Who Shapes the City? Governance, Resistance, and Urban Regeneration in Sant’Ana Hill

Abstract

Urban regeneration in historic city centers often encounters tensions between planning strategies, public expectations, and heritage preservation. This study examines the redevelopment process of Sant’Ana Hill in Lisbon, a site historically occupied by many hospitals now subject to closure and adaptive reuse. The transformation of all this 16-hectare area has sparked significant public contestation, highlighting governance challenges and the role of citizen engagement in shaping urban futures amid socio-political and ecological shifts. Using a case study approach, this research draws on urban planning documents, public debate records, media coverage, and semi-structured interviews to analyze the political, social, and architectural dimensions of the regeneration process. Findings reveal that prolonged decision-making, opaque governance, and inadequate public participation have fueled uncertainty, delaying project implementation and increasing public skepticism. The study argues that inclusive participatory frameworks and transparent governance are essential to mitigating conflicts in urban redevelopment. This research also contributes to debates on urban voids, adaptive reuse, and participatory planning, offering insights into the dynamics of contested regeneration in historic districts. Lessons from Sant’Ana Hill highlight the need for a more integrated, democratic, and heritage-conscious approach to large-scale urban transformation projects.

1. Introduction

1.1. Urban Regeneration and Its Challenges in Historic Center Areas

Cities constantly evolve, reshaping their built environments in response to economic, social, and political shifts. Urban regeneration, particularly in historic districts or urban central areas, presents a dual challenge: balancing heritage conservation with the need for adaptive reuse. Many cities worldwide have grappled with these complexities, as historic neighborhoods undergo redevelopment, often facing contestation from residents, preservationists, and policymakers [1,2].

Lisbon, like other European capitals, has undertaken ambitious regeneration projects, with Sant’Ana Hill emerging as a focal point of urban transformation. Historically home to some of the city’s most significant hospitals, Sant’Ana Hill is now at the center of a redevelopment plan following the decommissioning of these healthcare facilities. Spanning 16 hectares—a larger area than Lisbon’s iconic Baixa Pombalina—the site’s transition raises questions about land use, governance, and public participation in shaping the city’s future.

The significance of Sant’Ana Hill extends beyond its architectural heritage; it represents a social and economic lifeline for the communities that have developed around its institutions. The question of how to repurpose these urban voids—whether for housing, commerce, cultural spaces, or tourism—has sparked a highly politicized debate. The current work investigates this process, exploring the contested nature of urban regeneration and the role of participatory planning in reducing uncertainty and fostering sustainable urban development.

1.2. Urban Regeneration, Participation, and the Politics of Urban Redevelopment

The study examines how conflicting interests between public institutions, private developers, and civil society shape decision-making, reflecting broader patterns of urban commodification and governance fragmentation, grounded in the political economy of urban governance, drawing on perspectives from neoliberal urbanism [2,3,4], urban contestation and citizen participation [5,6,7], and the right to the city framework [8].

By applying this lens, the research assesses how governance failures and limited participatory mechanisms contribute to social resistance and policy deadlock in urban regeneration.

These processes have been the focus of extensive scholarly inquiry within urban planning, architecture, geography, and political science. From debates on neoliberal urbanism to discussions around heritage conservation, the literature underscores the inherently political and contested nature of urban regeneration.

1.2.1. Urban Regeneration Perspectives

• Conceptual foundations and neoliberal urbanism

Key concepts such as “urban regeneration” are connected to deliberate efforts to transform underutilized urban areas. Thus, urban regeneration not only involves physical and economic changes but also reconfigures social relations and the production of urban space. As Henri Lefebvre [8,9] and Manuel Castells [6] have argued, urban spaces are shaped by social agents whose collective actions and contestations play a pivotal role in determining their future form [10,11]. The theories on the social production of space accentuate that the city is continuously reconstituted through the desires and actions of its inhabitants.

Urban regeneration is broadly understood as a deliberate effort to transform degraded, underutilized, or functionally obsolete areas, often through large-scale policy interventions [2,12]. Traditionally, this has involved state-led strategies. However, the influence of neoliberal urbanism has progressively shifted the emphasis toward market-driven approaches, privatization, and the commodification of urban space [3]. Critics argue that neoliberal urban policies frequently prioritize economic returns over social equity, thereby exacerbating socio-economic inequalities and displacing marginalized communities [13]. This displacement is further fueled by the commodification of housing, which transforms homes into speculative assets, intensifying insecurities for low-income residents [7,14,15].

Under neoliberalism, market mechanisms start to play a decisive role. Public–private partnerships (PPPs) (as formal instruments of privatized urban governance) and urban mega-projects and deregulation (as often results as a downstream effect) enabling speculative planning are advocated as pathways to efficient development, but they often produce touristification and unaffordable housing and facilitate gentrification [7,14]. The logic of accumulation by dispossession [4,15] further illustrates how vulnerable groups lose land, housing, and livelihoods to pave the way for commercial ventures, particularly evident in Global South cities where informal settlements and formal regeneration agendas collide. Moreover, environmental gentrification—where ecological enhancements in degraded areas catalyze real estate speculation—exemplifies how even well-intentioned “green” projects can marginalize the very communities they aim to benefit [16,17].

• Gentrification and its drivers

Gentrification stands out as one of the most visible consequences of this kind of regeneration, entailing the systematic displacement of low-income and marginalized populations [15,18]. These processes result not only from housing market pressures but also from broader economic and political forces that undermine marginalized groups’ ability to remain in urban centers. Furthermore, racial and ethnic dynamics interweave with neoliberal redevelopment, as illustrated in Chester, Pennsylvania, where color-blind ideologies have masked and legitimized exclusionary policies [19].

