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[
### 2023-04-21
]

---

class: middle center
background-image: url("https://stanfordbloodcenter.org/wp-content/uploads/2021/01/iStock-1208283967.jpg")
background-position: center
background-size: cover

.font160[
**My research agenda**
]
.font200[
**Theory-driven empirical analysis of immigration-based ethnic diversity and stratification, & their contentious political consequences**
]

---
# Immigration and the welfare state

.push-left[
<iframe src="https://data.oecd.org/chart/6KSD" width="860" height="490" style="border: 0" mozallowfullscreen="true" webkitallowfullscreen="true" allowfullscreen="true"><a href="https://data.oecd.org/chart/6KSD" target="_blank">OECD Chart: Social spending, Public, % of GDP, Annual, 2019</a></iframe>
]

.push-right[
<img src="../COVID-19-Healthcare-Chauvi/COVID-Chauvi/media/Alesina.png" width="100%" style="display: block; margin: auto;" />
.center[.backgrnote[*Source*: Alesina, Glaeser, and Sacerdote (2001)]]
]

---
count: false
# Immigration and the welfare state

.push-left[
> The ordinary English worker hates the Irish worker as a competitor who lowers his standard of life. 
> [...] 
> His attitude towards him is much the same as that of the “poor whites” to the Negroes in the former slave states of the U.S.A..

> .font90[Marx in a letter to Engels] .backgrnote[(Marx and Engels, 1975 [1870])]
]

---
# .font70[Why don't European countries have US-style welfare states by now?]

.center[
<iframe src="https://data.oecd.org/chart/6KSC" width="700" height="500" style="border: 0" mozallowfullscreen="true" webkitallowfullscreen="true" allowfullscreen="true"><a href="https://data.oecd.org/chart/6KSC" target="_blank">OECD Chart: Foreign-born population, Total, % of population, Annual, 2019</a></iframe>
]

---
# 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="SciencePo_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="SciencePo_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="SciencePo_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?]

---
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="SciencePo_files/figure-html/Ethnic_Discr1-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]
---
count: false

<img src="SciencePo_files/figure-html/Ethnic_Discr2-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]
---

.left-column[
<img src="SciencePo_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 62 regions. Adjusted for gender of the caller and municipality fixed effects.
]]]

.right-column[
<img src="SciencePo_files/figure-html/unnamed-chunk-13-1.png" width="95%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]]

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

---

<img src="SciencePo_files/figure-html/Right_Wing1-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---
count: false
<img src="SciencePo_files/figure-html/Right_Wing2-1.png" width="90%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 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="SciencePo_files/figure-html/unnamed-chunk-15-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Means with 90 and 95% CI. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]]

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

---

<img src="SciencePo_files/figure-html/Right_Wing3-1.png" width="86%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* `$n$` = 590 telephone calls (resp. 284 & 306) to 198 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="SciencePo_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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---
count: false

<img src="SciencePo_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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---

<img src="SciencePo_files/figure-html/Right_Wing6-1.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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---

<img src="SciencePo_files/figure-html/Right_Wing7-1.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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---

<img src="SciencePo_files/figure-html/Right_Wing8-1.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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 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.                  284
# BW type                       mserd
# Kernel                   Triangular
# VCE method                       NN
# 
# Number of Obs.                   78          206
# Eff. Number of Obs.              20           57
# Order est. (p)                    1            1
# Order bias  (q)                   2            2
# BW est. (h)                   1.646        1.646
# BW bias (b)                   3.380        3.380
# rho (h/b)                     0.487        0.487
# 
# =============================================================================
#         Method     Coef. Std. Err.         z     P>|z|      [ 95% C.I. ]       
# =============================================================================
#   Conventional    -0.049     0.031    -1.584     0.113    [-0.111 , 0.012]     
# Bias-Corrected    -0.055     0.031    -1.770     0.077    [-0.116 , 0.006]     
#         Robust    -0.055     0.041    -1.336     0.181    [-0.136 , 0.026]     
# =============================================================================
```
]]

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

