The U.S. surgeon general is warning Americans that disrespectful or cutthroat workplaces could be hazardous to their health.

Surgeon General Dr. Vivek Murthy, whose office is more commonly known for warnings about nicotine or COVID-19, said Thursday that long hours, limited autonomy, abusive conduct and low wages can lead to chronic stress. This, in turn, can disrupt sleep, weaken the immune system and trigger a wide range of serious conditions, ranging from heart disease to depression.

The surgeon general’s office has created a 30-page framework for employers on “Mental Health & Well-Being in the Workplace” which outlines such measures as work/life balance; workplace physical and psychological safety; and “building a culture of gratitude and recognition.”

Murthy noted that of the 160 million Americans in the labor force, the average worker spends about half of their waking life at work. The surgeon general said it is in an employer’s best interest to invest in the well-being of their workforce, as it better ensures their organization’s success.

These efforts, the surgeon general said, “will require organizations to rethink how they protect workers from harm, foster a sense of connection among workers, show workers that they matter, make space for their lives outside work and support their growth.”

Eighty-four percent of American workers say there is at least one factor at their place of work that has a negative impact on their health, according to a survey by Mind Share Partners.

The surgeon general’s recommendations come at a time when about half of American workers, dissatisfied with their jobs, are “quiet quitting.” It also comes at a time when people are returning to their offices after 2-1/2 years of COVID lockdowns that caused many to work from home.

On the other hand, millions of workers are expected to remain out of the labor force, according to researchers. Many of them are women, lack a college degree or earn low wages. Some still fear COVID-19 contagion, and others are still part of the Great Resignation that started during the pandemic.

More employers are offering mental health services, and workers increasingly expect this benefit. A survey by the American Psychological Association found 81% of people will be looking for workplaces that support mental health in the future.

“Toxic workplaces are harmful to workers — to their mental health, and, it turns out, to their physical health as well,” Murthy said.