Hawaii’s health standing improved over the past year with the islands moving up a notch to No. 4 in a national ranking.

The 2011 America’s Health Rankings, released today by United Health Foundation, a not-for-profit, private foundation, placed Hawaii among the top five states for overall health because of its low rate of uninsured people, preventable hospitalizations and the highest public health funding per person.

The islands also had low levels of air pollution as well as lower prevalence of obesity and diabetes compared with other states.

Still, the state’s downfalls were its low number of immunization, widespread binge drinking and low high school graduation rate — all considered social determinants of health. Other challenges Hawaii faces include low use of early prenatal care and high geographic disparity within the islands.

"Hawaii’s improved ranking is a positive reflection of the overall health of our residents, but there are still many areas where we need to continue to work together to help people make healthier choices, break down the barriers to quality care and create positive health changes in the community," said David Heywood, vice president of insurance carrier UnitedHealthcare, in a statement.

Highlights of the Hawaii portion of the survey include:

» Smoking among adults declined to 14.5 percent in 2011 from 19.7 percent in 2001. However, 153,000 adults still smoke.

» The preventable-hospitalization rate dropped to 25.6 from 28.6 per 1,000 Medicare enrollees through the past year.

» Obesity in adults has grown to 23.1 percent from 19.7 percent in the past five years, with 244,000 obese adults living in Hawaii.

» The number of adults with diabetes has risen to 8.3 percent from 7.3 percent in the past five years.

» The percentage of poor children under age 18 jumped to 18.9 percent from 10 percent in the past five years.

The report also found major health disparities in Hawaii, based on race and ethnicity. For instance, the prevalence of obesity is significantly higher among Hawaiian or Pacific Islanders at 56.8 percent compared with whites at 19.3 percent. In addition, 10.1 percent of Hawaiian or Pacific Islanders are afflicted with diabetes compared with whites at 4.7 percent and Asians at 9.6 percent.

Vermont held its No. 1 spot on the list for the fifth consecutive year, followed by New Hampshire, Connecticut, Hawaii and Massachusetts. The bottom five states were Mississippi, Louisiana, Oklahoma, Arkansas and Alabama.

The report concluded there was no improvement in the nation’s overall health between 2010 and 2011.

Nationally, soaring obesity and diabetes rates and children in poverty are "offsetting improvements" in smoking cessation, premature deaths, preventable hospitalizations and cardiovascular deaths, the foundation said in a statement.

"Hawaii’s high ranking in the top five states is a positive sign. However, obesity trends, immunization rates and alcohol use cited in the report are serious areas of concern," said state Health Director Loretta Fuddy. "The state’s current focus on social determinants such as early childhood education, access to nutrition and physical activities and other societal issues are the best long-term approach to reversing troubling trends and creating healthier communities and islands."

Go to www.americashealthrankings.org/HI for more information.