Though Colorado has received loads of kudos for its year-round recreational possibilities and relatively low obesity rate, we’re not the healthiest state in the country. That honor, for the fourth consecutive year, belongs to Vermont. Colorado, which in 2009 was number eight on the American’s Health Rankings list, has fallen to number 13 this year (via The Associated Press). Released by the United Health Foundation, the American Public Health Association, and the Partnership for Prevention, the rankings take into account the state’s low immunization rate (48th in the nation) and the high rate of binge drinking (30th in the nation).

“Overall, the rankings indicated that Colorado may be set to fall even more, because the state currently ranks worse in health determinants than it does in health outcomes,” the report states. Another problem is geographic disparity, points out Fox 21 in Colorado Springs. And challenges like a high rate of uninsured people—15.6 percent—also contribute to making the state less healthy, according to a statement.