Vermont is slipping. For the first time in six years the Green Mountain State is no longer recognized as being the healthiest in the nation. Vermont dropped to the second healthiest state in the country, after Hawaii, in a national ranking released Wednesday by the United Health Foundation. Minnesota ranked third, bumping New Hampshire down to fifth place, while Massachusetts remained in fourth place.

Mississippi came in last, primarily due to its high prevalence of obesity, physical inactivity and diabetes. Numbers 47 through 49 are Alabama, Louisiana and Arkansas, respectively.

Overall, America's Health Ranking 2013 report showed some positive trends across the country. Americans are becoming more physically active, the report says, and for the first time in decades the nation's obesity rate did not rise between 2012 and 2013. This marks the first year since 1998 that obesity rates did not increase, making it "a victory of sorts," stated Reed Tuckson, senior medical advisor to the United Health Foundation.

"We are encouraged," Tuckson said. "Put all together, the big conclusion is that these trends give us reason to be empowered to do more. We're seeing it all across America -- individuals and families are making the decision to be active, to eat a more appropriate diet, to stop smoking."

Seventeen states had significant drops in smoking, the largest being in Nevada, Maryland, Oklahoma, Kansas and Vermont.

Vermont is also credited with having the highest rate of high school graduation -- 91.4 percent -- and the second lowest rate of violent crime -- 14.3 percent per 100,000 people; premature death and the percentage of people who lack health insurance -- 7.8 percent, the Vermont Health Department said. Vermont also scored well for its rate of obesity at 23.7 percent, diabetes rate of 7.3 percent and number of physicians at 170 per 100,000 people, the department said.

"We can take pride that our state continues to be one of the healthiest places to live, while we keep working to overcome our challenges," said Vermont Health Commissioner Harry Chen.

Among the challenges are the rate of childhood immunization in which Vermont ranked 45th, a statewide outbreak of whooping cough, and a greater prevalence of high-risk or binge drinking which ranked the state at 41, the report said.

Hawaii also had a high prevalence for binge drinking, but unlike Vermont it had low high school graduation rates. The one key area where Hawaii scored better than Vermont, and bumped us from our top perch, was its high childhood immunization rates. Last year's pertussis (or whooping cough) outbreak in Vermont certainly didn't help.

A survey released in August by the Vermont Health Department showed that about 87 percent of students going into kindergarten have had a full round of vaccines, which is the same as last year. The survey also showed that about 5.5 percent of kindergarten students did not get at least one of the shots because of a philosophical exemption, which is the second-highest rate in the country, Chen said. In a few schools, the rate of exemptions is up to 35 percent.

"In some schools the culture of those parents who make the decision not to be vaccinated and to fill out that philosophical exemption is even higher," the commissioner said at the time. "That's an area we can focus some of our efforts in terms of our school health liaison to try to focus their efforts in education on that population and those parents.

The issue has been controversial in Vermont. In the past legislative session, a bill passed the House that would have made it harder for parents to have their children exempt from Vermont's mandatory immunization law based on either medical, religious and philosophical reasons. But the Senate rejected the legislation after a group of parents raised concerns about the health effects of immunizations.

Some also argue, particularly after last year's whooping cough outbreak, that vaccines are not always effective and therefore do not warrant the risk of any possible negative effects from the immunization.

In an interview with VtDigger last year, Patsy Kelso, an epidemiologist for the health department, acknowledged that the current thinking among health officials is that the widespread uptick in pertussis was due to the vaccinations faltering.

Despite the vaccination's less-than-perfect track record, however, Kelso maintained that it's better to get vaccinated than to not. She said the vaccination can help fight off the illnesses when contracted, just as the flu vaccine can, so at least the symptoms are less severe.

Based on last year's outbreak and the health rankings released this week, Vermont has two main challenges going forward: To boost immunization rates and also push for improvements to the vaccines themselves so they produce better results and fewer negative health effects, which no doubt would convince more parents to get their children vaccinated.

Taking steps to curb the problem of binge drinking in Vermont would help improve our health ranking as well.