Compared with the other 49 states, California's overall healthiness could be worse. But it also could be better.

And though officials nationwide are making progress fighting smoking and heart disease, the country's overall health isn't improving.

Those conclusions come from America's Health Rankings, an annual report card produced since 1990 by the United Health Foundation, the American Public Health Association and the Washington D.C.-based Partnership for Prevention.

Each year, the group grades states on 23 health measures. It combines data from the CDC, the American Medical Association, the U.S. Census Bureau and other agencies. The group released its latest rankings on Tuesday.

California came in 24th in the overall ranking, up slightly from 26th last year. Vermont ranked first for the fifth year running. Mississippi finished last, as it has for the past decade.

California boasts certain strengths compared with other states, the report determined. Fewer people here smoke, for instance. More women get medical care early in their pregnancies, and the state's infant mortality rate is relatively low.

On the flip side, the Golden State came in dead last – ranked No. 50 – on air pollution. High numbers of Californians (more than 19 percent) have no health insurance, and low numbers of toddlers (88 percent) have all their basic immunizations.

In a less-than-promising sign, California did better in its rates of illness and death than it did in factors that affect health, such as pollution and vaccinations. In other words, state residents are healthier than it seems they should be given the conditions in California. If those conditions remain, the report said, residents probably will get unhealthier over time.

Nationally, the new report paints a worrisome picture. Obesity and diabetes are on the rise. More children are living in poverty.

There are good signs: Smoking is down, as are deaths from heart disease.

But the things that got worse since last year essentially canceled out those that got better, the report said. And it highlighted a sobering finding: For the first time, at least 20 percent of the people in every single state were obese. Until now, a handful of states still had obesity below that number.

On average, for every person who quit smoking in the past year, a person became obese.

Georges Benjamin, executive director of the APHA, called the rankings "a tool that gives us a sense of where we are and where we need to go."

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