When Flint, Michigan, changed its source of municipal water from Lake Huron to the Flint River, Flint residents were repeatedly assured that the water was of the highest quality. At the switch over ceremony, the mayor and other officials performed a celebratory toast, declaring "Here's to Flint " and downing glasses of freshly treated water. But as we now know, the water coming out of residents' taps harbored a variety of contaminants, including high levels of lead. In Flint Fights Back, Pauli distinguishes the political narrative of the water crisis from the historical and technical narratives, showing that Flint activists' emphasis on democracy helped them to overcome some of the limitations of standard environmental justice frameworks.

The author examines the health effects of lead exposure, analysing cases from New York City, Boston, and Glasgow. He draws on period accounts, government reports, court decisions, and economic and demographic analysis to document the nature of the problem, the recognised health threats, and official intransigence.