The milk production of dairy cows has been increased during recent decades through animal-husbandry, improved feeding regime, extensive veterinary service and proper management. It can be assumed that this tendency will be continued in the future. However, the incidence of diseases (production diseases), including ketosis, fat liver, mastitis, lameness, metritis and disturbed fertility, has also increased and exhibits a close genetic correlation with milk yield. The pathogenesis of these diseases is - more or less - causally related to the negative energy balance and hence, is a consequence of selection for high milk yield. The genetic disposition and health risks are modulated by the management of dairy cows and both factors contribute to the large variation of diseases in practice. An analysis of production diseases must therefore distinguish between the genetic disposition (cause) and the management (effect). An effective improvement of the complex of production diseases includes the critical discussion of the current breeding index for dairy cows.