This is not the kind of report card you would want to show your parents.

Indiana ranks only 39th among all states for health, just a slight improvement from 41st place a year ago.

The health challenges ahead for the Hoosier state are formidable, according to the United Health Foundation’s 2016 annual report.

A raft of unhealthy behaviors and complications, from smoking and drug abuse to obesity and cardiovascular problems, is costing Hoosiers years from their lives and taxpayers untold dollars in lost productivity and health care costs.

First the good news. The report calls out several strengths in Indiana, including its high percentage of high school graduates, low incidences of salmonella, and a small disparity in health status by educational attainment.

In the past three years, preventable hospitalizations have fallen 25 percent from 76 to 57 discharges per 1,000 enrollees. In the past year, disparity in health status by education decreased 17 percent.

But Indiana still lags the nation in healthy behaviors across many areas. That includes 20.6 percent of Hoosier adults who smoke (compared with 17.5 nationally), 31.3 percent who are obese (compared to 29.8 percent nationally), 10.8 percent who lack health insurance (compared to 10.6 nationally), 16.7 drug deaths per 100,000 population (compared with 14.0 nationally), and 277.1 cardiovascular deaths per 100,000 population (compared to 251.7 nationally).

That all adds up to a huge loss of life: 8,208 years of life lost before age 75 per 100,000 population (compared to 7,054 nationally).

Some of the biggest challenges facing Indiana: a high level of air pollution, a high infant mortality rate and rising drug deaths. In the past five years, drug deaths in Indiana have increased 27 percent.

At a glance, Indiana is in the bottom quarter of states by health, but is not at the bottom rung. That distinction belongs to Mississippi, which dropped from 49th to 50th this year, replacing Louisiana (now 49th). Other low scoring states are Arkansas (48th), Alabama (47th) and Oklahoma (46th).

Hawaii ranks as the healthiest state in 2016 for the fifth straight year, followed by Massachusetts (2nd), Connecticut (3rd), Minnesota (4th) and Vermont (5th).

For 27 years, America’s Health Rankings annual report has benchmarked health behaviors and trends across the country and compared each state’s progress.