The overall health of Georgians, already considered among the nation’s worst, has slipped further, according to an annual ranking by the United Health Foundation released Wednesday.

The foundation’s latest survey ranked Georgia No. 41 out of the 50 states. Last year, Georgia ranked No. 40.

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The report cited several health challenges in Georgia, including high levels of pollution and a high rate of infectious disease (estimated at 30 cases per 100,000 people). And during the past 20 years, the percentage of obese Georgians has ballooned from 11 percent to 29 percent of the population, according to the study.

On the bright side, Georgia has a low prevalence of binge drinking and high levels of immunization coverage, with 81 percent of children ages 19 to 35 months receiving complete immunizations, according to the report.

Georgia is not alone in its health challenges, the nonprofit foundation said. It offered some tough words for the entire nation, which it says is facing rising obesity rates and an uptick in the number of people without health insurance.

“Our collective national failure to successfully address the determinants of health over the past several years is tragically documented in this year’s report,” Dr. Reed Tuckson, a United Health Foundation board member, said in a press release. “Without action in these severe economic times, the harsh findings of this report will only be worse next year for our nation, states, communities, families, and individuals.”