Topeka ? Kansas continued to rank as the 27th healthiest state in the nation in 2014, according to the latest America’s Health Rankings from the United Health Foundation.

That’s the same position Kansas held last year, but it’s down sharply from its eighth place slot in 1991, a decline that authors said is largely due to the state’s high rate of obesity and smoking and its low rate of childhood and adolescent immunizations.

Tony Sun, an Overland Park physician and one of the authors of the report, said the trends are the result of Kansas getting less healthy in some areas and improving more slowly than other states in other areas.

“It’s probably a combination of all, but what some of Kansas’ strengths are, we have a very low rate of drug deaths,” Sun said. “On the environmental side, we have a high rate of high school graduations.”

But the report said Kansas has failed to keep pace with improvements that other states have made over the last 25 years.

Since the first ranking was made in 1990, infant mortality in Kansas has fallen 32 percent, to 6.3 deaths per 1,000 births. But it has fallen 41 percent nationally.

Also, deaths by violent crime have gone down only 2 percent in Kansas, compared with a 37 percent decline nationally.

“These aren’t just numbers. The decline in rankings represents real Kansans — children, parents and grandparents — who are sick and dying prematurely from preventable diseases,” said Dr. Jeff Willett, vice president for programs at the Kansas Health Foundation, a partner in the annual study. “We can and we must reverse this downward trend, because all Kansans deserve the opportunity to live a full, healthy life.”

The report also noted that Kansas has made little progress in the last 25 years to reduce the rate of adult smoking. Kansas had only the eighth lowest rate of adult smoking in 1991. But other states have done considerably more than Kansas to reduce smoking, and Kansas now ranks 31st in that category.

Willett said that corresponds to similar declines in Kansas’ rankings for cancer deaths, cardiovascular disease deaths and other premature deaths.

“The best thing we can do to improve the health of the state in the short term is to significantly reduce smoking,” Willett said.

The Kansas Health Foundation is a nonprofit organization that helps fund community-based health initiatives around the state. It started with a $200 million endowment that resulted when nonprofit Wesley Hospital in Wichita was sold to a for-profit corporation.

In addition to reducing smoking rates, Willett also said the state of Kansas should invest more in public health, particularly programs targeting the well-being of children.

“Children’s poverty has increased (since 1990),” Willett said. “We’re middle-of-the-pack or worse with children’s immunizations. Kansas has one of the highest infant mortality rates in the nation, especially for African-American infants. So fully supporting children’s programs — and that goes from early child care to education to just ensuring there are opportunities for children who grow up in our state to be successful.”

The ranking system uses data from multiple sources to measure the overall health of each state. Those include broad categories that influence health: behaviors; community and environment; policy and clinical care.

The study also looks at data on various health outcomes such as death rates from cancer and other diseases as well as the average number of days workers miss due to poor physical or mental health.

Overall, Kansas has slipped in 19 of the 30 factors examined in the study since 1991.