The 50 states of the U.S. might be united, but they differ vastly when it comes to health, according to a new report.

The 2017 America’s Health Rankings, a study conducted by the United Health Foundation, based its findings for the healthiest states on a number of factors, including rates of smoking, obesity, infant mortality and infectious diseases—in addition to the availability of health care providers and levels of air pollution.

“This year, the report reveals that the nation is facing serious public health challenges, including rising rates of premature death and an uneven concentration of key health care providers,” the report reads.

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United Health Foundation says it releases its annual report in order to help local, state and national policy-makers, public health officials and researchers improve health care.

There have been success stories, though. Florida (No. 32) rose significantly in the rankings for most health states this year.

But Issues continue to plague the country nationally, however, such as infant mortality and low birth weight. Premature death, defined as deaths before the age of 75, in addition to cardiovascular and drug deaths are on the rise as well.

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The healthiest states

1. Massachusetts

This year marks the first that Massachusetts has held the distinction as the healthiest state in America. The top ranking previously went to Hawaii in recent years.

2. Hawaii

Hawaii held the top spot in the healthiest states list for the last five years, but has finally been bumped into second place.

3. Vermont

Vermont has made remarkable improvement over the last 25-plus years, leaping from 30th in 1990—the inception of the rankings—to third in 2017.

4. Utah

Utah made one of the biggest improvements in this year’s healthy states ranking, rising four spots from 2016.

5. Connecticut

Connecticut’s strong ranking is boosted by the availability of primary care physicians, with more than 200 per 100,000 people.

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The least healthy states

1. Mississippi

Mississippi and Louisiana, in particular, have major health challenges, such as high levels of smoking, obesity and children in poverty, according to the study

2. Louisiana

Louisiana also saw its rate of drug deaths increase from 13.7 to 17.7 deaths per 100,000 people over the past five years.

3. Arkansas

Arkansas has a significant gap when it comes to primary physician care. The state has less than 100 per 100,000 people – half the number is top-ranked states.

4. Alabama

Alabama is not helped by its lack of mental health providers. The state has the lowest concentration in the entire country at a rate of 85 per 100,000 residents.

5. West Virginia

West Virginia crept into the five least healthy states in 2017, replacing Oklahoma, which now ranks as No. 43.

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