How does the well-being in your state stack up?

Hawaii topped the list of the healthiest states this year, followed by perpetually high-scoring states such as Vermont and Minnesota. On the other end of the spectrum, Mississippi once again ranked at the bottom of the list. 

Residents of Hawaii have something to celebrate Thursday after the United Health Foundation’s 2016 Annual Report revealed the state to be the healthiest in the country for the fifth year in a row.

The Annual Report’s findings are based on data provided by the Census Bureau, the American Medical Association, and the Centers for Disease Control and Prevention, among others, and measure a slate of factors, from obesity to childhood poverty rates to vegetable consumption.

While many categories saw overall improvement over the past year, experts say that there is still much more to be done. And some are particularly worried about the changes next year could bring, especially if president-elect Donald Trump follows through on his promise to dismantle the Affordable Care Act.

“There are clearly states that have been more innovative in their health policies than others, and there are some states where social norms are more conducive to healthy living,” says Matthew Kreuter, a professor of public health at Washington University, St. Louis. “All of these factors play a role in how healthy the people who live in a given place are.”

Generally, Dr. Kreuter tells The Christian Science Monitor in a phone interview, more liberal states are the most concerned about public health policy and are where politicians are most likely to have the political will to make big changes in the public health sphere.

Perhaps, then, it is no surprise that some of the nation’s most liberal states top the health rankings. The top five states, according to the 2016 Annual Report, are as follows: Hawaii, Massachusetts, Connecticut, Minnesota, and Vermont.

Yet while Hawaiians can rejoice (yet again) over their good health, the bottom five states also remain relatively stagnant, with Mississippi, Louisiana, Alabama, Arkansas, and Oklahoma again trailing the list.

Mississippi fell to number 50 this year from being ranked 49th, in part due to high rates of children living in poverty and high smoking and obesity rates. More than a third of Mississippi residents are obese, according to the report. In the past year, obesity rates have increased countrywide by seven percent, as well.

Nevertheless, 2016 was a good year for many sectors of the population. The number of children living in poverty nationwide decreased by seven percent, to nearly 20 percent of children, while the number of uninsured individuals also shrank to approximately 10 percent of the population.

Yet many challenges remain, note some experts.

“Some of the biggest challenges in public health in the coming years are going to be in the proposed changes in social and economic structures – changes to income and changes to education,” says Sandro Galea, dean of Boston University’s School of Public Health.

While the status of children, in particular, saw improvement this year, some experts say that they are poised to be among the most vulnerable populations over the next several years, particularly if Trump follows through on his proposal to repeal the Affordable Care Act.

“There are both short term and long term consequences to having children uninsured. Children who are uninsured have worse access to care, and when a child becomes uninsured, the entire family is at risk for medical debt or bankruptcy,” says Joan Alker executive director of Georgetown University’s Center for Children and Families, the author of a report on Medicaid's impact on children. 

“In the long term, having health coverage can help children to attend school more regularly, and those children have higher graduation rates and college attendance rates, which in turn reduces their impact on societal resources when it becomes easier for these children to get jobs. There’s a definite long term return on investment.”

Dr. Alker says that many children’s health advocates are concerned that losing ACA coverage will reduce the numbers of children who are covered by health insurance. Currently, 95 percent of children are insured.