Simple SummaryCows are sentient beings whose welfare depends on their physical health and how they perceive their living conditions. One scientific approach to this emotional realm is the method of qualitative behavior assessment (QBA) which relies on the animals’ body language expressing their affective state. In the present study we were interested whether important health impairments of dairy cows—udder infections and metabolic imbalances—and external aspects including housing, management, and human-animal contact might be associated with the qualitative behavior of the herds. For this purpose, QBA was carried out on 25 dairy farms. Farm data were recorded via interviews and observations, and health data retrieved from official milk recording reports. We found no associations between the included herd health indicators and QBA. However, herds on farms with deep bedded cubicles or straw yards expressed a more positive emotional state compared to farms with raised cubicles. Additionally, on farms with more voluntary stockperson-cow contacts and restraint of cows during main feeding times, possibly reducing competition, more positive QBA scores were found. These results underline that improved housing conditions and more intensive animal care are related to the emotional aspect of animal welfare.The affective state is an integrated aspect of farm animal welfare, which is understood as the animals’ perception of their living environment and of their internal biological functioning. The aim of this cross-sectional study was to explore animal-internal and external factors potentially influencing dairy cows’ affective state. For this purpose, qualitative behavior assessments (QBA) describing the animals’ body language were applied at herd level on 25 dairy farms. By means of principal component analysis (PCA), scores of PC1 (QBAscores) were determined for further analyses. From monthly milk recordings (MR) one year retrospectively, prevalences of udder and metabolic health impairments were calculated. Factors of housing, management, and human-animal contact were recorded via interviews and observations. A multivariable regression was calculated following a univariable preselection of factors. No associations were found between MR indicators and QBAscores. However, more positive QBAscores were associated with bedded cubicles or straw yards compared to raised cubicles, increased voluntary stockperson contact with the cows, and fixation of cows during main feeding times, the latter contributing to the explanatory model, but not being significant. These results underline the importance of lying comfort, positive human-animal relationship and reduction of competition during feeding for the well-being of dairy cows.