Even as one of the wealthiest nations in the world, the United States contends with plenty of health disparities. Of course, this is nothing unique to the US, but the latest report from the United Health Foundation has shown in stark terms exactly how deep these differences go.

This year, Massachusetts claimed the top spot as the healthiest state, knocking Hawaii into second place after five years at the top. These were followed by Vermont, Utah, and Connecticut. At the other end of the scale, Mississippi came in last, followed by Louisiana, Arkansas, Alabama, and West Virginia.

The annual report, called America’s Health Rankings, has looked at the nation’s health for close to 30 years now, and in general things have been taking a turn for the worse. The premature death rate for the US has grown for a third year in a row, and is now up by 3 percent since 2015 alone.

This is caused in part by the stark uptick in drug-related deaths, which over the same period has increased by 7 percent. This has led to the US falling to 27th out of 35 nations in terms of life expectancy, despite spending huge sums on healthcare annually.

The report assessed each state by looking at 35 different measures, including obesity, infectious diseases, premature death rate, smoking, infant mortality, and access to health care.    

One of the main reasons Massachusetts topped the list this year (despite seeing their drug death rate increase by 69 percent since 2012) is due to their much greater health care coverage. While The Bay State has 547.3 mental health providers per 100,000 people, Alabama has just 85. Similarly, there are over 200 primary care physicians and 80 dentists per 100,000 in the state, while Utah has fewer than 100 primary care physicians and Arkansas fewer than 45 dentists per 100,000.

In the past year, however, there have been some important gains when it comes to the health of the nation. Smoking is down 17.1 percent (and has declined in every state), while the number of uninsured people is down by 9 percent. Interestingly, air pollution has also been declining since 2003.

There are still clearly some big challenges to face. From obesity to access to health care to premature death rate, there are some steps that can be taken to reduce these. 

Check out whether your state makes the top healthiest states:

Top 10
1. Massachusetts
2. Hawaii
3. Vermont
4. Utah
5. Connecticut
6. Minnesota
7. Colorado
8. New Hampshire
9. Washington
10. New York

Bottom 10
41. Georgia
42. Kentucky
43. Oklahoma
44. South Carolina
45. Tennessee
46. West Virginia
47. Alabama
48. Arkansas
49. Louisiana
50. Mississippi