An Urgent and Avoidable Transit Mistake in Waterloo Region.
A Transit-Forward Town Takes A Step Back.
We are starting 2026 off with a bang, with a real activism post about a land use decision being made in Canada that is bad for the environment, transit, and people, and also entirely avoidable. Consider sharing this post and raising this issue with your elected officials — maybe we can make a good change!
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There are two fundamental truths that most Canadians who care about transit know.
Waterloo Region, establishing a fairly good light rail system — ION — in a region with well-under a million residents, using significant chunks of reused mainline railway to create speed, is a real leader on this continent (it’s actually the smallest North American region with an urban rail system).
Hospitals are major drivers of trips and should be located on prime transit sites.
These two fundamental truths are being thrown to the wind with plans for a very nice and much needed new hospital for Waterloo Region. In this post, I’m going to tell you why this is nothing new, such a bad plan, and what can be done about it.
Ontario has been building a lot of new hospitals. These are often nice facilities, but in many cities, these new hospitals trade off pretty good and central locations with dated buildings for new buildings in a beetfield. This is a bad move because it doesn’t obviously seem that way upon opening, but it locks small towns and suburban communities into the kind of bad land use patterns that we already regularly identify with them, even in the public consciousness at this point. You aren’t building a new hospital for decades, so this decision traps you.
Most people in a lot of these communities, especially the influential and wealthy ones, drive everywhere, so getting to a new hospital by driving a little further but over wide new suburban arterials seems a worthwhile trade. The issue is, wealthy and influential residents aren’t even just not representative of the population as a whole, they also get sick less, so they have to deal with the location less often. Doctors often become health network executives who make these decisions, and like the doctors working at these hospitals, these executives can afford to — and often — drive! Whenever I turn up at the local walk-in clinic, I don’t have to guess whose Porsche is always sitting out front.
This negative effect is amplified because hospitals are huge for transit. There’s a reason the existing Waterloo hospital has its own light rail stop, and in other cities, hospital complexes being colocated with transit facilities are common.
When Lyon’s Metro was extended a few years back, it was to a major hospital. Montreal’s two new “megahospitals” are both directly connected to that city’s metro network. Vancouver’s broadway subway extension has a new station at Oak-VGH ... Vancouver General Hospital.
Transit stops, rail stations, are so frequently located at hospitals because they are major trip generators. Not only do hospitals employ hundreds of thousands of people, but they also have tons of people travelling to them every single day for care: university students and trainees, support staff and the like. Something I really want to emphasize more to people is that a few apartment towers actually don’t generate that many trips, but big institutions like offices (which often end up colocating with hospitals for supporting businesses like medical labs) generate way more than you’d expect and from a broader area.
I often talk about how transit enables the amazing agglomeration and specialization effects of cities, and hospital fit right into this. Most cities have just one or two hospitals, and if they have multiple, they start to specialize. This means people from all over a city want to get to a hospital — not that different from downtown or the “central business district”.
When Waterloo built ION, it was able to put a light rail stop right out front of Grand River Hospital. This was a hugely positive move: the light rail gets tons of riders, the hospital becomes way more connected, and emissions fall while reliably getting to such an important destination gets easier.
So then, it’s absolutely nuts where the new hospital is going: in the foreground of the following image is the ION’s Research and Technology Park stop …
The new hospital is meant to be here . . .
That’s right, over a half-kilometre walk through a largely-undeveloped set of lands, unprotected from the weather and probably at best next to parking lots.
Waterloo Region is trading a hospital location which has rail right out front, for one where realistically maybe a tiny fraction will take transit. A lot of people with an ailment could quite reasonably use the existing stop: you literally have to walk like 50 metres from the tram to the front door of the hospital. The new location will be ten times as long. And actually, about transit use, they’re not dumb, look what they’ve proposed on the way as you walk from the tram to the hospital.
Yep, huge parking lots. Brought to you by the same folks that the province is getting to help with design to get rid of Toronto’s bike lanes …
What’s so frustrating, beyond the fact that money and time have been wasted designing a facility and lining up a site that in 2025, as we suffer dual climate and congestion crises forces most future hospital visitors and employees to drive to a new hospital when the existing facility has prime transit access, is that it so obviously doesn’t need to be this way.
For one, the existing site is not super dense. It could be redeveloped into a more vertical campus in the long term, akin to Mississauga’s new hospital. Which hilariously, is directly served by that city’s new tramway.
How to stage that construction? There is a giant parking lot across from the existing hospital almost as big as the entire existing site. That appears to be the parking lot for Sun Life’s HQ, but this is why we invented the parking structure! You could probably park just as many cars in a garage taking up a fraction of the current surface lot and use the rest for hospital expansion, all while not decimating a great transit connection.
And there are many other better options as well. Sun Life’s HQ doesn’t look great: What if they built an entire new campus in the Research and Technology Park, so they could be near other businesses, and this part of Waterloo could become an entire healthcare district.
You could also just put the hospital on a nicer rectangular site right near the light rail stop at the Research Park, developing the area more logically, grounding it with a major healthcare tenant, and expanding hospital coverage in the region overall — without tanking people’s ability to access a major destination on public transport.
This also screams total planning myopia: surely the land on this beetfield site was cheaper, or the closer plot is earmarked for something (almost certainly less important). These cost-saving measures mean wasted investment on an entire urban rail system! You’ll probably also have to run a shuttle bus for the rest of time between the rail and hospital site (and maybe the university as well) — and a light rail spur would probably eventually be the rational thing to do, but that’s super expensive and entirely self-inflicted. The long and short of it is that you aren’t actually likely to be saving money overall, just upfront.
I hope to write more about pressing issues like this in 2026, at times when changes to plans tilt us in the rational direction of the environment, people, and transit (notably not even away from drivers, just to drivers and transit). To make Canada more transit-friendly, we need to question and pushback against these decisions which scream “I don’t take the bus or train and didn’t seriously think about people who did”, which is frankly unacceptable for a super expensive public facility that is a huge trip generator. This would have been a horrible decision decades ago; with all we know in 2025 about crises in the climate, inequality, and urban design, it feels borderline negligent.
If you want to help fix this, consider writing about similar issues when you see them, and reach out to the relevant elected officials about this decision, like mayors, regional councillors, MPPs, Ministers, and other officials!
Totally agree. Apparently part of the reasoning for putting the hospital on the left side of the property is so that patient rooms look out onto the forested area and Laurel Creek.
The hospital plan includes transportation linkage between the RTP Ion station and the new hospital.
The lack of transit access is part of a larger mindset problem. The terms of reference (from the province, I think) for the site selection committee required a minimum size of 50 acres. So they were always thinking of a self-contained campus, not integration into the fabric of the city. This is bad not just for transit but also neighbouring complementary uses like private clinics or restaurants. (The midwife clinic we used is across the street from the current hospital.). Given that I am pleasantly surprised it isn't any farther out to the edge of the urban area.