Editor's note: This story has been updated to reflect where Massachusetts ranked on this year's list.

Vermont is the healthiest state in the country, according to the United Health Foundation's (UHF) latest America's Health Rankings report.

UHF is one of UnitedHealth Group's philanthropic foundations. Daily Briefing is published by Advisory Board, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group.

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Methodology

UHF for its 2019 America's Health Rankings report considered 35 health care measures that account for:

• Behaviors, including alcohol misuse, drug overdose deaths, and physical inactivity;
• Clinical care, including preventable hospitalizations among Medicare beneficiaries, the number of primary care physicians, and the number of dentists;
• Community and environment, including air pollution, childhood poverty levels, and infectious disease cases;
• Policies, including those related to immunizations and public health funding; and
• Outcomes, including cardiovascular deaths, cancer deaths, and health disparities.

The report is based on data from CDC, the U.S. Census Bureau, and other federal agencies.

State rankings

The report ranked Vermont as the healthiest state in the country, unseating Hawaii, which ranked as the healthiest state in 2018's rankings and for five consecutive years until 2017, when Massachusetts was named the healthiest state.

According to the 2019 report, after Vermont, the next healthiest states are:

2. Massachusetts;
3. Hawaii;
4. Connecticut; and
5. Utah.

According to the rankings, the five least healthy states in the United States are:

50. Mississippi;
49. Louisiana;
48. Arkansas;
47. Alabama; and
46. Oklahoma.

The states ranked, from healthiest to least healthy

The report stated that Vermont's No. 1 ranking is mostly attributed to a low violent crime rate, low percentage of uninsured individuals, and low incidence of chlamydia. Mississippi, the lowest ranking state, on the other hand struggled with high infant mortality and cardiovascular death rates.

Alaska, Virginia, and Wyoming experienced the largest improvement in their overall ranking, with all three states jumping five spots, according to the report. Maine saw the largest decline, falling five places to 21st.

Nationwide trends

The report found improvements in the national smoking rate, which decreased 6% in the last year and 45% since the UHF's first report in 1990. Infant mortality also decreased by 2% in the past year.

But premature deaths have continued to present a significant challenge for the country, according to the report. The United States' premature death rate increased for the fifth straight year, largely due to deaths from suicide and drug-related overdose deaths. According to the report, the drug death rate has increased 37% since 2016, indicating that there have been more than 53,000 additional deaths due to drugs over the last three years. Suicide deaths also increased 4% in the last year from 13.9 to 14.5 deaths per 100,000.

The country also has experienced a steady increase in levels of obesity and diabetes. Since the first report in 1990, obesity has increased 166% and diabetes has increased 148% ("America's Health Rankings," United Health Foundation, December 2019).