Hawaii claimed its spot as the healthiest state in the nation for the third year in a row in America’s Health Rankings, released Wednesday by the United Health Foundation.

“Hawaii’s top ranking as the healthiest state in the nation once again this year is very encouraging and reminds us of how fortunate we are to live in the Aloha State,” Gov. David Ige said in a statement.

In the past 26 years, Hawaii consistently has ranked among the top six healthiest states in the nation with few poor mental health days, low prevalence of obesity and a low rate of preventable hospitalizations.

However, the islands still face a number of challenges that include a high prevalence of excessive drinking, high incidence of salmonella and low immunization among adolescents for tetanus, diphtheria and pertussis.

“Even with this ranking, we cannot afford to be complacent and we must continue to invest in our public health efforts to ensure access to care and strengthen prevention measures,” Ige said.

The annual ranking found that 14.1 percent of locals smoke, compared with 18.1 percent nationally, while 1 in 5 adults in Hawaii — 19.6 percent — are physically inactive compared with 22.6 percent. In addition, 22.1 percent of island adults are obese, compared with 29.6 percent nationally; while 9.8 percent have diabetes versus 10 percent.

“For the last 26 years, the America’s Health Rankings annual report has provided a comprehensive picture of the challenges and opportunities facing Hawaii’s health, and where we stand against our peer states and the nation at large,” said Ron Fujimoto, chief medical officer of UnitedHealthcare. “We look forward to using this year’s report to continue identifying best practices that address Hawaii’s most pressing health challenges and encourage our residents to lead the healthiest lives possible.”

Dr. Virginia Pressler, director of the state Department of Health, added that while Hawaii ranks No. 1, there is a disparity in chronic diseases among different ethnic groups within the community.

“We need to remember that we are being compared to a nation that has been transformed over the last three decades with rising obesity and chronic disease rates,” she said. “We need to diligently increase collaboration that will achieve optimal health equity for all people in Hawaii.”