• Public–Private Partnerships and state involvement

With the ascendance of neoliberal governance, public–private partnerships (PPPs) have become a mainstay of urban regeneration. While promoted as innovative solutions to state resource constraints, PPPs have also been criticized for aligning public policy with market imperatives at the expense of public interest. In Israel and China, state-led regeneration programs designed to attract private investment often trigger predatory practices, fostering conflict among state, market, and community actors [20]. The financialization of regeneration further embeds market logic, as land value capture and planning gain become principal funding mechanisms. Though potentially creative, these models can exacerbate inequalities by depending on market forces to drive development [21,22,23]. In response, certain experiments with community equity shareholding suggest alternatives that recognize residents’ rights to profit-sharing and genuine decision-making, indicating a possible path toward more equitable regeneration [24].

• Shifts in State Power and social equity

The neoliberal turn has also reshaped the role of the state, diminishing welfare-oriented frameworks in favor of market-based governance. This transformation affects the distribution of public services and influences who benefits from, or is burdened by, urban redevelopment. Privatization of public amenities, land deregulation, and entrepreneurial governance have often deepened urban inequalities [23,25]. Yet, case studies like the regeneration of Crumlin Road Gaol and Girdwood Park in Belfast show that state intervention can balance economic growth with social cohesion if designed with inclusive objectives in mind [26]. Decentralization and empowering local governments are, moreover, presented as key strategies to democratize planning processes [27]. The varied outcomes of these interventions underscore the interplay between macro-level forces—such as global capital flows—and local political agency, which can steer projects toward either deeper inequality or greater inclusion.

• Social and spatial implications

Ultimately, the literature demonstrates that urban regeneration has mixed impacts on social equity. Policies can exacerbate spatial inequalities and residential segregation, especially in cities with entrenched social, racial, or ethnic divisions [18,28]. The aforementioned environmental gentrification, a subset of these broader processes, manifests when ecological or sustainability initiatives displace low-income populations [16,17]. Nevertheless, some authors propose inclusive planning approaches—incorporating participatory decision-making, social impact assessments, and tenant protections—to offset the adverse outcomes of neoliberal regeneration [24,25]. These calls for equity resonate strongly with critical urban studies, which stress the ethical imperative to safeguard vulnerable communities’ rights to remain in place.

1.2.2. Public Participation in Urban Planning

Amid mounting critiques of exclusionary urban regeneration, there is growing recognition of the importance of citizen engagement. The field has long referenced Arnstein’s “Ladder of Citizen Participation” (1969), a conceptual touchstone illustrating varying degrees of public influence in planning decisions. Empirical evidence reinforces that inclusive planning processes tend to yield more sustainable outcomes, diminish conflicts, and strengthen local ownership over redevelopment efforts [29]. Yet, in many global cities, participation remains limited or tokenistic, with decisions often consolidated by political and economic elites [30]. In a certain way, this was also the problem that brought us to this study.

Reflecting global pressures, communities worldwide are mobilizing to demand more equitable city-making practices. Urban activism—from Seoul to Cincinnati—asserts a collective “right to the city”, spotlighting how grassroots movements can counteract displacement and advocate inclusive growth [31,32]. Community-based equity initiatives, like inclusionary zoning and tenant protection, arise as direct responses to the failures of neoliberal regeneration [7,24]. These initiatives not only seek to mitigate displacement but also to reframe urban planning around principles of social justice and collaboration. The rise of social justice movements [16,32] further demonstrates how public contestation can disrupt dominant narratives that treat urban land primarily as a commodity.

It makes sense to highlight here that there are cases where processes of public involvement and even the design of governance models capable of facilitating and consensualizing these transformation dynamics have been conceived, including experiences in cities facing gentrification tensions, such as Berlin or Barcelona, where neighborhood councils, public–private partnerships, and grassroots movements have tried to balance the interests of old and new residents [33,34].

1.2.3. Heritage Preservation and Adaptive Reuse

A final layer of complexity in debates on urban regeneration involves heritage preservation. Historic city centers such as those in Barcelona, London, and Paris have witnessed heritage-led regeneration programs designed to adapt historic structures for new cultural or commercial uses [35]. These strategies reflect a growing appreciation for the cultural, touristic, and historical dimensions of urban landscapes; they aim to revitalize neighborhoods while safeguarding local identity and architectural legacy [36]. Nonetheless, critics argue that heritage-led initiatives can slip into “museumification” [37], whereby culturally significant sites become sanitized, tourist-oriented zones disconnected from the needs and values of resident communities. This tension underscores a broader dilemma: how to preserve historical authenticity without contributing to gentrification, touristification, and the exclusion of local populations.

1.2.4. The Case of Lisbon

Against this theoretical backdrop, Lisbon emerges as a particularly compelling case study, characterized by the interplay between institutional voids, heritage-led redevelopment strategies, and intensified market-driven pressures. This case is particularly relevant as Portugal, and especially the city of Lisbon, has been facing significant challenges in meeting the housing demands of residents who wish to live in the city.

It is important to highlight that Lisbon has been continuously losing population since the 1980s, revealing, among other issues, a persistent difficulty in retaining its residents and attracting new ones. It was only in the last census decade that this negative demographic trend stabilized (cf. Figure 1).

At the heart of this issue lies the housing supply in terms of quality, availability, and affordability. While in the past, much of the housing stock was in poor condition, leading many residents to seek homes in suburban areas, today’s challenge stems from a different dynamic. Urban regeneration has indeed taken place, but it has been largely driven by tourism-related developments (such as hotels and short-term rentals (cf. Figure 2)) and high-end residential projects, with prices that are prohibitive for large segments of the population.