```
# Sharp RD estimates using local polynomial regression.
# 
# Number of Obs.                  306
# BW type                       mserd
# Kernel                   Triangular
# VCE method                       NN
# 
# Number of Obs.                   95          211
# Eff. Number of Obs.              23           64
# Order est. (p)                    1            1
# Order bias  (q)                   2            2
# BW est. (h)                   2.054        2.054
# BW bias (b)                   3.684        3.684
# rho (h/b)                     0.558        0.558
# 
# =============================================================================
#         Method     Coef. Std. Err.         z     P>|z|      [ 95% C.I. ]       
# =============================================================================
#   Conventional    -0.653     0.198    -3.300     0.001    [-1.041 , -0.265]    
# Bias-Corrected    -0.718     0.198    -3.629     0.000    [-1.106 , -0.330]    
#         Robust    -0.718     0.224    -3.202     0.001    [-1.158 , -0.279]    
# =============================================================================
```
]]

.push-center[.font120[.center[

`$$\Delta_{\text{RDD}}= -0.718 - (-0.055) = -0.663$$`

]]]

---

<img src="SciencePo_files/figure-html/Boot_fig-1.png" width="83%" 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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---
count: false

<img src="SciencePo_files/figure-html/Boot_fig2-1.png" width="83%" 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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---
count: false

<img src="SciencePo_files/figure-html/Boot_fig3-1.png" width="83%" 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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

---
count: false

<img src="SciencePo_files/figure-html/Boot_fig4-1.png" width="83%" 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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]

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

.left-column[
<img src="SciencePo_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 62 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 586 telephone calls (resp. 284 & 302) to 194 municipalities.
]]]

.right-column[
<img src="SciencePo_files/figure-html/Boot_fig_quest-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. `$n$` = 586 telephone calls (resp. 284 & 302) to 194 municipalities.
]]
]

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

.left-column[
<img src="SciencePo_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 62 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 527 telephone calls (resp. 229 & 298) to 190 municipalities.
]]]

.right-column[
<img src="SciencePo_files/figure-html/Boot_fig_irrquest-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. `$n$` = 527 telephone calls (resp. 229 & 298) to 190 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.

<img src="SciencePo_files/figure-html/unnamed-chunk-19-1.gif" width="60%" 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**]
- European countries will most likely maintain their welfare states.

- "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[Merci pour votre attention!]]

---
count: false
# References

.push-left[.font70[
Alesina, A., E. Glaeser, and B. Sacerdote (2001). "Why Doesn't the United States Have a European-Style
Welfare State?" In: _Brookings Papers on Economic Activity_, pp. 187-254.

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.
]]

.push-right[.font70[
Kitschelt, H. and A. J. McGann (1997). _The radical right in Western Europe: A comparative analysis_.
Michigan: University of Michigan Press.

Marx, K. and F. Engels (1975). _Selected correspondence_. Moscow: Progress Publishers.

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
# RDD .font60[Choice of polynomials]

.push-left[
<img src="SciencePo_files/figure-html/Right_Wing_Poly4-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* OLS with 90 and 95% CI fitted separately on each side of the margin of victory. `$n$` = 527 telephone calls (resp. 229 & 298) to 190 municipalities.
]]]

.push-right[
<img src="SciencePo_files/figure-html/Right_Wing_Smooth-1.png" width="100%" style="display: block; margin: auto;" />
.backgrnote[.center[
*Note:* Locally Weighted Scatterplot Smoothing with 90 and 95% CI fitted separately on each side of the margin of victory. `$n$` = 527 telephone calls (resp. 229 & 298) to 190 municipalities.
]]]

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

.left-column[
<img src="SciencePo_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 62 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]]

.right-column[
<img src="SciencePo_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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]
]

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

.left-column[
<img src="SciencePo_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 62 regions. Adjusted for gender of the caller and municipality fixed effects. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]]

.right-column[
<img src="SciencePo_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. `$n$` = 590 telephone calls (resp. 284 & 306) to 198 municipalities.
]]
]

---
count: false
# Single rule versus in coalition

<img src="SciencePo_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="SciencePo_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.
]]