Utah has replaced Connecticut as the nation's fifth healthiest state, moving up one notch in the United Health Foundation's 2008 America's Health Rankings. But the Beehive state still faces serious challenges: Up to 44 percent of Latino residents don't have health insurance.

The Utah Department of Health disputes the figure, saying 34 percent is more accurate. But even that is "embarrassingly high," said health department Executive Director David Sundwall.

"If you believe health insurance is one tool in getting timely care in appropriate settings, in other words not in emergency rooms, it's just clear we need to focus on them instead of just the general public," Sundwall added.

Utah was ranked behind Vermont, Hawaii, New Hampshire and Minnesota in the 19th annual report put out by the foundation and the American Public Health Association and Partnership for Prevention. Louisiana was listed as least healthy.

States are ranked based on residents' personal behaviors, their environment, decisions made by public officials and the quality of medical care. For the fourth year in a row, improvement in the nation's health has stalled because of the rise in obesity, more uninsured and persistence of tobacco use, the report said.

With Americans having a healthy life expectancy of 69 years, the United States ranks behind 27 other developed countries.

Sundwall said he was pleased with Utah's standing, but said the report is valuable because it points out the state's weaknesses: It's ranked 25th because of Utahns' exposure to air pollution and 45th for having too few primary care physicians and for having a large disparity in death rates by county. The age-adjusted death rate is more than two times higher in Duchesne County than in Rich.

"It's got our attention," said Barry Nangle, director of the health department's Center for Health Data. He said his office will be analyzing the disparity to figure out the reasons.

Utah's strengths include having one of the lowest rates of binge drinking and preventable hospitalizations and the lowest rate of smoking and cancer deaths. It's ranked eighth for mental health. Infectious diseases have dropped but obesity is increasing --- it's up 28 percent during the past five years.

"We actually improved in our comparative standing [on obesity by] one point," Sundwall said. "That simply shows me the nation's getting fatter faster than we are. That gives me no comfort."

Using U.S. Census data, the report says 15 percent of Utahns don't have health insurance, placing it 32nd in the nation. Health department data puts the number of uninsured closer to 11 percent. The same state data shows Latinos report not having insurance because their employer doesn't offer it, they don't need or want it or they've lost their jobs.

"It's a huge concern," said Luz Robles, a senator-elect representing Salt Lake City who campaigned on a goal of insuring more children and adults. "You can't ask someone who makes $400 every other week to pay $400 or $500 a month for health insurance."

A health department report, based on interviews with 180 minority Utah residents, showed health insurance is their No. 1 concern. "It appears that purchasing private health insurance is a major financial challenge to all but the most skilled and affluent minority workers," the report said. The health department has spent $75,000 over the past year and a half on targeting Latinos to enroll in the heavily subsidized Children's Health Insurance Program, but the department continues to struggle to get people to enroll.

Jesse Soriano, director of Utah Office of Ethnic Affairs, said the high percentage of uninsured means lawmakers at the state or federal level must get serious about reform. "Somebody is going to have to come up with a way of dealing with health care in this nation."

hmay@sltrib.com