How a hospital’s location can heal—or hurt—a community

a map showing the distance between St. Johnsbury town center and the hospitalBy Dr. John Raser

This year we celebrated the 50th anniversary of Northeastern Vermont Regional Hospital in Saint Johnsbury. We are fortunate to have such a strong community hospital in our region. It is an institution with strong leadership and committed staff, and one with which I am proud to be affiliated.

The anniversary also marks the enormous public investment that went into the construction of Hospital Drive, where the hospital was built. Over the years, the medical campus on Hospital Drive has become home to other vital institutions, including Northern Counties Healthcare and our rehabilitation hospital. The impact of this development is a legacy that deserves reflection.

While our medical institutions are strong, the environment we built for them is unhealthy, and has undoubtedly increased the burden of chronic disease in our region. The reason for this is simple. Unlike our previous hospitals, our medical campus on Hospital Drive excludes walking as a viable transportation option for patients and staff. Why is this so vital? Lack of physical activity is one of the major causes of preventable death in our country. Among the other top 10 causes are elevated blood pressure, elevated blood sugar, elevated body mass index, and elevated cholesterol—all factors that are improved by walking and worsened by sitting in a vehicle. Motorized vehicles directly caused more than 40,000 violent deaths in the US in 2021, and are sadly the number one cause of death in children in our country—more than doubling the number killed by all childhood cancers combined.

Apart from the direct health impact, the movement of our healthcare system to Hospital Drive has also placed enormous financial burden on our healthcare workers, who now make up 24 percent of the workforce in Vermont. Consider a nursing assistant starting at the nursing home making $16/hr. They will have to work about four months straight just to cover the cost of owning their own vehicle. Compare this to the average worker at the Brightlook Hospital 75 years ago, who could walk to work for free and was healthier when they got there.

Town budgets are also strained by the sprawl-type development exemplified by medical office parks. It’s simple math: when we have the same number of taxpayers and amount of economic activity, but our water, sewer, road and other infrastructure is spread out over twice as much space, it’s more expensive to maintain. The result is that many struggle to pay property taxes while we become accustomed to crumbling water pipes and sidewalks. The public health repercussions are obvious and are playing out now in Vermont towns and throughout our country.

Many assume that everybody has a vehicle and drives where they need to go in rural Vermont, but this is not true and never has been. Over 10 percent of households in both St. Johnsbury and Lyndon do not own a single vehicle. Places like Hospital Drive make life harder and more dangerous for the many in our communities who don’t have the physical, legal, or financial ability to drive—and for the growing number of us who would simply rather not have to.

So what do we do now? We obviously cannot abandon our hospital, and we need to continue to invest to meet evolving clinical needs such as space for our neighbors who are facing mental health crises. But we can move the kinds of medical services we use every day - primary care, physical therapy, and mental health services - back into the walkable cores of our larger, denser towns. We have done this on a small scale with Northern Express Care St. Johnsbury, with encouraging success. We can eliminate medical zoning, and allow currently underutilized buildings on the hospital campus to be repurposed for medical workforce housing. We can imagine the hospital campus more like a healthy neighborhood, where elders living at the rehab can stroll around the block, and those living at the homeless shelter or Rural Edge housing down the street could walk to the hospital, pharmacy, or grocery store without risking their lives.

If we want to even start to imagine a world where we have less chronic disease, healthier communities, and more economic security—not to mention addressing crises of environmental health and climate change—we need to give more people the option of living good and full lives on a human scale without being forced to pay the financial and health costs of vehicle dependency. We in Vermont are blessed to have many livable town and village centers that were built to allow human bodies to thrive. Our healthcare system can and should be a leader in making this way of life possible again. We should start now.

Dr. John Raser is a family doctor who lives and works in St. Johnsbury. He is a former member of the planning board and currently serves on the town bicycle and pedestrian committee. He is a clinical assistant professor of family medicine and community health at Dartmouth’s Geisel School of Medicine, and adjunct assistant professor at UVM Larner College of Medicine.