Hawaii topped the second annual U.S. News and World Report state healthcare rankings, which used measures of access, quality and public health to come up with each state’s health score.

The healthcare category—which was weighted the highest among all others for the overall state rankings—was split evenly between the access, quality and public health benchmarks. Among the measures included were the size of each state’s uninsured population and the percentage of adults who haven’t had a routine medical checkup in the past year.

“It includes positive measures such as the percentage of children receiving medical and dental care under Medicaid,” the report explained in its methodology. “It includes measures of preventable hospital admissions, readmissions within 30 days of discharge, nursing home quality ratings and numbers of seniors covered under high-quality Medicare Advantage plans. It involves general measures that correspond with good physical and mental health – rates of smoking, obesity and suicide, along with self-reported mental health. And it takes into account infant and overall mortality rates.”

The top five states overall were:

1. Hawaii
2. Washington
3. Iowa
4. Connecticut
5. Massachusetts

Success in one category didn’t preclude states from having much lower rankings in another. While Hawaii was in the top two in all three measures (No. 1 in quality and No. 2 in both access and public health), Massachusetts saw a much bigger gap, being No. 1 in access but No. 31 in quality. Being first in a particular category also didn’t guarantee a spot in the top five—California topped the public health, but being ranked 36^th in access and 14^th in quality dropped its overall placement to No. 11.

The bottom five states on the list were:

46. Alabama
47. Louisiana
48. Oklahoma
49. Arkansas
50. Mississippi

Mississippi was ranked dead last in both quality and public health, and 49^th in access, where Alaska was ranked last.

The report also included the rankings on each individual measure which factored into the overall benchmarks. Here are the best and worst states in each of these subcategories:

• Adult dental visits: #1 Connecticut, #50 Louisiana
• Adult wellness visits: #1 Rhode Island, #50 Idaho
• Child dental visits: #1 Connecticut, #49 Wisconsin (North Dakota not ranked)
• Child wellness visits: #1 Massachusetts, #49 California (North Dakota not ranked)
• Affordability: #1 Hawaii, #50 Mississippi
• Insurance enrollment: #1 Massachusetts, #50 Texas
• Fewest hospital readmissions: #1 Hawaii, #50 Massachusetts
• Percentage of Medicare Advantage enrollees in 4-star or higher plans: #1 South Dakota, #49 Mississippi (Alaska not ranked)
• Percentage of nursing home residents in 4-star or higher homes: #1 Rhode Island, #50 Texas
• Preventable admissions: #1 Hawaii, #50 Kentucky
• Infant mortality rate: #1 New Hampshire, #50 Mississippi
• Overall mortality rate: #1 Hawaii, #50 Mississippi
• Obesity rate: #1 Colorado, #50 West Virginia
• Smoking rate: #1 Utah, #50 West Virginia
• Suicide rate: #1 New Jersey, #50 Alaska
• Mental health: #1 South Dakota, #50 West Virginia