On the demand side, access to housing has become increasingly difficult, primarily due to high property prices and rental costs, which effectively exclude both the middle class and more vulnerable communities.

As a result, a climate of heightened tension has emerged between the pressing demand for more affordable housing and, on the other hand, the relentless growth of tourism-oriented and high-end real estate investments.

Thus, Lisbon has been undergoing a rapid transformation, fueled by tourism, foreign investment, and real estate speculation [38]. While projects like the Parque das Nações (Expo 98) and Marvila’s creative hub illustrate successful regeneration cases, other projects—such as the eviction of traditional communities in Alfama—highlight the social consequences of speculative urbanism [39,40]. Sant’Ana Hill (cf. Figure 3) presents a unique case study within this broader trend, given its institutional legacy, central location, and highly contested redevelopment plans. Sant’Ana Hill also has the advantage of confronting a set of dynamics that have historically had a bad relationship in the neoliberal city, such as urban voids, participatory planning, and fragile governance.

1.3. Main Research Objectives

Over the past few decades, a considerable amount of research has emerged on urban regeneration and the significance of public participation in shaping revitalized cityscapes. Yet, Sant’Ana Hill—a historic district marked by former hospitals and convents—has remained notably absent from these discussions (cf. Figure 4).

While scholarly works on Lisbon’s regeneration frequently address residential neighborhoods, they tend to overlook what we might call “institutional urban voids,” or large public complexes whose original functions have lapsed, leaving behind vast, underutilized structures. This lack of attention to institutional spaces is more than a simple oversight: it conceals the critical ways in which these once-pivotal sites can dictate the future social and spatial configuration of surrounding communities.

Another major gap within the literature concerns the governance and decision-making processes that drive, and sometimes hinder, successful urban regeneration. Although a handful of studies hint at the complexity of political negotiations and institutional frictions underlying redevelopment initiatives, the specific nature of these negotiations—especially regarding privatization of public land—remains underexamined. Understanding how different actors, from municipal authorities to real estate developers, navigate conflicts and converge on decisions is crucial for explaining redevelopment outcomes, yet such analysis is scarce when it comes to Sant’Ana Hill. The absence of a nuanced perspective on policymaking and governance means that we have only a partial view of how power, resources, and interests align to shape urban change.

Alongside these institutional considerations, there is a limited scholarly focus on the role of public contestation and citizen mobilization in influencing Lisbon’s redevelopment projects. Gentrification research has indeed highlighted patterns of displacement and resident resistance. However, few studies have delved into the ways in which public pressure—be it through organized protest, civic advocacy, or direct engagement with planning bodies—can successfully reorient or halt proposed urban transformations, particularly in cases involving public land. By missing this dimension of community-led activism, researchers risk underestimating how collective action can recalibrate governance structures, inject accountability, and shift redevelopment trajectories [39].

By directing its analytical lens toward the governance frameworks, policy instruments, and forms of public participation that underpin the redevelopment of Sant’Ana Hill, this research seeks not only to illuminate the specificities of one urban space but also to contribute to broader discussions of institutional urban voids, contested land privatization, and the potent forces of grassroots mobilization. While initial planning for Sant’Ana Hill envisioned a balanced approach integrating heritage conservation, social infrastructure, and economic revitalization, the eventual trajectory favored profitable redevelopment. Thus, this research has the following aims:

i.

Analyze the urban transformation of Sant’Ana Hill:

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Identify institutional, economic, and political factors.

ii.

Investigate the role of public participation:

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Assess objections and influence on planning documents.

iii.

Analyze how fragmented governance structures contribute to uncertainty in urban redevelopment processes:

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Discussion on how fragmentation manifests itself and affects uncertainty.

iv.

Draw policy lessons:

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Derive actionable recommendations for integrated governance, engagement, and adaptive reuse. The remainder of this article is structured as follows: Section 2 outlines the methodological framework, detailing the research design and data collection strategies used to analyze the case of Sant’Ana Hill. Section 3 presents the empirical findings, organized around policy frameworks, governance challenges, public contestation, and heritage conflicts. Section 4 discusses these findings considering urban governance, participatory planning, and neoliberal redevelopment. Finally, Section 5 concludes by summarizing key insights and outlining policy recommendations for more inclusive and sustainable urban regeneration practices.

2. Methods

2.1. Research Design and Approach

This research employs a qualitative case study approach to analyze the contested urban regeneration of Sant’Ana Hill. Case studies are valuable for capturing complex socio-political processes and governance dilemmas [41]. Given the multi-layered nature of urban transformation, this research integrates four primary methods, each directly linked to the study’s core themes:

i.

Policy and Documentary Analysis: This method is used to trace governance inconsistencies and shifts in urban planning strategies. Documents reviewed include the PUCS (2013), DEICS (2014), and PATCS (2016). This method informs findings on policy fragmentation (Section 3.1).

ii.

Semi-Structured Interviews: These were conducted with 12 stakeholders, including urban planners, municipal officials, and community representatives. These interviews clarify governance conflicts, decision-making rationales, and public participation limitations. The results are central to Section 3.2 and Section 3.4 on governance and contestation.

iii.

Media and Public Discourse Analysis: This method examines how urban transformation is framed in public debates and media narratives. Newspaper reports, advocacy group statements, and city council debates were coded for recurring themes. These data contextualize public skepticism and heritage conflicts (Section 3.3 and Section 3.4).

iv.

Field Observations: This method assesses the physical transformations and informal uses of space in Sant’Ana Hill. On-site visits documented land use changes, accessibility barriers, and protest markers. These observations provide tangible insights into ongoing development contradictions (Section 3.5 and Section 4.1).

