In a multiyear decline, Minnesota has slipped from the healthiest state in the nation to No. 6, according to a closely watched annual report on the health of the nation.

The main reasons: more women going without prenatal care, falling immunization rates and more children living in poverty.

More Minnesotans are also binge drinking, according to data from America's Health Rankings, published Tuesday by UnitedHealth Foundation, a branch of Minnetonka-based UnitedHealth Group.

"This trend that we are seeing is a slippage over time," said Reed Tuckson, a senior vice president at the foundation.

Vermont took the nation's top spot, followed by Utah, Massachusetts, Hawaii and New Hampshire.

Minnesota ranked No. 1 for four consecutive years through 2006, then fell to No. 2 in 2007, No. 3 in 2008 and No. 6 in 2009. (The foundation initially ranked Minnesota No. 4 in 2008, but moved the state to No. 3 after revising its methodology.)

The rankings are based on 22 measures compiled from national health data sets and covering health outcomes, socioeconomic factors, public health policies and other factors.

This year's report found that:

•15 percent of Minnesota children now live in poverty, up from 10 percent in 2006.

•77.4 percent of children were immunized this past year, down from 85.2 percent in 2006.

•The percentage of pregnant women who got prenatal care has fallen to 70.2 percent from 76 percent in 2006.

Minnesota Health Commissioner Sanne Magnan noted yesterday that Minnesota is still "solidly in the Top 10, and that's a good thing.'' But she added:

"It is helpful when we shine a light like this. We need to renew our efforts."

Magnan pointed out that despite the falling overall ranking, Minnesota remained No. 1 for health outcomes, leading the nation on measures such as premature and cardiovascular deaths. That could be because of a time lag between the so-called determinants of health and the outcomes, she said.

Minnesota ranked 34th in the nation (where 50th is worst) for binge-drinking, defined as five drinks in one sitting for men and four for women. Some 17.2 percent of adults admitted to binge drinking at least once in the previous month.

Minnesota also ranked poorly for public health funding, with $40 per person spent this past year, or 46th in the nation. Magnan said the figure did not capture money spent by local public health departments.

Tuckson said the nation's health threats include tobacco use, which remains high at 18.3 percent, and obesity, which is "the fastest-growing public health threat in the nation."

The percentage of the population counted as obese is 131 percent higher than when the rankings first came out in 1990.

"These are a lot of people who have a preventable chronic disease who are going to be pouring into the medical system and driving costs up dramatically," Tuckson said.

Chen May Yee • 612-673-7434