Citizenship Policy and the Spread of Communicable Diseases: Evidence from the Dominican Republic

Fabiola Alba-Vivar, Eduardo Campillo-Betancourt and Jose Luis Flor-Toro
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Eduardo Campillo-Betancourt: CRI Foundation, Boston MA
Jose Luis Flor-Toro: Independent Researcher, Lima Peru

No 136, Working Papers from Wake Forest University, Economics Department

Abstract: We estimate the causal effect of exclusionary citizenship policies on communicable disease transmission. In 2013, the Dominican Republic's Constitutional Court Ruling 168-13 retroactively revoked citizenship from roughly 10 percent of the population—primarily individuals of Haitian descent—thereby restricting their access to healthcare. Leveraging municipality-level variation in exposure within a difference-in-differences framework as well as individual administrative data, we identify a two-stage dynamic in dengue incidence. In the short run, reported cases decline by 13.5 percent in high-exposure municipalities, consistent with healthcare avoidance among affected populations. This decline reverses after six months, as untreated infections generate spillover transmission to non-Haitian populations, increasing cases by 16.7 percent. Overall, the findings demonstrate that restricting healthcare access through citizenship policy imposes substantial public health costs that extend beyond the targeted population.

Keywords: citizenship; communicable diseases; dengue; Dominican Republic (search for similar items in EconPapers)
JEL-codes: C23 F22 I14 I18 J15 O15 (search for similar items in EconPapers)
Pages: 76
Date: 2026-05-01
New Economics Papers: this item is included in nep-mig
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Persistent link: https://EconPapers.repec.org/RePEc:ris:wfuewp:022596

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