2.2. Data Collection and Analysis

To respond to the complexity of the data sources and the methodology itself, four key methods were used to gather data:

• Documentary and Policy Analysis

Urban regeneration processes are largely shaped by policy frameworks, strategic plans, and legal instruments. This study reviewed key urban planning documents governing Sant’Ana Hill’s redevelopment, including the following:

i.

Plano Urbano da Colina de Sant’Ana (PUCS, 2013)—defining land use changes and redevelopment strategy.

ii.

Documento Estratégico de Intervenção da Colina de Sant’Ana (DEICS, 2014)—refining intervention priorities and participatory frameworks.

iii.

Programa Ação Territorial da Colina de Sant’Ana (PATCS, 2016)—defining phased implementation of urban interventions.

iv.

Plano Diretor Municipal de Lisboa (PDML, 2012)—outlining broader zoning and development regulations.

Additional legal and municipal reports on heritage conservation, land privatization, and hospital closures were analyzed to understand the legal basis and constraints of redevelopment.

This analysis focused on land use transformations (what functions were proposed for the former hospitals?), participatory mechanisms (how was public input integrated into planning decisions?), and policy contradictions (were there inconsistencies between different planning instruments?).

• Semi-Structured Interviews with Key Stakeholders

To understand the governance and public contestation process, 12 semi-structured interviews were conducted between December 2023 and January 2024 with urban planners and architects involved in Sant’Ana Hill’s redevelopment, municipal officials from the Lisbon City Council’s urban planning department, representatives of heritage and cultural organizations (ICOMOS-Portugal, Chamber of Architects), and community activists and neighborhood representatives engaged in public debates.

The interview guide was organized in several main topics: decision-making processes (who were the key actors shaping Sant’Ana’s redevelopment?); public participation (were residents and advocacy groups effectively involved?); challenges and conflicts (what were the main sources of contestation?). Interviews were transcribed and coded thematically, ensuring that diverse perspectives were systematically analyzed.

• Media and Public Discourse Analysis

The role of public perception and media coverage in shaping urban transformation was assessed through the following:

i.

Newspaper articles (2013–2023) from major Portuguese outlets (Público, Expresso, Diário de Notícias) covering Sant’Ana Hill’s redevelopment.

ii.

Public debate transcripts from the Debate Temático sobre a Colina de Sant’Ana (DTCS, 2013–2014).

iii.

Statements from advocacy groups, petitions, and protest materials from citizen movements opposing the regeneration plans.

The analysis provided some insights into three central dimensions of the contested redevelopment of Sant’Ana Hill. First, it revealed how public discourse framed the urban transformation project, highlighting the narratives, language, and imaginaries employed to present the proposed changes to this historic area. Second, it exposed the complexity of the conflicting narratives that emerged throughout the process, identifying the main arguments both in favor of and against the regeneration plans. Finally, it documented how policymakers navigated these tensions, analyzing their responses to increasing public contestation and illustrating the evolution of institutional positions as the debate intensified.

• Field Observations

Fieldtrips to Sant’Ana Hill were conducted to assess current land use and built environment conditions (hospital deactivation, ongoing construction, informal reuse), public space accessibility (are former hospital sites open, fenced, or repurposed?), and signs of contestation (graffiti, posters, community-led interventions).

Data analysis followed a thematic coding approach, integrating qualitative triangulation to cross-validate findings across sources. Content analysis of planning documents identified contradictions in policy frameworks. Thematic coding of interviews categorized stakeholder perspectives into governance inefficiencies, contested decision-making, and heritage concerns. Media discourse mapping revealed shifts in public perception over time. Observational data complemented the other methods by confirming spatial impacts and community reactions.

2.3. Limitations and Challenges

A final note is necessary to acknowledge some methodological challenges encountered, which are important to clarify. One of the main obstacles was access to decision-makers. While municipal officials were willing to participate, private developers and investors declined interviews, limiting insights into the economic drivers of regeneration. Additionally, inconsistencies in policy documents posed another challenge, as regulatory frameworks evolved over time, requiring careful cross-referencing across multiple sources. The analysis of media narratives also presented difficulties, as news coverage often reflected editorial biases aligned with different interest groups, influencing the portrayal of the redevelopment process. Furthermore, restrictions imposed by the COVID-19 pandemic led to adjustments in the research strategy, with planned in-person engagements with local communities shifting to virtual formats, thereby reducing direct interaction.

Despite all these challenges, the diversity of data sources and the triangulation of methods enhanced the robustness and validity of the findings, ensuring a comprehensive understanding of Sant’Ana Hill’s contested transformation:

i.

Urban Planning Documents: Analysis of key planning frameworks, including the Plano Urbano da Colina de Sant’Ana (PUCS, 2013), the Documento Estratégico de Intervenção (DEICS, 2014), and the Programa Ação Territorial (PATCS, 2016).

ii.

Interviews with Key Stakeholders: Semi-structured interviews with urban planners, architects, policymakers, and community representatives.

iii.

Media and Public Discourse Analysis: Examination of newspaper articles, public hearings, and political debates on Sant’Ana Hill’s future.

iv.

Field Observations: Fieldtrips to assess physical transformations, ongoing projects, and community interactions.

3. Results

The following findings systematize the results of policy analysis, interviews, media discourse and field observations, highlighting the main tensions and contradictions that have shaped the regeneration of Sant’Ana Hill. The process revealed inconsistencies in urban policies, strong civic opposition, contradictory views on built heritage, and persistent governance challenges.

3.1. Urban Planning Framework, Policy Inconsistencies, and the Controversy of Sant’Ana Hill’s Redevelopment

The redevelopment of Sant’Ana Hill in Lisbon is a complex and highly contested process, shaped by historical significance, governance challenges, and conflicting stakeholder interests. Originally a major institutional area, home to several hospitals and public facilities, Sant’Ana Hill has become the focus of urban renewal policies that, rather than ensuring a balanced transformation, led to social discontent and uncertainty about the site’s future.

