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

Author

Listed:
  • Fabiola Alba-Vivar

    (Wake Forest University)

  • Eduardo Campillo-Betancourt

    (CRI Foundation, Boston MA)

  • Jose Luis Flor-Toro

    (Independent Researcher, Lima Peru)

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.

Suggested Citation

  • Fabiola Alba-Vivar & Eduardo Campillo-Betancourt & Jose Luis Flor-Toro, 2026. "Citizenship Policy and the Spread of Communicable Diseases: Evidence from the Dominican Republic," Working Papers 136, Wake Forest University, Economics Department.
    • Handle: RePEc:ris:wfuewp:022596
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    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J15 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination
    • F22 - International Economics - - International Factor Movements and International Business - - - International Migration
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models

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