The fifth annual "County Health Rankings" are out.  

The report by the Robert Wood Johnson Foundation looks at factors such as smoking, employment and physical activity, as well as housing transportation and access to healthy foods.  

Paul Zykofsky with the Local Government Commission in Sacramento says the report emphasizes where people live really has an impact on their health, and that changes made in those communities can improve the lives of their residents.

"We often don't factor that in to the health discussion, but the environments in which people live have significant impact on whether they have access to all the things that make is possible for them to lead healthy lives," Zykofsky said. 

San Joaquin Valley counties once again came in at the bottom and San Francisco counties ranked at and near the top. 

Marin County came in at No.1  followed by Placer County, Santa Clara, San Mateo and Yolo County topping out the top five.  

San Diego came in at number 18, San Francisco at number 22 and Sacramento at number 30.  

Lake County was at the bottom of the list. 

Find out how healthy your county is, here.