The area, historically referred to as the “Colina da Saúde” (Hill of Health), had hosted major hospitals such as São José, Miguel Bombarda, Santa Marta, Capuchos, Desterro, and Dona Estefânia. Many of these institutions were originally monastic buildings repurposed as healthcare facilities after the 1755 Lisbon earthquake. However, as healthcare policies shifted in the early 21st century, these facilities were gradually decommissioned, opening a debate about the future use of the land they occupied.

The official restructuring process began in 2006, when the Portuguese government announced plans to construct a new hospital in Lisbon, more precisely in the parish of Marvila (Hospital de Todos os Santos), which would replace the existing healthcare facilities in Sant’Ana Hill. This decision set in motion a series of closures: between 2007 and 2011, hospitals such as Miguel Bombarda and Desterro were progressively shut down. Recognizing the need to repurpose the vast 16-hectare area, urban planning authorities introduced a series of frameworks to guide redevelopment.

In 2013, the Plano Urbano da Colina de Sant’Ana (PUCS) was introduced, outlining a mixed-use strategy that combined residential, commercial, and cultural spaces. A year later, in 2014, the Documento Estratégico de Intervenção da Colina de Sant’Ana (DEICS) attempted to refine these plans by emphasizing heritage conservation and public space integration. Despite these initial efforts, public concerns regarding the privatization of public assets and the potential gentrification of the area led authorities to introduce yet another plan in 2016, the Programa de Ação Territorial da Colina de Sant’Ana (PATCS), which sought to establish clearer implementation guidelines.

However, while these policies provided a formal framework for redevelopment, they also exposed deep governance inconsistencies. The Lisbon Municipal Master Plan (PDM, 2012) had classified the hospital sites as areas for urban consolidation, but subsequent revisions permitted privatization and commercial use, shifting priorities from heritage conservation to real estate investment. This policy ambiguity created uncertainty regarding land use, with different stakeholders interpreting the regulations in conflicting ways. The lack of a unified vision and effective coordination between governmental agencies, municipal authorities, and private developers led to a process marked by delays, policy reversals, and growing public mistrust.

• Governance Challenges and Conflicting Interests

One of the primary reasons for the controversy surrounding Sant’Ana Hill’s redevelopment was the fragmented nature of governance. Decision-making authority was distributed across multiple actors:

i.

The Ministry of Health was responsible for decommissioning hospitals.

ii.

The Lisbon City Council oversaw zoning and urban planning policies.

iii.

The state-owned real estate company ESTAMO acquired the hospital lands and negotiated their repurposing.

These entities often operated with conflicting objectives, resulting in a lack of transparency and coordination. While municipal authorities aimed to preserve public interest, real estate developers prioritized market-driven investments, and the national government sought to maximize land sales as a strategy to reduce public debt. This misalignment of interests fueled public skepticism, particularly when historic hospital buildings began to be transferred to private investors without a clear commitment to heritage protection or public benefit.

• Public Discontent and the Risks of Gentrification

The privatization of public land on Sant’Ana Hill was one of the key factors fueling opposition. Although initial redevelopment plans included references to affordable housing, cultural spaces, and public infrastructure, the reality soon reflected a stronger emphasis on high-end real estate and tourism-oriented development. Concerns arose that historically significant buildings would be transformed into luxury hotels, exclusive residences, and commercial venues, restricting public access and furthering the displacement of lower-income residents.

This pattern is not unique to Lisbon. Similar dynamics have been observed in European cities like Barcelona, Berlin, and Paris, where the transformation of historic neighborhoods often leads to touristification, rising property values, and the exclusion of local communities. In Sant’Ana Hill, these concerns materialized through active citizen mobilization, with heritage organizations, urban activists, and residents voicing opposition. Organizations such as ICOMOS Portugal and the Portuguese Chamber of Architects raised alarms about demolition threats to culturally significant buildings, while civic movements criticized the city’s tendency to prioritize economic interests over public needs.

• Participation Deficit: The Failure of Public Engagement

Public participation in the decision-making process was another major point of contention. To address concerns, the Lisbon City Council launched the “Debate Temático sobre a Colina de Sant’Ana” (2013–2014), inviting community representatives and stakeholders to discuss potential futures for the area. However, these public consultations were widely criticized as tokenistic, as key decisions had already been made behind closed doors.

While municipal authorities framed these debates as inclusive participatory processes, many citizens and advocacy groups felt that their input was disregarded in the final planning outcomes. This lack of meaningful engagement intensified public distrust in Lisbon’s urban governance model, reinforcing perceptions that Sant’Ana Hill’s transformation was being driven by political and economic elites rather than by local communities.

• Uncertain Future: The Risks of Policy Fragmentation

The absence of a clear and stable urban strategy has left Sant’Ana Hill’s redevelopment in a state of prolonged uncertainty. Multiple projects have been proposed but failed to materialize due to bureaucratic delays, shifting land use regulations, and ongoing civic opposition. Meanwhile, vacant hospital buildings remain abandoned, exacerbating concerns about urban degradation and missed opportunities for social reuse.

3.2. Public Contestation and the Role of Citizen Mobilization

Sant’Ana Hill’s redevelopment has been marked by strong community engagement and, at times, intense public opposition. In 2013–2014, the Lisbon City Council launched the Debate Temático sobre a Colina de Sant’Ana (DTCS), which attracted over 500 participants voicing concerns about displacement, reduced public space, and the loss of centrally located healthcare facilities. The objections raised during the public debate process largely fell into three categories: (i) the lack of guarantees for heritage preservation, (ii) insufficient allocation for public housing or community spaces, and (iii) the perceived lack of transparency and responsiveness in municipal decision-making.

