Rapidly rising obesity rates and continued tobacco use among North Carolinians are two of the state's most significant health challenges, according to the latest issue of America's Health Rankings.

The report profiles all 50 states in a variety of health measures. North Carolina is now ranked 32nd in the nation for overall health, up from 35th last year and from 37th in 2008.

"While any improvement is encouraging, we still have a long way to go to improve the health of all North Carolinians," Gov. Bev Perdue said in a news release. "Now is not the time to cut critical funding to health care and prevention among the most vulnerable members of our communities."

North Carolina was recognized for progress in reducing smoking rates among adults over the past decade; however, the report also points out more than 1.4 million adults still smoke in the state.

"The passage of the smoke-free bars and restaurants law was a tremendous milestone for public health in North Carolina," state Health Director Jeff Engel said. "Not only has it improved the health of restaurant workers by not exposing them to secondhand smoke, but also is expected to save an estimated $4.7 million per year in avoidable medical care costs for hospitality workers.

"We already have seen a 21 percent decrease in heart attacks associated with implementation of the law, which was implemented and enforced by state and local public health agencies using no new resources. Through policy change, we have seen and will continue to see real results in improved health."

The smoke-free legislation also has been a catalyst for local municipalities to enact smoke-free ordinances.

In a 2010 state survey, 81 of 100 county governments and more than 200 city/town governments reported they have implemented 100 percent smoke-free or tobacco-free buildings. North Carolina also has 100 percent tobacco-free campus policies in all public schools, all hospitals, all prisons and half of its community colleges. State-operated mental health and substance abuse treatment facilities are working toward 100 percent tobacco-free policies as well.

The Health Rankings report notes that North Carolina's rising obesity rates are mirrored in increased diabetes rates, with an estimated 711,000 adults with diabetes in the state. While state efforts include a strong emphasis on chronic disease management to keep people with diabetes healthy, the N.C. Division of Public Health also is working in numerous communities to prevent obesity and type 2 diabetes by promoting healthy eating and physical activity.

"Through activities like Corner Store Initiatives to offer healthier foods and drinks for the people who shop there, to making communities more walkable and bike-able, we are focusing on sustainable lifestyle changes," Engel said. "But it is only through continued investment at the local, state and national level in prevention efforts like these that we will see our overall health ranking improve."