According to the "America's Health Rankings 2008" list, Vermont has come on top while Louisiana has displaced Mississippi for the unhealthiest title. The list which is a collaboration of the United Health Foundation, the American Public Health Association, and the Partnership for Prevention states that the overall health of Americans remained static for a fourth year. The health assessment rankings are based on a series of measures which includes binge drinking, smoking and obesity. Public and health policy such as health insurance coverage, public health funding etc and clinical care factors such as adequacy of prenatal care, preventable hospitalizations, and primary care physicians. The fourth factor that was included was community and environmental factors such as air pollution, infectious disease rates, crime levels and rates of high school graduation.

Louisiana and other Southern states remained grouped at the bottom as these states have some of the highest rates of obesity which contributes to heart disease, stroke, diabetes and some types of cancer, as well as high rates of smoking, which causes cancer, lung disease, heart disease and other problems. In the state of Louisiana one out of five residents did not have health insurance cover and the state had a high rate of child poverty, infant mortality, and premature death rates.

Dr. Reed Tuckson of UnitedHealth Group Inc, the largest U. S. health insurer, and the private United Health Foundation said, "We've just not made any improvement in the overall healthiness of the nation."

Vermont topped the list second year in a row, followed by Hawaii at second place and New Hampshire at third. The remaining two slots in the top five were filled by Minnesota and Utah. California was in the middle of the list at 24th place while New York came in just behind at 25th. The bottom five starting in reverse were Louisiana, Mississippi, South Carolina, Tennessee, and Texas. Over the last year, the states which showed the biggest improvement in their overall health score were Arkansas, New Mexico, and Kentucky; while Texas and Montana showed the least improvement.

Vermont had an obesity rate of 22 % which was four points below the national average and had the third highest public health spending, factors which kept it at top slot. The state with the second smallest population of any state also had low child poverty and violent crime, a large number of doctors per capita and good high school graduation rates. Mississippi had the highest obesity at 33% while Colorado was the lowest at 19 %.

The United Nations lags behind many other countries in issues such as infant mortality, life expectancy, mortality for treatable conditions and overall health care system performance which President-elect Barack Obama and leading lawmakers want to change.