However, the debate was non-binding, meaning residents’ and advocacy groups’ inputs were not formally integrated into the final planning decisions. Organizations such as ICOMOS-Portugal and the Chamber of Architects also raised alarms about insufficient heritage safeguards. Beyond official avenues, citizen-led protests and media campaigns gained traction, particularly in response to demolition plans affecting historically significant hospital buildings. Major newspapers like Público and Expresso often framed these developments as the privatization of public assets, thus amplifying widespread apprehension. Although public pressure did prompt some revisions to planning proposals, citizen engagement largely remained symbolic rather than shaping the fundamental decisions around land use or redevelopment timelines. While public mobilization forced certain changes to planning documents, citizen involvement had limited power to influence core decision-making processes, illustrating the largely symbolic nature of official participation channels.

The analysis of 12 semi-structured interviews with urban planners, municipal officials, architects, heritage activists, and community representatives revealed key themes regarding governance challenges and stakeholder conflicts:

i.

Planners and architects emphasized the need for clearer zoning regulations and long-term heritage preservation policies, while also acknowledging the pressure to attract private investment.

ii.

Municipal officials cited bureaucratic inefficiencies and inter-agency conflicts as primary obstacles to coherent planning.

iii.

Community activists and residents criticized the lack of meaningful public participation, viewing the planning process as biased toward private-sector interests.

Beyond the structural limitations of public engagement, the nature of public discourse surrounding the Sant’Ana Hill redevelopment also warrants critical reflection. While the Debate Temático and related forums offered a space for civic input, the deliberations were marked by asymmetries in access to technical information and uneven representation. Some citizen groups and professional organizations—such as the Chamber of Architects and ICOMOS-Portugal—provided well-informed, evidence-based critiques of redevelopment plans, while broader community engagement tended to focus on emotive appeals and expressions of local attachment. Although discussions were generally respectful, the inclusivity of diverse social groups (e.g., low-income residents, immigrant communities) remained limited. As such, while segments of the discourse were sophisticated and constructive, the overall participatory environment struggled to achieve the deliberative depth and representational breadth required for high-quality democratic planning.

These findings confirm that public trust in urban governance is undermined when participatory processes lack transparency, and decision-making remains concentrated among elite stakeholders.

3.3. Heritage Preservation vs. Real Estate Pressures

One of the most prominent tensions in Sant’Ana Hill’s regeneration is the clash between heritage conservation and economic development. The area contains several architecturally and historically significant sites, such as the Hospital de São José (originating in a 17th-century Jesuit College), the Hospital Miguel Bombarda (noted for its unique circular psychiatric ward), and the Hospital do Desterro (formerly a monastery). Despite their cultural value, these structures face an uncertain future.

Real estate pressures have intensified following government decisions to sell large portions of these hospital sites to the real estate company ESTAMO, effectively transferring ownership from public to private hands. Initial proposals included converting the properties into luxury hotels, high-end apartments, and commercial venues, raising fears of both gentrification and “touristification”. Although some protective measures were introduced, demolition permits were nonetheless granted for select buildings, prompting public backlash and further fueling civic skepticism regarding the sincerity of heritage preservation efforts. Heritage safeguards have remained secondary to real estate interests, with uneven protection measures across the former hospital sites and ongoing concerns about the commodification of culturally significant buildings.

3.4. Governance Challenges and Political Repercussions

The contested and drawn-out nature of Sant’Ana Hill’s redevelopment has generated broader governance debates and political fallout. Decision-making authority is fragmented between the Lisbon City Council, the Ministry of Health, the real estate public company (ESTAMO), and private developers, resulting in slow approvals, frequent policy reversals, and heightened investment risks. Such bureaucratic delays have only deepened the sense of uncertainty among stakeholders.

Politically, the backlash against hospital privatization on Sant’Ana Hill tapped into wider anxieties about Lisbon’s real estate policies. Opposition parties seized this issue to criticize the government for favoring commercial and tourist-oriented projects over social housing and public services. By 2023, multiple proposed developments remained on hold, reflecting growing distrust among residents and reinforcing perceptions that urban regeneration in Lisbon chiefly serves private interests rather than the broader public good.

Governance inefficiencies and public distrust have stalled redevelopment, revealing the challenges of balancing private-sector investments with transparent and equitable urban planning in Lisbon.

3.5. Final Remarks on the Process

Thus, Sant’Ana Hill’s redevelopment process illuminates a complex interplay of policy fragmentation, intense public engagement, heritage-versus-real-estate debates, and political contention. Despite periodic attempts to reconcile preservationist and economic aims, the absence of a unified strategy and sustained community participation has consistently slowed progress. In fact, although there was a large volume of community feedback—over 500 proposals—the final planning documents incorporated only minor adjustments, such as preserving elements of the façade of the former Desterro Hospital. However, the proposals for social housing or community governance models were ultimately excluded, suggesting a limited influence of civic input on substantive planning decisions. As one community representative noted during a 2014 public hearing, “This is not participation; it’s presentation. The decisions have already been made”.

As such, the case of Sant’Ana Hill underscores the broader need for integrated governance structures, socially attuned urban policies, and genuine public collaboration in shaping the future of historic city spaces.

4. Discussion

4.1. Governance, Participation, and the Political Economy of Urban Regeneration

Urban regeneration is a complex and contested process shaped by multiple, often conflicting, interests. The transformation of Sant’Ana Hill illustrates the tensions between economic development, heritage preservation, and public participation, revealing broader governance challenges in urban planning. The findings from this research suggest that urban transformation is neither linear nor purely technocratic; rather, it is a negotiated process influenced by power dynamics, institutional fragmentation, and the agency of different stakeholders.

