Background: States are often ranked on a range of different indicators. In this study, states were ranked for each of the leading actual causes of death. Purpose: This study ranks states on how hazardous they are to the health of the citizenry in terms of the actual causes of death as identified in the seminal article by McGinnis and Foege. and later updated by Pilar et al. Methods: We ranked states for actual cause of death using multiple data sources. We also calculated an overall state ranking across all actual causes of death using the percent weightings attributable to each actual cause from the Pilar et al. study. States were ranked based on their overall score. Results: Significant differences were noted in actual cause ranking both within and across states. A different profile was found for the top and lowest ten ranking states. Discussion: Results suggest a comprehensive approach grounded in the socio-ecological model combining health promotion/education and health policy to affect change. Translation to Health Education Practice: Health professionals may use these rankings to determine methods for improving health services, programs, and behaviors in their communities.