Hawaii is the healthiest state in the country, claiming the top spot for two years straight in America’s Health Rankings, released annually by United Health Foundation.

"I’m elated that we have gotten the highest ranking in the nation for the second year in a row," said Keith Yamamoto, acting director of the state Department of Health. "We do think it’s a reflection of our community and their commitment to healthy lifestyles and environmental protection."

The national snapshot of health, released Wednesday, compares states on community indicators, policy, behaviors, clinical care and outcomes. It shows Hawaii excelling on a range of factors, from low rates of smoking and physical inactivity to the state’s strong commitment to public health and medical coverage.

"This is encouraging news and I look forward to working with our public health and health care communities to ensure access to care and strengthen prevention efforts to reduce chronic disease and injury in our state," Gov. David Ige said in a statement. "I’m proud to say that Hawaii is the healthiest state in the nation, and we must continue to invest in our public health efforts."

This is the 25th edition of the annual report, which relies on data from the Centers for Disease Control and Prevention, American Medical Association, the Census Bureau and other reputable sources. It is published by United Health Foundation, based in Minnetonka, Minn., in partnership with American Public Health Association and Partnership for Prevention.

Hawaii has never placed below sixth among the 50 states in the rankings. Recently, the Aloha State climbed from third in 2011 to second in 2012 to first place last year. Vermont placed second this year, followed by Massachusetts. The least-healthy state in the nation this year is Mississippi.

This anniversary report noted that Americans have made some strides in health care since 1990, with average life expectancy at a record high of 78.8 years. It pointed to reduced infant mortality, cardiovascular death and smoking over the past quarter-century. Meanwhile, chronic conditions such as obesity and diabetes have more than doubled nationally.

"There are 30 different measures, so it’s a very holistic view of how we rank as the healthiest state," said Ron Fujimoto, chief medical officer of UnitedHealthcare Community Plan of Hawaii. He credited the state’s robust health care system, both public and private, its low rate of uninsured, and residents’ active lifestyles due in part to weather.

"We are very, very lucky to be in Hawaii where we have the Hawaii Prepaid Health Act, which creates a very low uninsured rate and allows our people access to quality health care," he said.

Among the bright spots in the 2014 report is the fact that fewer people here are smoking, at 13.3 percent of adults, down from 16.8 percent two years ago. The 50th state also has the second lowest rate of obesity in the nation, at 21.8 percent of adults, compared with 29 percent nationally.

Aloha State residents also reported fewer "poor mental health days" in the previous month than their counterparts elsewhere in the country, placing second in that category nationally. Hawaii was also second nationally in terms of dollars spent per person on public health, on its insured rate, and on its cancer death rate.

Binge drinking remains relatively prevalent, but the rate has fallen to 18.3 percent of adults from 21.5 percent two years ago.

"We’ve done work regarding underage drinking, which is directly related to consumption as a whole," Yamamoto said. "People who binge drink tend to be younger adults. We are hoping that some of our prevention and education efforts have had some impact."

He also noted that while the state as a whole is doing well, there are disparities among certain populations.

"If you look at some of the smaller populations, we may not have good outcomes, Native Hawaiians in particular, and our rural communities don’t have access," Yamamoto said. "We still have a lot of work to do."

On the minus side, the report noted that Hawaii has a high incidence of infectious diseases, including chlamydia and salmonella. And there has been a dramatic drop in the rate of immunization among toddlers.

Hawaii plunged from a No. 1 ranking on that indicator in last year’s report to 40th place this year. In the 2013 report, 80 percent of children aged 19 months to 35 months in the state were vaccinated. In the 2014 report, the rate was 66.5 percent.

The reason for the change wasn’t clear, but Fujimoto stressed that parents should not miss immunizing their keiki.

"Many parents have a myth or a belief that immunization causes all kinds of problems, which has never been proven," he said. "This is a good opportunity to remind everyone about the public health importance of immunizations. One of the biggest improvements in health care outcomes, besides washing your hands, has been immunizations."

For full details, visit americashealthrankings.org

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