Photovoice is a participatory health promotion strategy in which people use cameras to document their health and work realities. As participants engage in a group process of critical reflection, they may advocate for change in their communities by using the power of their images and stories to communicate with policy makers. In public health initiatives from China to California, community people have used photovoice to carry out participatory needs assessment, conduct participatory evaluation, and reach policy makers to improve community health. This article begins to address ethical issues raised by the use of photovoice: the potential for invasion of privacy and how that may be prevented; issues in recruitment, representation, participation, and advocacy; and specific methodological techniques that should be used to minimize participants' risks and to maximize benefits. The authors describe lessons learned from the large-scale Flint Photovoice involving youth, adults, and policy makers.