With the aim to identify European health and welfare strategies in organic pig production, we summarized information about health and welfare status and potential hazards for organic fattening pigs. The results were primarily based on studies of organic production or comparisons between organic and conventional production. Conventional Danish herds consumed three times as much antibiotics (anthelmintics not included) as the organic herds, whilst there was no difference in mortality rate nor more pigs in need of treatment in the organic herds. Slaughter data indicated that organic pigs had fewer respiratory problems, skin lesions (including abscesses and hernias) and tail wounds compared to conventional pigs. On the other hand, remarks because of joint lesions and white spot livers were more common among organic pigs. The risk of parasitic infections in organic fattening pigs has been confirmed. To control endoparasites, outdoor areas should be rotated with as long interval as possible, i.e. by including the pigs in the crop rotation. Outdoor housing with functional wallows and access to grass and roots or outdoor runs and roughage can enhance pig welfare and reduce pen-mate-directed oral activity and aggression. Minimizing negative environmental impact may conflict with animal welfare, i.e. raising the pigs indoors may not only reduce plant nutrient losses but also reduce the pigs’ activity options. With an increasing number of specialized organic units, implementation of age-segregated production and buying piglets from only one or few units is necessary to maintain a good health in transferred pigs.