Objective: Using the draw-and-write methodology, this study examined cross-cultural similarities and differences in children's perceptions of health. Design: Cross-sectional design. Setting: One public elementary school in the USA and in Guatemala. Method: The total sample included 161 children 9-10 years of age, 80 in the USA and 81 in Guatemala. Children in each setting were asked to draw-and-write responses to two prompts regarding things that make someone healthy/unhealthy. Responses were coded for the presence of themes for each topic, and statistical tests were performed to test for significant differences by gender and country. Results: Food is central to children's perceptions of healthy and unhealthy in both locations, as over 90% of children overall depicted food items for both topics. Fruit, in particular, constitutes the majority of depictions for healthy items in both countries, followed by vegetables. In terms of differences, children in the USA were more likely to depict drinking water and exercise as things that make someone healthy and fast food as being unhealthy. Guatemalan children, in contrast, were more likely to depict hygiene and the environment as both healthy and unhealthy. Conclusion: There are more cross-cultural similarities than differences in children's perceptions of health. While similarities derive from the centrality of food in perceptions of health, differences in perceptions of health emerge from unique national health conditions and initiatives, local socio-ecological contexts and school curricula.