Hawaii again ranks among the nation's healthiest states, although dropping from No. 1 to fourth in the rankings. As tradewinds bless the islands with clean air, the climate encourages outdoor exercise and state law provides the nation's best medical care, Hawaii residents should appreciate wellness at the top level.

The ratings are determined yearly by the United Health Foundation, the American Public Health Association and Partnership for Prevention. Hawaii's top ranking last year was its second in the past decade, and it has been in the six healthiest states every year.

Competing in some of the criteria is effortless. Year after year, Hawaii registers the cleanest air in the country. The state's required employer-based health insurance law, in effect for 35 years, assures among the lowest percentage of uninsured residents, a second-best 7.7 percent; the national average is twice that.

The island's prevalence of smoking at 15.4 percent of the population - nearly 3 percent below the national average - has resulted largely from state and county laws forbidding lit cigarettes in most public places and a series of price increases for tobacco products.

As the economy has struggled nationally, the percentage of Hawaii children living in poverty increased in the past year from 11.6 percent to 14.3 percent. Nationally, the percentage of children in poverty went from 18 percent to 19 percent, but that comparison is distorted by the evaluation of poverty by federal standards without taking into account Hawaii's high cost of living.

Hawaii is fifth best for the low percentage of obese residents: 23.1 percent, 2.5 percent below the national percentage and fifth lowest among the states. However, the report warns that the percentage is likely to increase in the next decade, at great cost.

By 2018, Hawaii's obese population is calculated to reach 48.6 percent, nearly 6 percent more than the percentage of the obese forecast national. If that holds true, the $307 million in medical costs yearly now associated with obesity in Hawaii will grow to more than $1.5 billion - $1,593 per adult.

Hawaii's strongest ratings result from comprehensive health care: generous public health funding and few preventable hospitalizations and cancer and cardiovascular deaths and high ratings in nearly every category related to medical care.

Overall, with the state's health care system as entrenched as the year-round mild climate, Hawaii residents can and should feel fit for the years ahead.