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The U.S. is the largest economy in the world, but performs worse than to be expected in areas such as health and wellness, personal safety, and environmental quality, according to the Social Progress Index, which ranks the U.S. at No. 28 of 163 countries.

The index is based on the concept that societies are successful not just through economic development, but by meeting the needs of the people to improve their quality of life with a healthy environment and the opportunity to reach their full potential.

The index, which also ranks the U.S. states, seeks to define the success of our societies beyond economic indicators. The U.S. states report, published in 2018, compares quality of life in all 50 states, highlighting what life is truly like for ordinary Americans, including issues hidden by changes in the economy.

The researchers at ranked the states based on a composite score that is formed by using a variety of indicators within three categories:

  • Basic human needs includes factors such as food and shelter, water, sanitation, medical care and personal safety.
  • Foundations of wellbeing includes access to education, information and communication, living long and healthy lives, and environmental quality
  • Opportunity includes personal rights, personal freedom and choice, inclusiveness and access to advanced education.

Massachusetts tops the ranking with a score of 64.82/100. The state has some of the nation’s top hospitals and universities, and excels in many areas measured by the index, including nutrition,  basic medical care and advanced education. But Massachusetts still has real problems with homelessness and drug abuse, the report says.

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Based on the Social Progress Index: U.S. States, these are the states that have the highest social progress scores, and includes the areas in which each state scored highest and lowest.