A/HRC/32/32 such as national wealth, income inequality, gender systems and access to education.21 Additional determinants include social norms, laws and policies and the physical environment, as well as the online social media environment, which plays an increasingly influential role in adolescents‘ lives. 36. States must take legal, policy and other measures to address the underlying and social determinants of adolescent health, including: road and environmental safety; racial prejudice; access to education; persistence of forced and early marriage; corporal punishment; social, economic, political, cultural and legal barriers to health services, including sexual and reproductive health services; inadequate social protection; institutionalization; punitive drug laws; absence of comprehensive sexuality education; criminalization of exposure, non-disclosure of HIV status and transmission of HIV; criminalization of same-sex relationships; and lax legal frameworks governing the sale of tobacco, alcohol and fast foods. 37. Measures to address the right to health should be holistic and integrated, go beyond the provision of health services and be underpinned by cross-departmental commitment. States should take account of and respond to the particular challenges faced by different groups, such as younger and older adolescents, males, females and lesbian, gay, bisexual, transgender and intersex persons. Right to protection from all forms of violence 38. Exposure to violence increases during adolescence, to the point that it is a primary cause of mortality and morbidity in the second decade.22 Violence occurs in the family, in the community, at work or at the hands of State actors. 39. Adolescent girls, adolescents with disabilities, lesbian, gay, bisexual, transgender and intersex adolescents, adolescents living in institutions and adolescents from communities with a proliferation of unregulated weapons or experiencing armed conflict are among those particularly vulnerable to violence. The risks for girls include, for example, exposure to sexual violence and exploitation, forced and early marriage, honour killings and abusive practices often carried out in health-care settings, such as forced sterilization and forced abortion for girls with disabilities, and forced virginity testing. 23 40. Violence in intimate relationships among adolescents is also common, resulting in both immediate and potential long-term consequences for their physical, mental and social health. In addition to its immediate health consequences, the trauma of violence perpetrated by an intimate partner can lead to long-term physical injuries, to both immediate and delayed-onset health problems and to experiences of repeated revictimization. 24 41. Lesbian, bisexual and transgender youth are at risk of “punitive” rape on the basis of their sexual orientation or gender identity. Adolescents suffer disproportionately from the effects of gun violence and significant numbers of adolescents face serious harm or death as a consequence of armed conflict. 42. The focus in the Sustainable Development Goals on tackling violence against women and girls is welcome. However, significant levels of violence are also experienced 21 22 23 24 R.M. Viner and others, “Adolescence and the social determinants of health”. WHO, Health for the World’s Adolescents. See joint general recommendation No. 31 of the Committee on the Elimination of Discrimination against Women/general comment No. 18 of the Committee on the Rights of the Child on harmful practices. C.C. Pallitto and V. Murillo, “Childhood abuse as a risk factor for adolescent pregnancy in El Salvador”, Journal of Adolescent Health, vol. 42, No. 6 (2008), pp. 580-586. 9