This review provides an assessment of research findings into the current practices and standards and the principles and aspirations for organic dairy production, with respect to the health and welfare of the dairy cow. The relationships between the four main factors: management, environment, genetics and nutrition and their impact on the health and welfare status of organic dairy cows are considered. The concept that good animal health and welfare is more than merely the absence of disease, with behavioural aspects of health and welfare such as physiological and psychological needs, is also discussed. These factors are inter-related and important in all dairy systems, irrespective of whether the system is organic, low-input or intensive. Incidences of individual clinical and sub-clinical diseases that are recorded in conventional dairy systems also occur in organic dairy systems, with infertility, lameness and mastitis being the major problems. However, the magnitude of the incidence of many of these diseases may be either lower or higher in organic systems due to different management practices and the standards defined for organic milk production that, for example, prohibit the routine use of conventional medicines and require the feeding of high-forage diets. In relation to different systems, it is important to note that contrary to a common assumption, good welfare does not necessarily occur with more extensive systems. The type of organic system (self-sufficient, purchased-feed) also has the potential to have a major influence on the incidence of health problems and the reproductive status of organic dairy herds. Health status is also influenced by environmental and welfare factors, including the method of rearing replacement animals, type of housing and the geographical and climatic conditions of individual farms. Overall, this review identifies where conflicts arise between current practice and the organic principles and standards, and aims to provide suggestions to bring about further improvement in organic dairy health and welfare.