Despite an increasing drug death rate and high levels of air pollution, Pennsylvania kept the same ranking for the third year in the row in United Health Foundation’s 2019 America Health Rankings.

Pennsylvania is reportedly in the middle of the pack when it comes to the health of its women and children, with the state seeing a low percentage of uninsured women and substance use disorder among teens but an increase in drug death rates among women and teen suicide over the last year.

Food insecurity and mental distress among Pennsylvania seniors rose over the last year even though most of its older residents regularly see health care providers and many take advantage of federal nutrition assistance, according to an annual report by the United Health Foundation.