Louisiana has displaced Mississippi as the unhealthiest U.S. state and other Southern states were close rivals due to high obesity and smoking rates in new rankings that deemed Vermont the healthiest.
The overall health of Americans remained static for a fourth year, according to an annual report issued on Wednesday assessing a series of measures also including binge drinking, health insurance coverage, air pollution, infectious disease rates, crime levels and immunization coverage.
Many Southern states were clustered near the bottom of the rankings. The region has some of the highest rates of obesity, which contributes to heart disease, stroke, diabetes and some types of cancer, as well as high rates of smoking, which causes cancer, lung disease, heart disease and other problems.
One in five Louisianians lacked health insurance, while 31% were obese. It also suffers from high child poverty, infant mortality, premature death rate and cancer deaths, according to the report.
"We've just not made any improvement in the overall healthiness of the nation," said Dr. Reed Tuckson of UnitedHealth Group Inc, the largest U.S. health insurer, and the private United Health Foundation.
The foundation, American Public Health Association and the Partnership for Prevention advocacy group put together the 19th annual state-by-state rankings.
It was the second straight year that Vermont topped the rankings. It was followed by Hawaii, New Hampshire, Minnesota, Utah, Massachusetts, Connecticut, Idaho and Maine.
Louisiana fell from 49th to 50th, replacing Mississippi. Rounding out the bottom 10 were South Carolina, Tennessee, Texas, Florida, Oklahoma, Arkansas, Nevada and Georgia.
California, the most populous state, ranked 24th and New York 25th.
Vermont, with the second smallest population of any state, had the third-highest public health spending and an obesity rate of 22%, four points below the national average.
It also had low child poverty and violent crime, a large number of doctors per capita and good high school graduation rates.
Hawaii had similarly low obesity, the highest public health spending, little air pollution, low rates of uninsured people, a low rate of preventable hospitalizations and low rates of death from cancer and cardiovascular disease.
Mississippi led the nation in obesity at 33% of the population, while Colorado was lowest at 19%.
The United States trails many other industrialized nations in infant mortality, life expectancy, mortality for treatable conditions and overall health care system performance.