DENVER -- Colorado continues to fall behind when it comes to children's health, with the overall grade for healthy children dropping to a D+ in 2009, according to a report released Thursday.

The 2009 Colorado Health Report Card, released by the Colorado Health Foundation, tracks key indicators of health status at five different life stages. The state earned a grade of C- in 2008.

The most dramatic drop was in childhood obesity, where the state fell from third in the nation to 23rd, according to the Colorado Health Foundation. In addition, Colorado remains in the bottom half of all states in four out of the six key indicators for healthy children. The state ranked 45th for the number of children who do not have health insurance; 38th for children who do not receive routine preventive dental care; and 34th for school-age children who participate in vigorous activity.

"The results of this year’s report make clear that we are failing to meet the basic health needs of Colorado’s children. We can and must do better," said Anne Warhover, president and CEO of the Colorado Health Foundation. "This data should serve as a rallying cry for the people of Colorado and especially the state’s health care community to make changes that will reverse this alarming trend and positively impact the health of our children."

Colorado has gotten high marks on other surveys for healthy lifestyles, but the Report Card indicates that there are several areas where the state is losing ground.

Gov. Bill Ritter said the state has made progress in areas such as providing healthy breakfast programs, providing higher-quality health insurance coverage to more kids and providing a stronger focus on prevention and wellness through diet and exercise.

"But we clearly have much more work to do on behalf of our children," Ritter said. "We must take on this challenge because the cost of doing nothing is far too high."

The Colorado Health Report Card is in its third year of reporting on the health of Coloradans based on 38 key indicators. The 2009 Report Card breaks down the population into five life stages: Healthy Beginnings, Healthy Children, Healthy Adolescents, Healthy Adults and Healthy Aging.

“Now is the time to make positive changes that will improve the lives of our children. Any grade below an A is unacceptable,” said David Livingston, chairman of the Colorado Health Foundation’s Board of Directors. “If we do not take proactive steps to address the indicators where we are lagging behind other states, we run the risk of losing even more ground.”

Click here to read the full 2009 Colorado Health Report Card.