Minnesota, long one of the healthiest states in the nation, isn't as robust as it was.

With an increase in child poverty and a decrease in public health spending, the state slipped to No. 4 this year from No. 2 last year, according to annual rankings released Wednesday by the United Health Foundation. Before 2007, Minnesota ranked No. 1 for four consecutive years.

"First, second or fourth, Minnesota is still a leader," said state Health Commissioner Sanne Magnan. "But this is a change."

Vermont was the healthiest state for the second year, and Louisiana replaced Mississippi as the least healthy.

Each year since 1990 the nonprofit United Health Foundation, created by insurance giant UnitedHealth Group, has compared states on a variety of health measures to determine whether the nation's health is getting better or worse. This year, the report rated states on 23 measures, including immunization rates, obesity, premature death and violent crime.

For the fourth consecutive year, the health of the nation as a whole declined. Contributing factors included rising obesity rates, more people without health insurance and the persistence of unhealthy behavior such as tobacco use.

"The health of the nation is stagnant," said Dr. Reed Tuckson, senior vice president of the Minnetonka-based foundation. The United States also continues to fare worse than other comparable countries, he added. For example, a baby girl born today in the United States can expect to live 71 years, compared to 78 years in Japan.

"That gap is extraordinary," Tuckson said.

Minnesota dropped in part because per person public health spending fell from $62 to $45, or 43rd in the nation. Public health spending is included because research has shown it has a signficant effect on overall health. An investment of $10 per person per year in programs to increase physical activity, improve nutrition, and prevent smoking would cut national health care costs by $16 billion annually within five years, according to the Robert Wood Johnson Foundation. That is a return of $5.60 for each dollar spent.

But the data used in the report may have put Minnesota at an unfair disadvantage. Magnan said this year the Legislature approved $47 million for public health programs to reduce smoking and obesity, money that was not included in the latest analysis, but which could improve Minnesota's ranking next year.

Sen. John Marty, the DFL chair of the state Senate Health, Housing and Family Security Committee, questioned if that would be enough to reverse the trend. "It will help correct some of this decline but is not sufficient to truly address health needs," he said.

Public health funding in the state also declined because of a 21 percent decrease in federal money for pandemic flu preparedness.

Minnesota is also unusual because about $100 million in public health money comes from county and city taxes, which are not included in the tally, Magnan said.

But Minnesota fared badly in other areas as well. The share of children living in poverty surged from 11 percent to nearly 14 percent, and that is expected to get worse with the current recession.

"I see the effects of the economy all the time," said Dr. Elizabeth Frost, a family practice doctor at the West Side Community Health Center, which serves a poor and working-class neighborhood in St. Paul. "It's not surprising that there are so many children in poverty."

Frost also sees the health consequences. Last year she was worried that a 2-year-old patient with a severe case of the flu would end up in the hospital because her mother could not pay for the $150 medication she needed. The child recovered.

Obesity rates in Minnesota continued a steady climb, increasing from 25 to 26 percent of the population in the last year. That's up from 10 percent in 1990.

There were a few bright spots for Minnesota. Smoking rates, which weigh significantly in the overall score, dropped from 18.3 to 16.5 percent of the population, rocketing Minnesota from fifteenth nationally in that category last year to fifth this year. Binge drinking declined from 18 to 16 percent, and the number of cardiovascular deaths per 100,000 people dropped from 227 to 219.

To see the report, go to www.americashealthrankings.org.

Josephine Marcotty • 612-673-7394