NEW YORK, NY — Hawaii is the healthiest state in America, according to the 29th annual report from the United Health Foundation. The report, “America’s Health Rankings,” was published Thursday and looks at 35 health markers that seek to evaluate how healthy a state really is. This includes indicators involving behaviors, community and environment, policy, clinical care and health outcomes.

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Hawaii ranked in the top 10 in all five categories and top five in four of them.

“Hawaii regains the title of healthiest state this year, after dropping to No. 2 in 2017,” the report said. “This is Hawaii’s ninth year in the No. 1 spot since 1990 when the health rankings were first published. The state has been No. 1 four of the past five years.”

The state also has a low prevalence of smoking at 12.8 percent and benefits from lower levels of air pollution compared to the rest of the country. Hawaiians also have a low prevalence of obesity at 23.8 percent for adults, even as the national rate climbed to more than 30 percent for the first time.

“Obesity continues to be a leading cause of cardiovascular disease and cancer — chronic diseases that are contributing to premature death rates,” the report said.

Overall, the healthiest states were located in the Northeast, though a few were in the Midwest and West.

Here are the top 10 healthiest states:

Meanwhile, the least healthy states were located in the South, with the notable exceptions of Indiana (No. 41) and Ohio (No. 40). Louisiana ranked dead last in the country, surplanting Mississippi for the dubious honor. Louisiana, which ranked last in both behaviors and community and environment, had the highest prevalence of children in poverty at 28 percent — the national average is 18.4 percent — and a high prevalence of adult smokers at 18.4 percent.

Furthermore, 36.2 percent of Louisianans are obese compared to 31.3 percent nationwide. The researchers noted the state has the “greatest opportunity for improvement,” but it won’t be easy — there’s a large health gap even between 50th ranked Louisiana and the 48th ranked state, Alabama.

Mississippi, Oklahoma and Arkansas rounded out the bottom five.

The United Health Foundation is a not-for-profit, private foundation dedicated to improving health and health care. The rankings built upon the World Health Organization’s definition that health is a state of “complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

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