Smoking, obesity and infant mortality are still the top challenges facing the health of North Carolinians. The latest release of America's Health Rankings puts North Carolina at 36 in the nation, behind Delaware and just ahead of Kentucky.

The list evaluates states on 22 different health measures, including factors that determine health, like personal behaviors and public health policies, as well as health outcomes, like infant mortality and deaths from cardiovascular disease.

N.C. State Health Director Dr. Leah Devlin says the findings are no surprise.

"We have enormous disparities in the health of people in our state," said Devlin. "That translates into being in the lower one-third to one-quarter in almost health area you can pick."

The report, by the Robert Wood Johnson Foundation, highlights two health disparities in particular:

• *Low birth weight babies are more common among non-Hispanic blacks at 14.3 percent than Hispanics at 6.3 percent.
• *Access to health care varies significantly by race and ethnicity; 63.8 percent of Hispanics lack health insurance compared to 15.1 percent of non-Hispanic whites.

Devlin says many of the problems revealed in the report are regional and reflect fundamental problems, like poverty and lack of opportunity. In the past five years, the percentage of children in poverty in the state increased by 28 percent. The rate of uninsured North Carolinians has gone up by 37 percent since 1990.

North Carolina still ranks above most of its southern neighbors - South Carolina (48), Tennessee (47), and Georgia (41). Virginia moved up in the ranking from 22 in 2007 to 20 in 2008.

There were some positive changes reflected in the report, including a decrease in the number of deaths from cardiovascular disease and an increase in the high school graduation rate.

"We use reports like this to raise public awareness about what people can do to improve their own health and to try to get other partners in the community engaged," said Devlin. "These reports should e a wake up call to every policy maker, every business and community leader out there. We've got to invest in fundamental issues of prevention and health protection to improve outcomes and reduce overall health care costs."