This review investigates genetic strategies aimed at improving robustness in pigs to enhance disease resistance and reduce reliance on antibiotics. Robustness refers to a pig’s ability to stay healthy and productive under stressful or challenging conditions. The review outlines current breeding practices focused on key traits such as maternal ability, growth, immune function, and survival, and highlights that these robustness-related traits show measurable heritability, making them suitable for genetic improvement. Special attention is given to resistance against porcine reproductive and respiratory syndrome (PRRS), a major disease in swine. We also evaluate breed-specific differences, environmental influences, and immune response profiles, emphasizing their impact on breeding outcomes. The development of robust pig lines emerges as a sustainable strategy to reduce antibiotic dependence and enhance herd health. A distinctive contribution of this work is the integration of genetic robustness and resilience strategies with antibiotic stewardship objectives. We link genomic selection, advanced phenotyping, and targeted management interventions within a One Health framework to outline actionable, system-level pathways for reducing antimicrobial inputs. To our knowledge, this combined genetic and public health perspective has not been comprehensively addressed previously.