WASHINGTON — Hawai'i is the fourth-healthiest state in the nation, and Minnesota is No. 1 for the fourth straight year, according to an annual report released Tuesday.

The report also concluded that the nation's health improved slightly in the past year.

Vermont was second on the list, followed by New Hampshire, Hawai'i and Connecticut. The report listed Louisiana as the least-healthiest state, followed by Mississippi, South Carolina, Tennessee and Arkansas.

The report by United Health Foundation, an independent, not-for-profit foundation funded by the healthcare company UnitedHealth Group, said Americans are 0.3 percent healthier than they were a year ago.

The report is based on factors such as personal behaviors, the environment people live and work in, decisions by public and elected officials, and the quality of medical care delivered by health professionals.

Examples include smoking, motor vehicle deaths, high-school graduation rates, children in poverty, access to care and incidence of preventable disease.

Dr. Reed Tuckson, senior vice president of the United Health Foundation, called the report a "call to action for all of us" to make the nation healthier.

"We can do better and our children deserve better," he said.

Minnesota, which has held the top spot in 11 of the 17 years of the survey, was cited for, among other things, its low rate of uninsured (8.4 percent), low percentage of children in poverty (10 percent), and low infant mortality rate (5.1 deaths per 1,000 live births).

The report also points out states that have made the most progress in overall health since last year, as well as those that have regressed the most. Illinois saw the biggest jump forward, followed by Ohio, Wisconsin and Kansas. New Mexico had the biggest decline, followed by Idaho and West Virginia.

Nationally, the level of growth in health as measured by the report has been nearly flat since 2000, averaging only 0.3 percent a year.