Background: Stable staff and trainers are essential to racing yards and horse welfare, yet limited research focuses on this vital workforce that the thoroughbred industry heavily relies on. This systematic narrative review synthesizes existing literature on the occupational health and well-being of stable staff and trainers in the thoroughbred horse racing industry. Methods: A systematic narrative review was conducted across PubMed, Google Scholar, and Scopus using relevant keywords. Manuscripts reporting occupational or mental health data on stable staff and/or trainers and had the full-text available were synthesized narratively in line with PRISMA guidelines. Findings: Of 2,456 studies screened, 21 met eligibility criteria. In the past year, 43% of staff experienced an injury, with 18% requiring medical attention. Mental health concerns were prevalent, with 65% of injured staff experiencing anxiety, 60% depression, and up to 80% of UK stable staff and trainers reporting stress linked to financial pressures and limited support. Poor sleep contributed to self-reported daytime dysfunction and psychological distress. Substance misuse was notable, with 34% needing treatment for alcohol and 14% for drug misuse. The staffing crisis was influenced by occupational illnesses, poor working conditions, inexperienced staff, and limited career progression. Conclusions/Application to Practice: Occupational health challenges highlight the need for interventions to improve mental health support, workplace safety, and working conditions. Industry governing bodies and racing authorities should implement frameworks and standards that ensure safe, supportive, and sustainable work environments. Racing yards should prioritize career progression and educational programs to safeguard the well-being and longevity of this workforce.