The world population is expected to grow to about 10 billion in 2050. To supply the future human population with food while sustaining a liveable planet, food should be produced sustainably. One of the most urgent environmental issues is climate change, induced by greenhouse gas (GHG) emissions. The dairy sector is a large contributor to GHG emissions. Important GHGs related to milk production are carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O), mainly emitted during feed production, enteric fermentation, and manure management. Diseases in dairy cows can reduce milk production, reproduction performance and longevity, and increase the amount of discarded milk. The objectives of this thesis were to estimate the impact of diseases (subclinical ketosis, clinical mastitis, and foot lesions) on GHG emissions, and to understand the relation between impact of diseases on GHG emissions and economic performance. First, a dynamic stochastic simulation model was developed to simulate the dynamics of the diseases and the associated production losses (reduced milk production, discarded milk, a prolonged calving interval, and removal (culling or dying on the farm)) per cow during one lactation. This model was combined with a life cycle assessment to quantify the impact of diseases on GHG emissions per ton fat-and-protein-corrected milk (kg CO2equivalents/t FPCM) from cradle to farm gate. Processes included were feed production, enteric fermentation, and manure management. The emissions of GHGs of cows with a disease increased on average by 21 (2.3%) kg CO2e/t FPCM per case of subclinical ketosis, by 58 (6.2%) kg CO2e/t FPCM per case of clinical mastitis, by 4 (0.4%) kg CO2e/ t FPCM per case of digital dermatitis, by 39 (4.3%) kg CO2e/ t FPCM per case of white line disease, and by 33 (3.6%) kg CO2e/ t FPCM per case of sole ulcer. An economic analyses was performed to estimate the costs of subclinical ketosis and related diseases. The total costs of subclinical ketosis were €130 per case per year. Comparing the impact of production contributors from a GHG emissions and economic perspective showed that a reduction in milk production had the highest impact on the economic performance, whereas removal and discarded milk had the highest impact on increase in GHG emissions. Prevalence, pathogen type, farm management (e.g. culling, feed, and manure), and prices (e.g. milk and feed) will affect the impact of production contributors on GHG emissions and economic performance. Therefore, specific farm analyses are needed to estimate the impact of diseases for a specific dairy farm. Diseases in dairy cows increase GHG emissions by approximately 0.4 Mton per year, which equals 15% of the Dutch governmental goal of GHG emission reductions in agriculture in 2030. Reducing diseases can decrease GHG emissions, can increase the income of the farmer, and can improve animal welfare. Therefore, reducing diseases can contribute to sustainable development of the dairy sector.