NEW DELHI: Kerala has topped the Health Index report prepared by NITI Aayog while Uttar Pradesh appeared at the bottom among larger states, though it has shown improvement in the recent past.As per the index report for large states, Kerala was followed by Punjab, Tamil Nadu and Gujarat. On the other hand, Uttar Pradesh, Rajasthan, Bihar and Odisha are among the states that performed poorly in the health index.According to the index, among large states, Jharkhand, Jammu & Kashmir and Uttar Pradesh are the top three ranking states in terms of annual incremental performance.Among small states, Mizoram ranked first, followed by Manipur and Goa.Releasing the report, NITI Aayog CEO Amitabh Kant said that NITI Aayog believes that the Health Index will act as a tool to leverage cooperative and competitive federalism, accelerating the pace of achieving health outcomes.Speaking on occasion, NITI Aayog menber Vinod Paul said that absolute and incremental changes in health outcomes, as measured by the Health Index, promotes cross-learning between states, capturing the very spirit of cooperative & competitive federalism.