Rising obesity rates and the number of people without health insurance are placing a drag on health gains for the American population, according to the results of a survey released Monday.

The national health “report card,” which has published a national report card on health each year since 1990, found continuing improvements in several key areas, including fewer deaths from violent crime, infectious diseases and car accidents. But the improvements have been largely offset in the last few years by a relentless rise in obesity and other factors.

Dr. Reed Tuckson, vice president of the American Health Foundation, said that he was also “distressed” by evidence that the US child mortality rate increased slightly between 2003 and 2004, the first uptick in 40 years. The United States now has an infant mortality rate of 7 deaths per 1000 live births, putting it behind 27 other nations.

The annual report evaluates all 50 states on 18 different measures. Some, like smoking rates, infant mortality, and infectious disease deaths, are direct indicators of the health of the population. Others, including insurance rates and education levels, are indirect indicators that have been shown to be associated with well-being.

The report pulls together data from a variety of sources, including the Centers for Disease Control and Prevention and the US Census Bureau.

Overall health scores for the 50 states improved by an average of 1.5 percent per year between 1990 and 2000. But those improvements have dwindled to just a 0.2 percent annual improvement in the last 4 years.

“Our improvement overall has definitely slowed down,” said Dr. George Benjamin, executive director of the American Public Health Association, one of three non-profit groups releasing the report.

Benjamin said that the 23 percent adult obesity rate - double what it was in 1990 - appears to be slowing progress in other areas.

In addition, 45 million Americans continue to lack health insurance, which is associated with poorer health outcomes, especially for minorities.

“The obesity epidemic clearly is the major component of what we’re seeing,” he said.

Meanwhile, the report blames rising rates of poverty, obesity, and stagnant smoking rates as contributors to the increase in child mortality rates.

State rankings placed Minnesota, Vermont, and New Hampshire at the top of the list for best overall health conditions. Mississippi remained in last place, unchanged from 2003. All but two states in the top 10, Hawaii and Utah, were northern states, while all but two at the bottom, West Virginia and Oklahoma, are in the Southeast.

Those southern states tend to have the highest rates of poverty, high rates of obesity, and lower levels of education. In addition, persistent disparities in health indicators for minority persons tend to have the most effect in those states.

“We know that one of the most important determinants of health is whether or not someone graduated from high school,” said Jonathan Fielding, director of public health for Los Angeles County and Chairman of the Board of the non-profit group Partnership for Prevention.

Alaska’s public health care spending led the nation, with $716 per capita. Such spending has increased drastically in most states due to terrorism preparedness efforts in the wake of the September 11, 2001 attacks.

The spending does not necessarily reflect improved public health since much of the money is directed toward anti-bioterror and other security measures, Tuckson said.