South Carolina inched up one spot in the latest round of America's Health Rankings, but the Palmetto State still landed near the bottom of the pack in the annual report card.

Top 10

1. Hawaii

2. Vermont

3. Minnesota

4. Massachusetts

5. New Hampshire

6. Utah

7. Connecticut

8. Colorado

9. North Dakota

10. New Jersey

Bottom 10

41. Indiana

42. Tennessee

43. South Carolina

44. Oklahoma

45. Kentucky

46. West Virginia

47. Alabama

48. Louisiana

49. Arkansas

50. Mississippi

Healthiest, least healthy

The rankings, published Wednesday by the United Health Foundation, aggregated a long list of factors that shape statewide health, including diabetes, obesity, violent crime, lack of health insurance and high school graduation rates. In 2013, South Carolina ranked 43rd overall out of 50 states, a slight improvement from 2012, when it ranked 44th in the country.

Find this story on to see the South Carolina report.

The report card shows this state has one of the lowest rates of adolescent immunization, one of the highest rates of low birth weight babies and some of poorest rates of diabetes and obesity in the country.

It also ranked 49th for cases of salmonella, a food-borne illness.

A statistic like that could hurt the state's tourism industry, said Dr. Leslie Lenert, the chief research information officer at the Medical University of South Carolina.

"There's no excuse for being No. 49 if we are going to be feeding people here," he said.

While dollars spent on public health are also much lower here than other states - $66 per person in South Carolina versus $225 per person in Hawaii - there are other tangential factors that shape population health, Lenert said.

"We want a healthier population in South Carolina? Well, let's get more of our population graduating from high school," he said.

The new report card shows Hawaii earned the best overall score in the U.S., while Mississippi ranked at the very bottom.

Seven states in the bottom 10, and none of the states in the top 10, are located in the South.

"It's almost completely attributed to poverty and everything that poverty brings and implies," said Tony Keck, director of the S.C. Department of Health and Human Services.

"When you've got lots of poverty, it indicates that you have some serious problems with incomes, serious problem with education attainment, and you have associated problems, many times, with family structure," he said.

"Those are all things that really, really drive poor health. I think that's why you generally see a lot of Southern states in the bottom."

Virginia ranked higher than any other Southern state at No. 26.

Keck pointed out some bright spots in the report - the drop in South Carolina's rate of residents without health insurance and a relatively high ranking (10th) for health disparities by educational attainment.

"I was really impressed by our high ranking for health disparities. We actually have some of the lowest disparities in the country between people with a high school degree and people without," he said.

"It shows that our disparities are actually a lot less than in many so-called blue states that have more generous policies."

Reach Lauren Sausser at 937-5598.