For the third year in a row, Hawaii is the healthiest state, according to a private-sector ranking.

Three New England states — Vermont, Massachusetts and Connecticut, in that order — followed, with Utah ranking fifth, according to the latest edition of America’s Health Rankings, an annual look at state-by-state health that has been conducted for 25 years in a partnership among the United Health Foundation, American Public Health Association, and Partnership for Prevention.

Hawaii has ranked among the top six states since the rankings began in 1990, thanks to low smoking, obesity, child poverty and preventable hospitalization rates, among other successes. Its ongoing challenges include high rates of binge drinking and salmonella infections. It also dropped from first to 40th on child immunizations in the last year.

Mississippi, which has relatively low binge drinking rates and high child immunization rates, ranked dead last for the third straight year and has ranked among the bottom three each year the rankings have been calculated. It ranks among the bottom five states in 16 of the 27 health measures used to calculate the overall rankings. Arkansas, Louisiana, Kentucky, and Oklahoma all ranked among the bottom five as well.

The overall health rankings are derived from 27 variables mostly tracked by the federal government covering behavior, disease rates, socioeconomic status, policy and community health. Each annual ranking compares state to each other for that year. As a result, the rankings track only relative progress over time (e.g. a state can rise in rank relative to its peers even as the nation’s overall health overall declines).

New York has most improved since 1990

States in the Northeast and Northwest of the country were most improved since 1990, when the rankings were first conducted, with New York leading them by jumping from 40th to 14th place. Vermont was the second most-improved state, rising from 20th to second place.

Iowa fell from sixth to 24th, the biggest decline among states. Wisconsin fell from seventh to 23rd.

Improvement over time

While the rankings don’t show overall progress over time, there is a rough but imperfect proxy that may, according to the report:

The measure of premature death, defined as the number of years not lived by people who die before age 75, can be used to examine our nation’s health over the last 25 years as that measure strongly correlates with the final outcome score (r=0.92) of the Rankings. While premature death is a good proxy for the nation’s health, it does not reflect quality of life.

The premature death rate has fallen 20 percent over the past quarter century:

This improvement means an increase in years of productive life in the population. While premature death has decreased nationally, improvement differs greatly by state. In New York, in the last 25 years premature death improved 41%, from 9,754 to 5,737 years of potential life lost [before age 75 per 100,000 people], whereas in Oklahoma premature deaths worsened 13%, from 8,551 to 9,654 years of potential life lost.

The nation has seen other major improvements since 1990: infant mortality fell 41 percent, cardiovascular deaths fell 38 percent and the number of adults who smoke regularly dropped 36 percent.

In the last year, the smoking rate fell 3 percent, infant mortality fell 4 percent, and immunization coverage among adolescents rose 5 percent. Obesity and drug deaths each rose 7 percent, and physical inactivity increased 3 percent.

The obesity epidemic

One of the nation’s most pernicious problems has been the virtually constant rise in obesity. Since 1990, the rate has risen 153 percent (from 11.6 percent to 29.4 percent of all adults).

In all but eight states — Colorado, Hawaii, Massachusetts, California, Utah, Montana, Vermont and Connecticut — more than a fourth of people are now obese. (Colorado has the lowest rate, of 21.3 percent. West Virginia’s rate of 35.1 percent is highest.)

As the graphic below, made from slides in a Centers for Disease Control and Prevention PowerPoint file, shows, the national rise in obesity has been quick and broad-based. The graphic shows obesity rates from 1985 through 2010. The methodology was changed in 2011, and the CDC discourages comparing rates since then to historical rates.