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CBS Local — After the average life expectancy in the United States declined for the first time in decades, a new report is out detailing which states have the best and worst health care systems.

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The non-profit health care advocacy group, The Commonwealth Fund, released a state-by-state scorecard on May 3 looking at each state’s ability to deliver medical care to its residents. The study broke down over 40 areas of health care from access, to the value of care Americans were paying for.

According to the results, which studied each state from 2013 to 2016, Hawaii ranked as America’s top state for health care services. Massachusetts, Minnesota, Vermont, and Utah followed in the rankings.

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The nation’s worst health care system was found in Mississippi, with Oklahoma, Louisiana, Florida and Arkansas finishing in the bottom five in the U.S. “If every state achieved the performance of the top-ranked state on each Scorecard indicator, the gains in health care access, quality, efficiency, and outcomes would be dramatic,” the study’s researchers concluded.

The health care scorecard also found a dramatic increase in “deaths of despair” across the country. Deaths caused by suicide, alcohol, and drug use have reportedly risen by 50 percent since 2005.

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Obesity was also found to be growing problem in the country with between 25 and 39 percent of adults in each state now registering as obese. The study also added that the health care you receive may be up to three times better in a strong performing state than a poor performing one.