OKLAHOMA CITY — A state-by-state ranking of America’s health puts Oklahoma 43rd in the nation in the wellness of its citizens, and Dr. Terry Cline says that’s good news for a state that was ranked 49th when he took over as state health commissioner in 2009.

The bad news, Cline says, is that Oklahoma is still in the bottom 10 in health rankings nationwide, pulled down by high rates of smoking, obesity and sedentary lifestyles that result in thousands of premature deaths every year.

“You don’t need to be dying in your 50s and 60s. How do you change that norm?” Cline said. “If you’re in the bottom five, even in the bottom 10, that to me is alarming. My goal is to get us out of the bottom 10.”

Cline, a clinical psychologist who serves as Gov. Mary Fallin’s secretary of health and human services, is spearheading the Oklahoma Health Improvement Plan, a blueprint for improving health that encourages Oklahomans to eat better, move more and become tobacco free.

“The good news is those are all things we can influence,” Cline said. “They drive health outcomes.”

The 2012 health rankings were released last month by the United Health Foundation, a non-profit, private foundation dedicated to improving health and health care. Oklahoma’s ranking of 43rd is the second highest in the seven-state region behind Arkansas, ranked 48th, but ahead of all the other bordering states including Texas, ranked 40th, and Colorado, which was ranked 11th — the highest health ranking in the region.

Cline, 54, said improving the state’s health ranking relative to other states is not a competition to see which state will claim the top ranking, which in 2012 went to Vermont.

“But it is a race because our lives depend on it,” said Cline, an Ardmore native who has been involved in public health issues for more than 20 years. “The implications are really serious. It has very serious, dire consequences.”

Cline is a former state secretary of health and commissioner of the state Department of Mental Health and Substance Abuse Services who left those positions in 2006 to become the head of the federal Substance Abuse and Mental Health Services Administration.

Cline took over as state health commissioner after completing work as health attache at the U.S. Embassy in Baghdad, where he advised the U.S. ambassador, the Iraqi minister of health and the U.S. Department of Health and Human Services on health-related challenges in Iraq.

At the top of Cline’s list for improving Oklahomans’ health is reducing their rate of smoking. Oklahoma, which ranked 48th in the nation in the percentage of adult smokers in 2011, was 47th last year. About 26 percent of Oklahomans, or 745,000 adults, still smoke.

“We have to drive down this smoking rate,” Cline said. Oklahoma has experienced a statistical decrease in tobacco use over the last decade, and 2011 was the first year that there were more former smokers in the state than current smokers.

“That’s important,” Cline said. But the state still lags behind the progress experienced by other states and has been well above the national average for smoking for the past 11 years.

Statistics provided by the United Health Foundation show the state ranks high in the number of cancer and cardiovascular deaths, diseases Cline said are linked to smoking. The state averages about 200 cancer deaths per 100,000 residents, but the rate of cardiovascular deaths is an alarming 330 per 100,000 residents — 48th in the nation.

“One in four Oklahomans smoke, and it’s the number one preventable cause of death,” Cline said.

Obesity is another issue that has a negative impact on the state’s overall health. Almost one in three adults in the state, or 888,000 people, is classified as obese and at an increased risk for ill health.

One consequence of obesity is diabetes, which afflicts more than one in nine adults in Oklahoma, or 317,000 people.

“We have an epidemic of children with diabetes,” Cline said. Without reversing the trend, almost an entire generation of Oklahomans will be forced to manage the disease throughout their lives, he said.

Finally, Oklahoma ranked 45th in the nation in the percent of the adult population who live sedentary lifestyles, meaning they get no exercise other than what they experience on the job. About 891,000 Oklahomans are classified as sedentary, an important indicator for future obesity rates.

Cline said Oklahomans are showing progress in improving their health, steps that are reflected in the national health rankings.

“Having that relative ranking of 43rd is very good news. But it’s not advancing as rapidly as it is in other states,” Cline said. “We’re trending in the right direction. But it’s not good enough.”

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