The number of adults and children who get sick and die before their time is rising in Louisiana, that's according to the American's Health Ranking report, gathered each year by the United Health Foundation.

The report spells out some health changes that doctors say people in Louisiana need to make now.

Once again, the news is not good. When it comes to the health of Louisiana citizens, the state ranks dead last. Local doctors say the reason we keep switching places with Mississippi for the bottom two slots is not related to Hurricane Katrina.

"Over the past 15 to 20 years we've been 50th much more frequently than we've been 49th," says Dr. Elizabeth Fontham, dean of LSU Health Sciences Center's School of Public Health. 

Three of the state's biggest problems mirror America's overall problems. The first is smoking.

"Too many Americans are smoking tobacco.  We still find 20 percent of the American people smoking cigarettes, the number one preventable risk factor for death and disease in our country," says Dr. Reed Tuckson of the United Health Foundation.

"An example of that goes way back to the Virginia Slims-era -- we have a whole cohort of young women who were born between 1950 and 1960 were targeted during their teenage years and it's a group of adult women now who are really hooked," adds Dr. Fontham. 

The next problem is obesity.

"Twenty-six percent of our population is obese and that number increases year over year over year. We simply understand the health consequences of that are catastrophic," adds Dr. Tuckson.

"The prevalence of obesity in Louisiana has increased since 1990 by 150 percent. That's huge," says Dr. Fontham. 

And another top problem is access to health care.

"Forty-six million Americans are uninsured and that has grave consequences for the promotion of health and the inability to manage disease once it becomes apparent," says Dr. Tuckson. 

So what is so broken here? 

"Poverty, education and economics are intimately tied into health care, health care access, and we have a very large proportion of our population living at or below the poverty line who are uninsured," says Dr. Fontham. 

And when it comes to education the survey finds that the number of Louisiana teens expected to graduate from high school is dropping, down to less than 64 percent, continuing the cycle of poverty and the high number of people who die young from preventable illness, such as heart disease.

 On a positive note, the survey found that there was an increase in the number of primary care doctors.

Also, the state is spending a lot more money on public health, needed for the state's sicker population and to prevent future illness in the children growing up today.

For a complete look at the survey state by state go to links on 4.