As a state, Colorado residents are thinner than the rest of the nation, but binge drink more often and many don’t get their children immunized.

That’s the news from Health Rankings America, a national nonprofit that has compared the health of the nation for more than 20 years.

Colorado’s always ranked high on the list — the state has fewer cancer and cardiovascular deaths than other states. Fewer people die prematurely here, and the state has fairly clean air.

But that much-vaunted health status is at risk. Colorado slid five spaces in the report, from eighth place last year to 13th this year. It’s the first year since the report’s inception 20 years ago that Colorado hasn’t been in the top 10.

It’s the binge drinking, low immunization rates and high childhood poverty that account for the drop.

But the report also highlights something more troubling. Colorado ranks lower in the issues that determine health than it does in health outcomes. Why is that a problem? It’s an early indicator that the state’s health is going to continue to decline.

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For example, the state ranks 38th in the number of pregnant women who receive early prenatal care; and it’s 23rd for the number of primary care doctors. It’s at the very bottom — 48th — for childhood immunization rates. That rate has dropped from 92.1 percent a year ago to 85 percent this year.

The state’s rocky economic state is also to blame for the lower rankings. The unemployment rate is 8.2 percent, while the underemployment rate is 13.7 percent. The percentage of children in poverty is now at 18.2 percent, up from 11.6 percent just a decade ago.

America’s Health Rankings gathers information based on behaviors, such as smoking; environment, such as violent crime or workplace fatalities; public and health policies, such as immunization rates; clinical care and health outcomes.

The healthiest state: Vermont. Other top 10 healthiest states: Massachusetts, New Hampshire, Connecticut, Hawaii, Minnesota, Utah, Maine, Idaho, Rhode Island.

In the west, Utah, Idaho and Washington rank above Colorado, while Arizona, California, Montana, New Mexico, Oregon and Wyoming rank below the Centennial state.

The report also highlighted national improvement during the 20 years it has been gathering data. Health successes include lower rates of infectious diseases, lower infant mortality rates, lower smoking rates.

Violent crime has decreased nationwide, as have cardiovascular and premature deaths. The air is no longer as polluted; and occupational fatalities are lower. The report cites a 10-year decline in preventable hospitalizations.

But nationally, there are challenges as well: more people are obese, more people lack health insurance. The high school graduation rate — 73 percent — hasn’t changed in a decade. More people are calling in sick, and more children live in poverty.

And like Colorado, nationwide, more adults participate in binge drinking — a total of 15 percent across the country.

All the numbers add up to a single conclusion: the nation isn’t getting healthier. Despite spending more money on health care than any other industrialized nation, life expectancy in the country hovers at 70, lower than 31 other industrialized countries. Clearly, it takes more than simply throwing money at the problem.

But there are groups working on the problem. United Health Foundation, a sponsor of the health rankings reports along with America Public Health Association and Partnership for Prevention, has partnered with Centura Health System to provide high-definition telemedicine via video portals and the Internet for people who live in four very rural counties, said Dr. Chris Stanley, chief medical director for the group.

“You don’t have to have insurance with United to participate, you can be with any insurance company, or not have insurance at all,” he said. “We really felt the need to get this program started in areas that don’t have easy access to specialists.”

Wellness and prevention is frequently the key, he said.

“There are many programs out there — nearly every insurer has them,” he said. “At United, we have programs for both large and small businesses that focus on wellness. And for our diabetes patients, we waive co-pays as long as they are participating in a wellness program.”

Meanwhile, even the state’s good news is tempered, he said.

“While we’re thrilled that we’re still the thinnest state in the nation, at 18.9 percent obesity rate, it’s sad that this is as good as it gets,” he said.

Amy Gillentine can be reached at 719-329-5205 or at Friend her on Facebook.