In pig production, the widespread conventional indoor system with a slatted floor currently dominates. However, this production system is becoming less socially acceptable. In addition to general environmental protection issues, animal welfare, the absence of suffering and distress, and the management of pain also constitute societal concerns. In this context, alternative production systems are gaining ground. Although they are popular with consumers and other citizens, these alternative systems have their critical points. Here, we reviewed the international scientific literature to establish the state of the art of current knowledge regarding welfare, biosecurity, animal health and pork safety in this type of farming system. In general, alternative farms give pigs the opportunity to express a broader range of behaviours than conventional farms. However, the management of feeding, watering, temperature and predators is often more complicated in these outdoor systems. In addition, biosecurity measures seem to be applied less strictly in alternative farms than in conventional farms, especially in free-range systems, where they are more difficult to implement. On the other hand, pigs kept in these farming systems seem to be less affected by respiratory diseases, but parasitism and piglet crushing (in farrowing units) both remain a real challenge. Furthermore, the higher prevalence of many zoonotic pathogens in these farms may represent a risk for human health.