Do Far-Right Mayors Promote Informal Healthcare Chauvinism?

class: center, middle, inverse, title-slide

.title[
# Do Far-Right Mayors Promote Informal Healthcare Chauvinism?
]
.subtitle[
## Ethnic Discrimination in Access to Basic Healthcare in Italy
]
.author[
### Krzysztof Krakowski, Dina Rosenberg, Alessio Romarri, and Merlin Schaeffer
]
.date[
### 2022-10-24
]

---

# The far-right and welfare chauvinism

.left-column[
> A system of social protection for those who belong to the ethnically defined community

> .font80[Kitschelt and McGann (1997)]
]

---

count: false
# The far-right and welfare chauvinism

.left-column[
> A system of social protection for those who belong to the ethnically defined community

> .font80[Kitschelt and McGann (1997)]

<img src="Cepdisc_files/figure-html/Venn1-1.gif" width="90%" style="display: block; margin: auto;" />
]

.right-column[

.push-left[
 
Two examples of welfare chauvinistic policy in Denmark: .backgrnote[(Jørgensen and Thomsen, 2016)]

- **Direct**: "Start Aid": Ca. 50% lower benefits to refugees & recent immigrants.

- **Indirect**: "225 hour rule": Both partners in a union need to have worked 225+ hours in the past 12 months to qualify for benefits.
]

.push-right[
 
<img src="https://api.time.com/wp-content/uploads/2019/01/denmark-immigration-mjolnerparken.jpg" width="90%" style="display: block; margin: auto;" />
]
]

---
# The far-right and welfare chauvinism

.left-column[
> A system of social protection for those who belong to the ethnically defined community

> .font80[Kitschelt and McGann (1997)]

<img src="Cepdisc_files/figure-html/Venn2-1.gif" width="90%" style="display: block; margin: auto;" />
]

.right-column[
.center[Danes' public opinion on who should to get vaccinated first]
<img src="media/VaccinationChauvinism.svg" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: Schaeffer and Haderup Larsen (2022)]]
]

---
# The far-right and welfare chauvinism

.left-column[
> A system of social protection for those who belong to the ethnically defined community

> .font80[Kitschelt and McGann (1997)]

<img src="Cepdisc_files/figure-html/Venn3-1.gif" width="90%" style="display: block; margin: auto;" />
]

.right-column[
.center[Quality of written answers from German welfare office administrators]
<img src="media/Anselm.png" width="60%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: Hemker and Rink (2017)]]
]

---
layout: false
class: middle center
# .font90[Do far-right mayors promote informal healthcare chauvinism?]

.right-column[
<img src="Cepdisc_files/figure-html/Venn4-1.gif" width="60%" style="display: block; margin: auto;" />
]

.left-column[.content-box-blue[
**Potential mechanisms**
.left[
1. Informal policy.
2. Hiring.
3. Erosion of social norms.
]]]

---
layout: false
# A field experiment

.push-left[

<img src="media/OSF.png" width="90%" style="display: block; margin: auto;" />
]

.push-right[
.center[.font110[Research assistants call 200 Italian "Azienda Sanitaria Locale" to ask for a general practitioner]]
.push-left[
<img src="media/Black_Female_Caller2.png" width="60%" style="display: block; margin: auto;" />
<img src="media/Black_Male_Caller.png" width="60%" style="display: block; margin: auto;" />
.center[.font90[Two students with West-African accent]]
]
.push-right[
<img src="media/White_Female_Caller.png" width="60%" style="display: block; margin: auto;" />
<img src="media/White_Male_Caller.png" width="60%" style="display: block; margin: auto;" />
.center[.font90[Two students with native Italian accent]]
]
]

---
# Interview guideline

---
layout: true
# Ethnic discrimination .font60[in access to basic healthcare]

---

<img src="Cepdisc_files/figure-html/Ethnic_Discr1-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]
---
count: false

<img src="Cepdisc_files/figure-html/Ethnic_Discr2-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]
---

.left-column[
<img src="Cepdisc_files/figure-html/Ethnic_Discr3-1.png" width="95%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects.
]]]

.right-column[
<img src="Cepdisc_files/figure-html/unnamed-chunk-11-1.png" width="95%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]]

---
layout: true
# Ethnic discrimination .font60[by far-right mayors]

---

<img src="Cepdisc_files/figure-html/Right_Wing1-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]

---
count: false
<img src="Cepdisc_files/figure-html/Right_Wing2-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]

---

.push-left[
.center[Municipalities where far-right candidates *ran* versus where they *won*]
<img src="media/Map_Italy.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[*Source*: Romarri (2020)]]
]

.push-right[
 
 
<img src="Cepdisc_files/figure-html/unnamed-chunk-13-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]]

