The aim of the study was to propose direct breeding for health in the local population of Holstein cattle. The existing SIH selection index was expanded to include resistance traits to udder and hoof diseases. The calculation considered the current production, genetic and economic parameters of the breed. Positive (i.e. desirable) correlations were found between the health traits (on average 28%). The occurrence of clinical mastitis and overall claw diseases and disorders resulted in a direct loss to the breeder of -3245 CZK and -3166 CZK per cow and year. The current setting of the SIH index has an indirect positive effect on animal health (stabilisation, possible slight decrease in the occurrence of diseases and disorders). Direct inclusion of health in breeding would result in a slight decrease in both diseases while maintaining the selection response for other breeding goal traits and a slight decrease in selection reliability (by 2 percentage points). Direct health traits should contribute 5% to the SIH index.