Group housing of sows during gestation is mandatory in the EU since 2013. Compared to housing in individual crates, group housing allows the animals to express normal activity and behavior. The present paper discusses the impact of group housing on health, with emphasis on lameness, aggression and possible spread of infectious diseases. The prevalence of lameness is generally higher in sows housed in group than in sows housed individually. Floor space per sow, group size, pen design and flooring are the main factors of group housing involved in lameness development. Especially floor characteristics are important, and particular attention should be paid to the type, building material and quality of the floor, hygiene and the use of bedding such as straw or rubber mats. Aggression between sows is another critical issue in group housing systems. It occurs predominantly because of competition for access to a limited resource, or to establish a social hierarchy. Key factors to prevent aggression in group housing include gradual familiarization of unfamiliar animals, sufficient space and pen structure during initial mixing, minimizing opportunities for dominant sows to steal food from subordinates, provision of a good quality floor, environmental enrichment and use of straw bedding. Very scarce evidence-based information is available on the relationship between group housing and infectious disease. Compared to individual housing, sows in group housing have more nose-to-nose contact, and they have more oral contact with feces and urine. These factors could contribute to a higher or faster transmission of pathogens, but so far, there is no evidence showing more disease problems in group housing systems. In conclusion, in group housing systems, particular attention should be paid to prevention of lameness and aggression. Management is crucial but also feeding strategies, floor and bedding, and design of housing are very important as relatively minor adjustments may exert major effects on the animals.