America's Health Rankings, a new report from the nonprofit United Health Foundation, reveals the best and worst states for health in 2017.

Massachusetts (1), Hawaii (2), Vermont (3), Utah (4) and Connecticut (5) were the healthiest states. Hawaii had held the top national ranking for the past five years. Massachusetts had the lowest percentage of uninsured residents at 2.7 percent. The Bay State also had a low incidence of obesity.

The least healthy states were Mississippi (50), Louisiana (49), Arkansas (48), Alabama (47) and West Virginia (46). The health disparity between the top five states and bottom five states reflect in part a wide variation in the concentration of healthcare providers.

For example, Alabama had the lowest rate of mental health providers (85 per 100,000 population) and less than 45 dentists per 100,000. By contrast, Massachusetts had the highest rate of mental health providers (547 per 100,000 population) and 80 dentists per 100,000.

To define "healthy," the group uses the World Health Organization's definition: "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." The report's four categories of determinants evaluates 35 core measures across behaviors, community and environment, and policy and clinical care.

Image: United Health Foundation

The premature death rate in the U.S., which counts the number of years of potential life lost prior to age 75, rose 3 percent since 2015, a trend that included the top five healthiest states in 2017. The rate of premature death had fallen by 20 percent from 1990 to 2015, according to the report.

Nationwide, drug deaths rose by 7 percent "to the highest level recorded by America's Health Rankings (15 deaths per 100,000 population) and were particularly high among whites," according to the report. Despite a top ranking in the report, Massachusetts experienced a 69 percent rise in the drug death rate since 2012.

Drilling down on data for drug deaths reveals the sobering scope of the nation's opioid epidemic.

"More than 6 out of 10 drug deaths involve an opioid, primarily prescription pain relievers (morphine, oxycodone, hydrocodone) or heroin," according to the report. "Opioid-related overdose deaths increased 200 percent between 2000 and 2014, and since 1999 opioid pain reliever prescribing quadrupled."

Florida (32) and Utah (4) improved their rankings in health outcomes the most in 2017, according to the report. Florida’s percentage of children in poverty and frequent mental distress fell, while Utah reduced air pollution and increased childhood immunizations.

Utah, the fourth-healthiest state in 2017, experienced a 10 percent increase in the cardiovascular death rate since 2012. Overall, cardiovascular deaths across the U.S. increased for the second straight year, with the rate among African-Americans much higher versus the rate for whites, Hispanics, Asians and American Indians/Alaska Natives.

Meanwhile, South Dakota's health ranking plummeted seven places to 18, the largest drop of any state. Driving that downward trend were the state's lack of progress for reducing smoking and increasing childhood immunizations.

International comparisons of health outcomes are instructive.

According to the report, the "U.S. has a higher infant mortality rate, a higher prevalence of obesity and a lower life expectancy at birth compared with most Organization for Economic Cooperation and Development member countries. The top U.S. state in each of these measures ranks toward the bottom among OECD countries."

One thing is clear in the report: Federal, state and local policymakers have their work cut out for them to improve the health of the American population.