Last year's healthiest state has been dethroned by a newcomer.

By Aric Jenkins
December 13, 2017
Photo By BSIP/UIG Via Getty Images

The 50 states of the U.S. might be united, but they differ vastly when it comes to health, according to a new report.

Massachusetts, Hawaii, Vermont, Utah and Connecticut rank as the five healthiest states in the country, while Mississippi, Louisiana, Arkansas, Alabama and West Virginia have been deemed the least healthy, according to the 2017 edition of America’s Health Rankings, conducted by the United Health Foundation.

The rankings are based on a number of factors, including rates of smoking, obesity, infant mortality and infectious diseases, in addition to the availability of health care providers and levels of air pollution.

This year marks the first that Massachusetts has held the distinction as the healthiest state in America. The top ranking previously went to Hawaii in recent years.

West Virginia, on the other hand, crept into the worst five after replacing Oklahoma, which now ranks as No. 43. In the bottom five, Mississippi and Louisiana in particular have major health challenges, such as high levels of smoking, obesity and children in poverty, according to the study.

There have been success stories, though. Florida (No. 32) and Utah (No. 4) made the biggest improvements with an increase of four spots each. Issues continue to plague the country nationally, however, such as infant mortality and low birth weight. Premature death, defined as deaths before the age of 75, in addition to cardiovascular and drug deaths are on the rise as well.

“This year, the report reveals that the nation is facing serious public health challenges, including rising rates of premature death and an uneven concentration of key health care providers,” the report reads.

United Health Foundation says it releases its annual report in order to help local, state and national policy-makers, public health officials and researchers improve health care.

This story originally appeared on Travel + Leisure.

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