‘Worst health systems in the country’: Who are the worst in the nation?

Health systems in every state and the District of Columbia are among the worst performing in the United States, according to a report released Wednesday by the advocacy group Families USA.

The report, “America’s Healthiest States, 2016,” ranked health systems across the country based on data from more than 1,400 public health systems nationwide.

The report ranks the best and worst states based on a “score” that considers a range of factors including quality of life and the impact of a specific disease on health systems.

States ranked on the list include Alaska, Arizona, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming and Puerto Rico.

The five states that made the top 10 are Alaska, Texas and California, which together accounted for 19.4% of the total.

The rankings include states where the average annual income was above $75,000, the highest score in the report.

The average annual household income was $54,500, the lowest score in this year’s report.

The other states ranked below the average were Alaska, California and Hawaii.