The case of Sant’Ana Hill aligns with international research that highlights the contradictions inherent in urban regeneration projects. While planning frameworks often articulate an integrated vision for redevelopment, the reality is that these visions are subject to modifications, delays, and competing political and economic pressures. As observed in cities like London, Barcelona, and Porto, large-scale regeneration projects frequently shift from publicly driven goals to private-sector priorities, particularly when market forces play a dominant role in shaping the final outcome. In Sant’Ana Hill, the initial planning frameworks emphasized a balance between heritage preservation, social uses, and private investment, yet the eventual trajectory of redevelopment has been marked by an overwhelming prioritization of real estate commercialization, leading to significant public opposition.

The findings also highlight the limitations of public participation in urban planning. While formal mechanisms for civic engagement, such as the Debate Temático sobre a Colina de Sant’Ana (DTCS), were implemented, these participatory processes remained largely symbolic rather than substantive. Citizen concerns were acknowledged but had little impact on the final decision-making process, reflecting the wider phenomenon of tokenistic participation in urban governance. This dynamic can be critically assessed through the lens of Arnstein [5] which differentiates between genuine empowerment and tokenistic forms of consultation. In the case of Sant’Ana Hill, public engagement mechanisms—such as the Debate Temático—functioned more as symbolic gestures than as avenues for substantive influence. Although residents and civic organizations were invited to participate, their feedback did not significantly alter project priorities or governance arrangements. As such, the participatory process appears to have served more to legitimize pre-determined outcomes than to facilitate collaborative decision-making, aligning with what Arnstein describes as the lower rungs of participatory practice.

Similar trends have been observed in other European cities, such as Berlin’s Media spree redevelopment [42], where public protests delayed but did not fundamentally alter commercial-driven urban transformation. The case of Sant’Ana Hill illustrates that participatory planning, when not meaningfully integrated into governance structures, does little to reduce public distrust or mitigate conflicts over urban space.

A critical dimension of the Sant’Ana Hill redevelopment is the tension between heritage preservation and real estate pressures. While historic hospital buildings such as São José, Miguel Bombarda, and Desterro hold significant architectural and cultural value, their future remains uncertain due to conflicting urban policies and speculative real estate investment. The privatization of former hospital sites to developers such as ESTAMO underscores a broader trend in which public assets are transferred to market-driven redevelopment projects without a clear framework for safeguarding cultural heritage. This mirrors international cases where heritage-led regeneration has been either successfully integrated or largely undermined. For instance, in Paris, the redevelopment of Saint-Vincent-de-Paul Hospital was framed within a sustainable, mixed-use model, ensuring the adaptive reuse of historical buildings [43]. In contrast, in Venice, unchecked commercialization has led to the depopulation and excessive touristification of historic districts, raising concerns about loss of local identity and heritage degradation. The trajectory of Sant’Ana Hill leans more toward the latter scenario, where economic interests appear to override heritage conservation and community-based uses.

Another key challenge in Sant’Ana Hill’s regeneration was the fragmentation of governance structures, which has resulted in delays, policy reversals, and growing public skepticism. The decision-making process has been marked by a lack of coordination between different institutional actors, including the Lisbon City Council, the Ministry of Health, and private developers. This institutional misalignment has led to inconsistent zoning regulations, shifting land use priorities, and a prolonged lack of clarity over the redevelopment timeline. Similar governance failures have been observed in Madrid’s Canalejas Complex [44], where land use changes and political contestation delayed regeneration efforts and increased public distrust in urban planning authorities. The case of Sant’Ana Hill underscores the need for stronger institutional coordination, long-term planning consistency, and transparent decision-making processes to prevent uncertainty and ensure that urban transformations align with public interest rather than short-term economic gains.

To better situate these governance challenges within a broader theoretical frame, insights from classical democratic theory and social order can be illuminating. In fact, the governance fragmentation and participatory deficits observed in the Sant’Ana Hill redevelopment process resonate with classical democratic theory, particularly concerns raised by thinkers such as [45,46]. Dahl [45] emphasized the importance of polyarchy, where multiple centers of power enable effective citizen participation and accountability. In contrast, the Sant’Ana Hill case reveals institutional disarticulation, where overlapping authorities and a lack of coordination limit public influence and blur responsibility. Similarly, Habermas’ theory of communicative action underscores the necessity of deliberative legitimacy in decision-making processes. The symbolic participation mechanisms implemented in Lisbon fell short of fostering rational–critical debate, instead reflecting what Habermas would describe as strategic action dominated by instrumental logics. These shortcomings contribute to governance opacity and reinforce public distrust, thereby undermining social cohesion and the perceived legitimacy of urban transformation.

Considering these findings, there are important policy lessons for urban regeneration projects of this scale. First, participatory planning mechanisms must be institutionalized and binding, ensuring that citizen input directly shapes redevelopment strategies rather than serving as a retrospective consultation tool. This requires a shift from reactive engagement to co-governance, where civil society actors are actively involved throughout the entire urban planning process. Second, urban policy frameworks should establish clear and stable land use regulations that prevent speculative rezoning and provide greater predictability for both investors and local communities. Third, heritage-led development models should prioritize adaptive reuse strategies, ensuring that historic sites are repurposed for public and social uses rather than being commodified solely for high-end real estate. Finally, institutional governance must be streamlined to avoid bureaucratic inefficiencies and conflicting policy priorities, particularly when large-scale urban transformations involve multiple stakeholders.