---
layout: true
# Far-right mayors .font60[A regression discontinuity design]

---

<img src="Cepdisc_files/figure-html/Right_Wing3-1.png" width="86%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]

---
layout: false
# .font90[Balanced confounders around the margin of victory]

<img src="media/Balance_test.png" width="40%" style="display: block; margin: auto;" />
.backgrnote[.center[*Source*: Romarri (2020)]]

---
layout: true
# Far-right mayors .font60[A regression discontinuity design]

---

<img src="Cepdisc_files/figure-html/Right_Wing4-1.png" width="86%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* OLS with 90 and 95% CI fitted separately on each side of the margin of victory. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]

---
count: false

<img src="Cepdisc_files/figure-html/Right_Wing5-1.png" width="86%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* OLS with 90 and 95% CI fitted separately on each side of the margin of victory. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]

---
layout: true
# Far-right mayors .font60[a Diff-in-RD design]

---

.center[Bias-corrected non-parametric RD with optimized bandwidth .backgrnote[(Calonico, Cattaneo, and Titiunik, 2014)]]

.push-left[.font80[
.center[RD among callers with native Italian accent]

```
# Sharp RD estimates using local polynomial regression.
# 
# Number of Obs.                  391
# BW type                       mserd
# Kernel                   Triangular
# VCE method                       NN
# 
# Number of Obs.                  116          275
# Eff. Number of Obs.              32           88
# Order est. (p)                    1            1
# Order bias  (q)                   2            2
# BW est. (h)                   3.035        3.035
# BW bias (b)                   6.032        6.032
# rho (h/b)                     0.503        0.503
# 
# =============================================================================
#         Method     Coef. Std. Err.         z     P>|z|      [ 95% C.I. ]       
# =============================================================================
#   Conventional    -0.026     0.021    -1.257     0.209    [-0.066 , 0.014]     
# Bias-Corrected    -0.039     0.021    -1.892     0.058    [-0.079 , 0.001]     
#         Robust    -0.039     0.023    -1.669     0.095    [-0.085 , 0.007]     
# =============================================================================
```
]]

--
.push-right[.font80[
.center[RD among callers with West-African accent]

```
# Sharp RD estimates using local polynomial regression.
# 
# Number of Obs.                  421
# BW type                       mserd
# Kernel                   Triangular
# VCE method                       NN
# 
# Number of Obs.                  136          285
# Eff. Number of Obs.              26           72
# Order est. (p)                    1            1
# Order bias  (q)                   2            2
# BW est. (h)                   2.330        2.330
# BW bias (b)                   4.301        4.301
# rho (h/b)                     0.542        0.542
# 
# =============================================================================
#         Method     Coef. Std. Err.         z     P>|z|      [ 95% C.I. ]       
# =============================================================================
#   Conventional    -0.536     0.178    -3.012     0.003    [-0.885 , -0.187]    
# Bias-Corrected    -0.616     0.178    -3.457     0.001    [-0.964 , -0.267]    
#         Robust    -0.616     0.196    -3.146     0.002    [-0.999 , -0.232]    
# =============================================================================
```
]]

.push-center[.font120[.center[

`$$\Delta_{\text{RDD}}= -0.616 - (-0.039) = -0.577$$`

]]]

---

<img src="Cepdisc_files/figure-html/Boot_fig-1.png" width="45%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]

---
count: false

<img src="Cepdisc_files/figure-html/Boot_fig2-1.png" width="45%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]

---
layout: false
# Nr. of questions asked .font70[by administrator (0 - 10)]

.left-column[
<img src="Cepdisc_files/figure-html/Ethnic_Discr_NrQuestions-1.png" width="85%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 806 telephone calls (resp. 391 & 415) to 252 municipalities.
]]]

.right-column[
<img src="Cepdisc_files/figure-html/Boot_fig_quest-1.png" width="65%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 806 telephone calls (resp. 391 & 415) to 252 municipalities.
]]
]

---
# Nr. of *irrelevant* questions asked .font70[by administrator (0 - 4)]

.left-column[
<img src="Cepdisc_files/figure-html/Ethnic_Discr_NrIrrQuestions-1.png" width="85%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 805 telephone calls (resp. 392 & 413) to 252 municipalities.
]]]

.right-column[
<img src="Cepdisc_files/figure-html/Boot_fig_irrquest-1.png" width="65%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 805 telephone calls (resp. 392 & 413) to 252 municipalities.
]]
]

---
layout: false
# Conclusion

.push-left[
1. Immigrant minorities face discrimination in access to basic healthcare. .backgrnote[At least those with a West-African accent.]
 
2. Far-right mayors promote this type of discrimination.

3. *Next step*: 3 Mechanisms.

