(Des Moines) -- As Iowa works to become the healthiest state in the nation, a study finds Iowa has lost some ground in that effort.

A report called “America’s Health Rankings” by the United Health Foundation ranks Iowa the 18th healthiest state in the U.S., down one position from 17th last year. Foundation spokeswoman Dr. Rhonda Randall says the 24th annual study is based on 27 measures in four key health categories.