Despite years of efforts to even out health disparities across the United States, some states are dramatically healthier than others, according to a new report.

Massachusetts, Hawaii, Vermont, Utah and Connecticut rank as the five healthiest states, while West Virginia, Alabama, Arkansas, Louisiana and Mississippi rank the least healthy in America’s Health Rankings, according to the report by the United Health Foundation.

The rankings take into account a variety of health factors, such as rates of infectious diseases, obesity, physical inactivity, smoking and infant mortality, as well as air pollution levels and the availability of health care providers.

This is the first time Massachusetts has been named the healthiest state, ending Hawaii’s five-year reign.

The Bay State won the honor in part due to having the lowest percentage of uninsured residents at just 2.7% of the population, plus a low prevalence of obesity and a high number of mental health providers.

Mississippi and Louisiana, ranked 49th and 50th, have major health challenges, according to the report, including a high prevalence of smoking, obesity and children in poverty.

“We don’t have a system with everybody in,” said Dr. Georges Benjamin, executive director of the American Public Health Association, which was not involved in the new report. “We’re failing in our fundamental task to be a healthier nation.”

The report, America’s Health Rankings, has been analyzing state health standings for 28 years.

This latest report shows that the nation’s health overall is getting worse.

The nation’s premature death rate — the number of years of potential life lost before age 75 — increased 3%since 2015.

That increase is driven in part by drug deaths, which increased 7% during that time, and cardiovascular deaths, which went up 2%.

That leaves the United States ranking 27th in terms of life expectancy in a comparison of 35 countries, according to the report.

Benjamin said it’s frustrating to see these numbers, despite the fact that the US spends significantly more on health care than other nations, according to the Kaiser Family Foundation.

“We’re spending more on health care and we die sooner,” he said. “We need to do a time out and figure out how to do this better.”

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