The contested redevelopment of Sant’Ana Hill illustrates that urban regeneration is not merely a technical exercise but a deeply political process. As observed by Lefebvre and Castells, the production of urban space is inherently social, with the actions of various stakeholders influencing its evolution. In this case, the interplay of governance failures, market imperatives, and superficial public participation led to outcomes that prioritized short-term economic gains over long-term social and cultural sustainability.

The findings underscore the need for robust, inclusive governance frameworks that move beyond mere consultation. Genuine participatory models must empower communities to actively shape urban transformation processes. Furthermore, consistent policy frameworks are essential to balance economic development with heritage preservation and social equity.

4.2. Drivers of Social Discontent in Sant’Ana Hill’s Transformation

The redevelopment of Sant’Ana Hill ignited significant social discontent due to three inter-related factors:

i.

Lack of Meaningful Public Participation: Despite formal participatory channels (e.g., Debate Temático sobre a Colina de Sant’Ana), decision-making remained top–down. Citizen concerns, particularly regarding public space reduction and housing affordability, were acknowledged but not integrated into final planning decisions. This mirrors patterns seen in other contested urban transformations where public input is symbolic rather than substantive [5].

ii.

Market-Driven Planning Priorities: The transfer of hospital sites to private developers (e.g., ESTAMO) raised concerns over gentrification and touristification, reinforcing perceptions that Lisbon’s urban policies prioritize investment over social needs. The rapid conversion of institutional land into luxury developments exacerbated existing housing inequalities, further fueling discontent.

iii.

Governance Fragmentation and Policy Inconsistencies: Multiple agencies, including the Lisbon City Council, the Ministry of Health, and private developers, held decision-making power without clear coordination. This fragmentation led to uncertain regulatory frameworks and delayed implementation, amplifying public skepticism and reinforcing the perception of an opaque planning process.

5. Conclusions

Democratic urban planning frameworks rest on several foundational principles: procedural fairness (ensuring inclusive and non-discriminatory access to planning processes), transparency (clarity around how decisions are made), accountability (clear lines of responsibility), and participatory parity. These principles are not merely normative ideals but function as institutional safeguards against elite capture and technocratic dominance. In practice, however, such ideals are frequently compromised. The Sant’Ana Hill case reveals how symbolic participation and fragmented authority structures undermined these democratic norms, leading to planning uncertainty, diminished legitimacy, and growing citizen disillusionment.

The contested regeneration of Sant’Ana Hill in Lisbon serves as a critical case study in urban transformation, highlighting the complex interplay between governance structures, public participation, and heritage preservation. As this study has demonstrated, the redevelopment of the former Health Hill has been shaped by policy inconsistencies, limited citizen engagement, real estate pressures, and governance fragmentation, ultimately generating significant public resistance and uncertainty.

One of the key findings of this research is that urban planning is inherently a negotiated process, often caught between competing visions of development. In the case of Sant’Ana Hill, initial urban plans emphasized a balanced approach integrating heritage, social infrastructure, and economic revitalization. However, over time, the prioritization of commercial real estate development over public-oriented land uses has led to widespread opposition from both civil society groups and urban researchers. This pattern aligns with broader international experiences in urban regeneration, where heritage-led policies frequently come into tension with market-driven redevelopment strategies.

Another important takeaway from this study is the role of public participation in shaping urban transformation. While formal participatory mechanisms, such as the Debate Temático sobre a Colina de Sant’Ana (DTCS, 2013–2014), were implemented, they remained largely symbolic rather than substantive. The findings support existing research on urban governance, which suggests that tokenistic public consultation processes often fail to build trust or meaningfully influence planning outcomes. This raises the need for more inclusive and binding participatory frameworks, ensuring that citizen engagement is not merely a procedural requirement but a core component of urban policymaking.

The conclusions also underscore the need for clear and consistent governance mechanisms in large-scale urban regeneration projects. The case of Sant’Ana Hill has been characterized by institutional fragmentation, with conflicting priorities between the Lisbon City Council, the Ministry of Health, and private developers. This lack of coordination has resulted in delays, policy reversals, and a growing perception of opacity in decision-making. Similar governance failures have been documented in other European cities undergoing rapid urban transformation, reinforcing the necessity for long-term planning consistency, transparent regulatory frameworks, and cross-institutional collaboration.

From a policy perspective, the case of Sant’Ana Hill provides several important lessons. Future urban regeneration efforts must prioritize heritage-led development models that integrate adaptive reuse, public space preservation, and cultural sustainability. At the same time, urban policies should establish mechanisms to prevent speculative rezoning and uncontrolled privatization of public assets, ensuring that economic development does not come at the expense of social equity and historical preservation. Moreover, governance structures must be reformed to streamline decision-making, reduce bureaucratic inefficiencies, and enhance democratic accountability in urban transformations.

Beyond its immediate implications for Lisbon’s urban policy, this study contributes to broader academic discussions on urban voids, contested redevelopment, and participatory governance. As cities worldwide confront the challenges of repurposing underutilized institutional spaces, the findings from Sant’Ana Hill offer valuable insights into how urban transformations can be made more equitable, transparent, and sustainable. Future research could expand on this case by conducting comparative analyses with similar contested regeneration projects, examining longitudinal impacts of urban redevelopment, and exploring alternative governance models that successfully integrate public participation and heritage conservation.

Finally, the case of Sant’Ana Hill illustrates the fundamental tensions that define contemporary urban regeneration efforts. As Lisbon continues to evolve, the ability to balance economic imperatives with social and cultural sustainability will determine whether the city’s future transformations serve as models of inclusive and participatory urban planning or cautionary tales of speculative redevelopment. The lessons drawn from this research emphasize that successful urban regeneration must be driven not only by financial viability but also by a commitment to democratic governance, heritage protection, and long-term social inclusivity.