The hot thing on social media right now is the “10-year challenge” — to post a picture of yourself from when the decade began and one now to see the changes.

If Roanoke did the same, we’d want those pictures to be from the area around Jefferson Street and Reserve Avenue.

In 2010, that area was a combination of industrial brownfields and a construction zone that was giving rise to the medical school and research institute that opened later that year.

Today that area is still partly a construction zone — as the entity we now know as the Virginia Tech Carilion Academic Health Center continues to expand.

More is coming: Last week, Carilion President and CEO Nancy Agee and her husband Steven — a federal appeals court judge — announced they’re giving $1 million to kick-start a fundraising drive to build a new cancer center for the hospital. Total estimated cost: $75 million to $100 million. Time frame: About four years or so, depending on how fund-raising goes.

At present there are no particular metrics to quantify the scale of this new center other than the goal is to be “world class.” At one time, that might have been dismissed as public relations puffery. That was back when we were all still amazed that there’d be a medical school in Roanoke at all. Technically, this cancer center isn’t part of the school or research institute— it will be squarely on the Carilion side of the Virginia Tech Carilion ledger — but those are organizational details. The larger point here is that this is yet another example of Roanoke’s transformation from what we used to be to what we will be.

Former city manager Chris Morrill popularized the phrase “from train city to brain city” to describe Roanoke’s evolution — the latter part of the phrase name-checking the brain research that the Fralin Biomedical Research Institute part of the Virginia Tech Carilion operation is famous for. And famous really is the operative word. In a remarkably short span of time, the institute has put itself on the global map for brain research.

What’s really happening, though, is that Roanoke is creating a health care economy. The new cancer center will certainly check off some important medical boxes, but it also helps check off some important economic ones, too. Into the early 2000s, we had hospitals; now we have an entire medical ecosystem that we’re banking on to grow even bigger. It’s not just Carilion; it’s not just the medical school and research institute, either. It’s the combination of all of them together and what that might produce. Here’s what it’s produced already: Three of six start-ups accepted for the inaugural cohort at RAMP, the Regional Acceleration and Mentoring Program, were medical in nature. In the second cohort, five of seven were health-related. The third cohort was more tech-focused, but overall health-related companies still hold a disproportionate share of the start-ups going through that program designed to take small companies and turn them into bigger companies. The fact that most people can’t name any of these companies is beside the point; the point is that Roanoke is starting to grow companies.

On the one hand, our 10-year-challenge has seen Norfolk Southern shut down its regional office in Roanoke and Advance Auto move its headquarters out of town — both companies that were born here long ago. Those moves mark the end of an era. The growth of a health care ecosystem marks the start of a new one.

Here are some relevant numbers: Carilion now employs about 9,000 people in the Roanoke Valley (and about 13,500 system-wide). By contrast, Norfolk & Western’s Roanoke shops employed abut 6,000 in the 1930s. There are an additional 650 Virginia Tech employees connected with the Roanoke Health Science and Technology Campus. All those numbers are expected to grow, too — some projections put employment at the Health Science and Technology Campus in eight years at 3,150. The goal here is not to cheerlead for Virginia Tech and Carilion but to offer some context and perspective. Roanoke is still in love with its railroad heritage and there’s nothing wrong with that nostalgia. We turn out by the thousands to see the 611 engine blow off steam and roll back into town. We cheer for our hockey team named the Rail Yard Dawgs. Not sure what to name something in Roanoke? You can’t go wrong with a railroad theme. But let’s not get too weepy for the past, especially when the future is starting to happen, right before our eyes.

We just haven’t quite made our new health care economy part of our civic identity yet. One rejected name for the hockey team was the Brain Freeze. Instead of having a loveable pooch mascot skate around the ice, we could have had a brain! OK, maybe we need to work on that one some more . . .

A year ago this time, Virginia was celebrating Amazon’s decision to locate in Arlington. That’s a move that helps underscore Northern Virginia’s role as a technology capital — and perhaps the beginnings of a Silicon Valley East. Meanwhile, a year ago this time in Roanoke, we were getting word that the Fralin family — partly through The Horace G. Fralin Charitable Trust, partly through Cynthia and Heywood Fralin themselves — was donating $50 million to Virginia Tech for the medical research institute that now bears the family name. At the time, we observed what we were witnessing was really the Roanoke Valley’s Amazon — or, to mix metaphors, the beginning of our own Research Triangle.

It seemed improbable in the 1950s that North Carolina could create much of anything out of the pine forests outside Raleigh. Today, it’s accepted fact that the Research Triangle is home to world-class research, world-class companies, world-class lots of things. This donation by the Agees fits into that long arc of similar development for Roanoke. “We wanted to do what we could to make a difference,” Steven Agee said. Nancy Agee talks about how it’s important to look at what the hospital — and by implication the region — will need in not just the next 10 years, but the next 40 years. That’s a timeframe that will outlast most of us, but the world is best shaped by those who are looking beyond the horizon. With this gift, and the challenge to build a cancer center that can rival those of the best-known hospitals anywhere, the Agees show that they are among those thinking in terms of not just a 10-year challenge, but a 40-year-challenge.

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