency’s plans include:

• Widening one critical downtown bridge on Michigan Street from four to five lanes. The bridge sits in front of a church and a block of new medical facilities that could include a new Michigan State University medical school.
• Widening part of College Avenue from five to as many as seven lanes to add more turning lanes and smooth the flow of traffic onto the interstate. Although College is a highly urbanized city street in the heart of a district with a historic neighborhood, the state agency is proposing a design modeled on a suburban bridge project in a completely different setting that is miles south of the city.
• Widening Interstate 196, which runs through the heart of downtown, from four to six lanes.

MDOT’s proposal ignores the city’s recently updated master plan, which aims to reduce dependence on automobiles, expand mass transit options, and redevelop city streets to promote pedestrian activity and interest. The plan views mass transit in the same way city officials view Health Hill, which is part of Michigan’s $3 billion biotech business: as critical to the city's ability to compete and prosper in the new economy.

That is why the road work planned for Health Hill is now drawing pointed criticism from some top local officials.

"The citizen involvement in this project is much narrower than I expected," said Mayor George Heartwell, speaking on August 30, 2006 at an MDOT-sponsored public meeting about the Michigan Street bridge expansion project. "There is such an intensity of use up on Health Hill that you can't possibly build a roadbed wide enough to handle all the auto traffic that will be there. So the non-motorized options are every bit as important as the motorized travel.

"We really need some out-of-the-box thinking here," Mayor Heartwell added, noting the importance of clearly marked pedestrian crossings, dedicated lanes for the city bus system, and other alternatives that MDOT’s plan lacks.

Concrete Love
Events in Greeley, Pensacola, and St. Louis suggest that changing road design standards after new highways are installed, even in the face of fatal accidents, is a considerable challenge. After Dr. Manning’s death, one early idea that emerged in Greeley involved reducing the four-lane roadway where he died down to three lanes in order to lower traffic speeds, expand sidewalks and pedestrian space, and enhance the medical district. But the idea gained little traction.

"If we were starting from scratch we'd probably build a well-designed street with fewer lanes, wider sidewalks, that kind of stuff," said Mr. Bagley, the city engineer. "But there was concern that narrowing the road from four to three lanes would be perceived as a downgrade. We talked it over quite a bit. And it would have been a bold move. But politically it would have been attacked."

Even in St. Louis, where the bulk of the Public Realm Initiative involved simply planting flowers and improving sidewalks, new ideas were slow to gain acceptance. "It was a tough sell," said the university’s Mr. Davis.

Several nationally preeminent road design experts interviewed for this article agreed that, with so many hospitals and medical campuses in self-contained, monolithic districts isolated by wide streets, parking lots, and automobiles, Grand Rapids has an opportunity to establish its urban design leadership in a new way.

"As I go around to various cities, I'm continually amazed how bad of a job we do integrating our healthcare facilities into our communities," said Michael Ronkin, Bicycle and Pedestrian Program Manager with the Oregon Department of Transportation. "They always remind me of the Citadel, and the perception of this unreachable place high up on a hill that's separate from everything else around it."

"Wherever we build hospitals we should strive to create places that are safe, benign, and encourage human activity," said Dan Burden, director Walkable Communities Inc., based in Orlando, Fla. "You've got doctors and medical staff walking around. People on drugs or with disabilities. These are just two reasons why you want safe walking areas, lower traffic speeds, and clearly defined crosswalks to avoid danger and treacherous situations."

Journalist Andy Guy directs the Michigan Land Use Institute’s Water Works project and writers about Smart Growth issues from Grand Rapids. He is also managing editor at Rapid Growth Media and maintains a blog at http://greatlakesguy.blogspot.com. Reach him at aguy@mlui.org.