Vermont takes the top spot as healthiest state. (Image credit: Getty Images/America 24-7)

Reported by Dr. Amish Patel:

The annual America's Health Rankings list is out, pitting U.S. states against each other in a no-holds-barred contest of health. So, how did your state fare?

For the fourth year in a row, Vermont takes the top spot as healthiest state. Applauding the state's high rate of high school graduation and low rate of uninsured population, the report also finds that Vermont is not without its problems. Vermonters have a relatively high rate of cancer deaths and participate in binge drinking more than most states (Wisconsiners binge drink the most, Tennesseans the least). Vermont is in good company in the northeast with seven states from the region making it into the top 10.

Second place goes to Hawaii, a regular contender for first place. Since the ranking started in 1990, Hawaii has consistently ranked in the top six states. Hawaiians enjoy low rates of obesity and smoking, but have high rates of binge drinking and low birth weight babies.

Louisiana and Mississippi are tied for the least healthy state and have consistently been at the bottom of the list for the past 23 years. Both states have low rates of binge drinking, but suffer from high rates of occupational fatalities and children in poverty. These two states are in the bottom five in about half of the 24 components that make up the overall ranking, including high rates of chronic conditions like sedentary lifestyle, obesity and diabetes.

These chronic conditions are also putting the entire nation's health most at risk. Obesity alone is the leading cause of preventable death and costs our nation about $200 billion each year. More than 66 million adults are obese - that's more than one in four Americans. Colorado is the least obese and least sedentary state, in contrast to Mississippi which is the most obese and most sedentary.

"It is important to note that we are living longer, but not necessarily better," says Jane Pennington, spokesperson from the United Health Foundation, the group responsible for the report. "Despite improvements, we still have unhealthy behavior that threatens our health status. It continues to be disappointing that we are seeing a rise in chronic illness. It doesn't have to be that way. That is the alarm that we want to sound."

Although smoking in the U.S. has been decreasing recently, more than 45 million Americans still smoke, according to the U.S. Centers for Disease Control and Prevention. Utah has the lowest percent of its population smoking and Kentucky has the highest.

"People should care about this report," says Dr. Anthony Shih, executive vice president for Programs at the Commonwealth Fund. "It is clear that where you live matters in terms of overall health and it should motivate action to improve."

States should be looking at their healthier neighbors for ways to improve.

"The relatively high performance of [fourth-ranked] Massachusetts - where a law similar to the Affordable Care Act was enacted in 2006 - may hopefully motivate other states to participate in Medicaid expansion and more aggressively implement the ACA within their own state. Successful implementation will likely raise the performance of most states," according to Shih.

By having programs and policies that support better health, states can expect better rankings. If a state increases the tax on cigarettes or bans smoking in public places, for example, the number of smokers in that state should decrease, cutting deaths from cardiovascular disease and cancer deaths.

The statistics show that states can improve their ranking. Vermont was ranked 20 th in 1990, but steadily made improvements over the years to get where it is now.