Hawaii is routinely deemed among the healthiest states not solely by circumstance but also due to careful public policies that require continual reinforcement, lest the islands’ natural advantages give way to woes that plague other states.

Hawaii has never ranked lower than sixth in the 25 years the Minnesota-based United Health Foundation has issued America’s Health Rankings, and this year repeats at No. 1. With that track record, it is easy to grow complacent.

That would be a mistake, however, because embedded among the report’s many highlights were continuing challenges and some surprising declines that require renewed attention.

Standing out among the areas of concern were the relatively high incidence of infectious diseases and the reported plunge in the immunization rate among toddlers. In the 2013 report, 80.2 percent of children in Hawaii ages 19 months to 35 months were counted as up-to-date on their vaccinations. This year’s report puts the rate at 66.5 percent, a decline that sent Hawaii’s ranking in the category from first to 40th.

Hawaii Department of Health officials say they cannot explain the reported decline, especially since they do not know the details of the methodology used or the data collected. Overall, America’s Health Rankings 2014 relies on data from the Centers for Disease Control and Prevention, American Medical Association, the Census Bureau and other trusted sources.

Although perplexed, the health officials did not refute the finding outright, because they know that numerous challenges persist in ensuring that youngsters are vaccinated and outbreaks of preventable childhood diseases are thwarted, not the least of which is declining federal resources toward that vital effort.

Dr. Sarah Park, chief of the Disease Outbreak Control Division of the state Department of Health, emphasized that "low immunization rates in our communities put families at risk, as demonstrated by the recent measles outbreaks. With continued annual cuts in federal funds, it is vital to ensure that current immunization services and programs are adequately and appropriately resourced to be able to reach our most vulnerable individuals."

Attaining federal funding for these efforts should be a high priority for the department, and if those efforts fall short the state government must contribute. Childhood immunization programs are a vital public health effort that should not be allowed to falter.

One crucial element provided by the Department of Health is the Hawaii Immunization Registry, which stores patient immunization records provided by pediatricians, insurance companies and other health care providers. This tool, which depends on widespread adoption of electronic medical records to be fully functional, could be used to identify areas where large numbers of children have not been vaccinated and prioritize resources to reach those families. Health information already being collected by individual doctors and insurance companies serves the public good as part of a larger data set.

Public-information campaigns must be part of the effort, too, tailored for a generation of parents that has grown up largely free of the scourge of polio, measles, mumps and other once-common childhood diseases and therefore may not fully appreciate the potential risk to their own children, and to the broader community, when immunization rates fall.

Amid all the good news about Hawaii’s overall health status, it’s important to recognize the weaknesses, too, and act now to prevent further declines.