<img src="Cepdisc_files/figure-html/unnamed-chunk-17-1.gif" width="50%" style="display: block; margin: auto;" />
]

.push-right[
<img src="media/Romarri_HateCrime.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[*Source*: Romarri (2020)]]
]

---
# Implications

.push-left[
.center[**For immigrant minorities**]
- More exploratory qualitative and field experimental work on further informal channels of welfare chauvinism.

- Excess prevalence of diseases that need preventive healthcare?

- Benefits and dangers of digitized administration?
]

.push-right[
.center[**For everyone**]
- "No one is safe until everyone is safe" .backgrnote[(Farrar and Ahuja, 2021)]
 + Pre-reg hypothesis: Far-right mayors increased excess death rate during first wave Italian COVID-19 pandemic.
]

---
count: false
class: middle center

.font160[.alert[Thank you for your attention!]]

---
count: false
# References

.push-left[.font70[
Calonico, S., M. D. Cattaneo, and R. Titiunik (2014). "Robust Nonparametric Confidence Intervals for
Regression-Discontinuity Designs: Robust Nonparametric Confidence Intervals". In: _Econometrica_, pp.
2295-2326.

Farrar, J. and A. Ahuja (2021). _Spike: The Virus vs. The People - the Inside Story_. Profile Books.

Hemker, J. and A. Rink (2017). "Multiple Dimensions of Bureaucratic Discrimination: Evidence from
German Welfare Offices". In: _American Journal of Political Science_, pp. 786-803.

Jørgensen, M. B. and T. L. Thomsen (2016). "Deservingness in the Danish context: Welfare chauvinism in
times of crisis". In: _Critical Social Policy_, pp. 330-351.

Kitschelt, H. and A. J. McGann (1997). _The radical right in Western Europe: A comparative analysis_.
Michigan: University of Michigan Press.
]]

.push-right[.font70[
Romarri, A. (2020). _Do Far-Right Mayors Increase the Probability of Hate Crimes? Evidence From
Italy_. SSRN Scholarly Paper ID 3506811. Rochester, NY: Social Science Research Network.

Schaeffer, M. and M. Haderup Larsen (2022). "Who Should Get Vaccinated First? Limits of Solidarity
during the First Week of the Danish Vaccination Programme". In: _European Sociological Review_, p.
jcac025.
]]

---
class: inverse middle center
count: false
# Appendix

---
count: false
# Binary success .font70["Yes" & "Probably yes": 1; else: 0]

.left-column[
<img src="Cepdisc_files/figure-html/Ethnic_Discr_SuccessBi-1.png" width="85%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]]

.right-column[
<img src="Cepdisc_files/figure-html/Boot_fig_SuccessBi-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]
]

---
count: false
# Binary success .font60["Yes", "Probably yes", or "Don't know": 1; else: 0]

.left-column[
<img src="Cepdisc_files/figure-html/Ethnic_Discr_SuccessBi2-1.png" width="85%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]]

.right-column[
<img src="Cepdisc_files/figure-html/Boot_fig_SuccessBi2-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 812 telephone calls (resp. 391 & 421) to 257 municipalities.
]]
]

---
# Perfectly balanced data

.left-column[
<img src="Cepdisc_files/figure-html/Perf_balance-1.png" width="85%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 54 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 492 telephone calls (resp. 246 & 246) to 123 municipalities.
]]]

.right-column[
<img src="Cepdisc_files/figure-html/Boot_fig_PerfBal-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 492 telephone calls (resp. 246 & 246) to 123 municipalities.
]]
]

---
# Balanced data

.left-column[
<img src="Cepdisc_files/figure-html/Balanced-1.png" width="85%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Point estimate with 90 and 95% CI based on OLS with standard errors clustered on the level of 72 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 686 telephone calls (resp. 343 & 343) to 220 municipalities.
]]]

.right-column[
<img src="Cepdisc_files/figure-html/Boot_fig_Bal-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent. `$n$` = 686 telephone calls (resp. 343 & 343) to 220 municipalities.
]]
]
---
count: false
# Single rule versus in coalition

<img src="Cepdisc_files/figure-html/Boot_fig_SuccessCoal-1.png" width="80%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals based on 2,000 bootstrap samples stratified by Italian/West-African accent.
]]

---
count: false
# La Lega

<img src="Cepdisc_files/figure-html/Boot_fig_SuccessLega-1.png" width="80%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$\Delta_{\text{RDD}}$` estimates based on rdrobust() with 90 and 95% BCa confidence intervals (capped at -2) based on 2,000 bootstrap samples stratified by Italian/West-African accent.
]]

---
count: false
# RDD .font60[1st election round]

---
count: false
# RDD .font60[2nd election round]