This article clarifies the differences between occupational health and workplace health and reveals how the two overlap. It unravels a multi-layered narrative about cotton textile workers' understandings and experiences of ill-health at work in America and Britain, utilizing a combination of oral histories, government documents, company and union records, and the trade press. It aims to identify the multiple influences on contemporary debates about health at work. Contrary to current historiography, I argue that gender was only occasionally important to such discussions among workers, and that gender did not significantly influence their responses to unhealthy conditions. Workers' understandings of, and responses to, workplace hazards were individual and related to knowledge about risk, ill-health and socioeconomic factors. American and British workers' understandings of and responses to their 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 by gender.