These are the healthiest—and least healthy—states in America

New York, California, and Colorado may have a thriving wellness scene, but all three fail to crack the top five of the country’s healthiest states, based on the United Health Foundation‘s just-released annual report.

The health ranking takes into account obesity rates, air pollution, number of health-care providers, infant mortality rate, physical inactivity metrics, number of smokers, and rate of infectious diseases. (So no points were docked against states lacking grocery #goals quantities Whole Foods or Trader Joe’s outposts.)

For the past five years, Hawaii laid claim to UHF’s veritable gold medal of healthiness, but this year, a different state swiped the wellness crown: Massachusetts.

For the past five years, Hawaii laid claim to UHF’s veritable gold medal of healthiness, but this year, a different state swiped the wellness crown: Massachusetts. (But don’t worry Hawaiians, you still ranked second.) Rounding out the top five were Vermont, Utah, and Connecticut.

The findings declared Mississippi as the least healthy state, with Louisiana (49), Arkansas (48), Alabama (47), and West Virginia (46) finishing the list. “Mississippi and Louisiana have major health challenges, including a high prevalence of smoking, obesity and children in poverty,” the report reads.

Florida—which came in at 32—and Utah were highlighted as making the biggest improvements in the past year due to a lowered number of children in poverty, better mental-health services, and better-managed air pollution.

Of course, it’s impossible to ignore that income level plays a role in the extent and quality of health-care services a given community—and in this case, state—has access to, as well as many of other factors that may affect a ranking.

It’s a reminder that the country, as a whole, still has serious work to do, like rectifying food deserts and providing better mental-health and wellness services to those who need it most. The burden is on the country as a whole—not just the states that rank low.

If you’re a sucker for rankings, check out this list of the happiest states and the best and worst states for women’s equality.