Kealakekua Bay, Hawaii (Photo by Flickr user Karol Franks via Creative Commons License)

For the fourth year in a row, Hawaii ranks as the healthiest state in the country, according to a new report. Seen here: Kealakekua Bay, Hawaii. (Photo by Flickr user Karol Franks via Creative Commons License)

For the fourth year in a row, Hawaii ranks as the healthiest state in the country, according to a new report.

“Somehow, in Hawaii, individuals are certainly more prepared and prone to enhance their health,” said Dr. Reed Tuckson, a senior medical adviser to United Health Foundation, which produced the report. “They have a favorable environment that people care a lot about and that environment supports healthy behaviors.”

On average, people in the Aloha state tend to weigh less and smoke less, while also being more physically active. There are low rates of preventable hospitalizations, and fewer people in the balmy state take poor mental health days.That’s not to say Hawaii doesn’t face challenges. It does, including a high incidence of excessive drinking.

healthy_map_fixedThe other healthiest states include Vermont (2), Massachusetts (3), Minnesota (4) and New Hampshire (5).

North Carolina was the most improved state, having moved up to 31st place from 37th in 2014.

The state’s rise in the health rankings was thanks in part to an improved immunization rate among children and an increase in physical activity.

The unhealthiest state in the nation is Louisiana which, at 50th, came in last place. The state is grappling with high smoking, obesity and infant mortality rates, while many of the state’s children live in poverty.

Mississippi, which was at the bottom last year, moved up one spot to 49th. Arkansas (48), West Virginia (47) and Alabama (46) round out the bottom five.

The states in the bottom five have a number of things in common, including high poverty rates and lower levels of higher education, which suggests there’s a notable socioeconomic component to overall health.

Garden District in New Orleans, Louisiana. (Photo by Flickr user Wally Gobetz via Creative Commons License)

Garden District in New Orleans, Louisiana. (Photo by Flickr user Wally Gobetz via Creative Commons License)

“Perhaps individuals who are poor, who have not as much hope for the possibilities of a meaningful future, people who are in despair, may make often inappropriate health decisions,” Tuckson said. “It may mean that in those states there are less resources to help overcome those problems and to create a supportive environment that helps people act in their own best interests.”

The United Health Foundation puts out a report each year, with the purpose of sparking dialogue that will eventually lead to change, initiated by elected and regulatory officials, community members and organizations, the health care system and individuals.

“We certainly cannot have any notion of a mature democratic civilization if we are prepared to let our babies die unnecessarily, if we are prepared to tolerate preventable misery and suffering among our friends and neighbors,” Tuckson said.