This article clarifies the differences between occupational health and workplace health and reveals how the two overlap. It unravels a multi-layered narrative about textile workers’ understandings and experiences of ill-health at work in both America and Britain, utilizing a combination of oral histories, government documents, company and union records, and the trade press and identifying the multiple influences on debates about health at work. Contrary to current historiography, gender was only occasionally important to such discussions and among workers, gender did not significantly influence responses to unhealthy conditions. Understandings of, and responses to, workplace hazards were individual and related to knowledge about risk, ill-health and socio-economic factors. Consequently, workers’ understandings of and responses to the working environment reveals more convergence than divergence, suggesting a universal human response to the health risks of work that is not significantly influenced by national or industrial constraints, or gender.