Hawaii is the healthiest state in the nation for the fifth year in a row, according to the United Health Foundation’s 2016 report.

The ranking, released Wednesday, rated Hawaii favorably against other states in its 27th annual comparison of 34 measures which the foundation said is meant to provide a “road map for states, local communities and the public health sector to work together” to address coming challenges.

The state Department of Health said Hawaii has remained among the top five healthiest states in the foundation’s report since 2003. Since the report’s inception, DOH said Hawaii’s rank has varied from first to sixth place. Hawaii’s 2016 rank did not change from 2015, and it beat other top-scoring states such as Massachusetts, Connecticut, Minnesota and Vermont.

Hawaii scored better than the national average. Fewer people were obese; more were insured; smoking rates were lower; and there were fewer drug, cardiovascular and premature deaths.

State Department of Health Director Dr. Virginia Pressler said Hawaii’s strong performance reflects its status as the state with the nation’s second-highest public health investment. The weather, anti-tobacco initiatives and legislation like Hawaii’s pre-paid health care and clean air laws also have contributed to its ranking.

“We do invest in our people and our public health,” Pressler said. “We do a lot of good things, but I don’t want to be complacent.”

Pressler cautioned that Hawaii has geographic areas and ethnic and socioeconomic groups that experience “significantly worse health than the average population.”

For instance, Native Hawaiians and Pacific Islanders are three times as likely to die from cancer and overall have less longevity than other ethnicities, she said. Japanese and Filipino residents are prone to developing diabetes even at lower weights, which Pressler said is concerning given that Hawaii’s adult obesity rate has doubled since 1990.

State Sen. Josh Green (D, Kona-Kau) said Hawaii also continues to struggle with problems like immunization rates, excessive drinking and health problems that accompany mental health and homelessness.

“My largest issue this year will be homelessness — it’s a health condition that has about 8,000 or 9,000 of our residents in its grip,” he said. “The average lifespan is (about) 77, and it’s 50 if you’re homeless, which knocks off about a third of someone’s life and encompasses a lot of other problems.”

Green plans to propose doubling the state’s $38 million budget for addressing mental illness and drug addiction. He’ll also work to address rural isolationism, which he believes contributes to Hawaii’s addiction and suicide rates.

“We normally serve about 11 or 12 percent of the population that has addiction,” he said. “That’s about what other states do, but we could set ourselves apart by providing increased access.”

Pressler said the Health Department’s main priorities for the 2017 legislative session will be investing in “healthy babies and families, and taking health to where people live, learn, work and play.”

Art Gladstone, CEO of Straub Medical Center and Pali Momi Medical Center, said the health care industry in Hawaii and across the nation is placing greater emphasis on preventive health.

“At Hawaii Pacific Health, our mission is to create a healthier Hawaii, and we are focused on educating our patients about the importance of prevention, early intervention, monitoring and regular check-ups,” Gladstone said. “This focus on identifying indicators of future health issues early and managing chronic health conditions before they become serious health problems definitely contributes to a healthier population and a healthier state.”

Visit americashealthrankings.org for more information about the report.