these communities leads to the continuation of their troubles. Pricing and affordability The median household in the U.S. spent about 1.1% of its income on water and sewerage in 2002. However, poor households face a different situation: In 1997 18% of U.S. households, many of them poor, paid more than 4% of their income on their water and sewer bill. The mean U.S. water tariff – excluding sewer tariffs – was $2.72 per 1,000 gallons ($0.72 per cubic meter) in 2000, with significant variations between localities. Average residential water tariffs for a monthly consumption of 15 cubic meters varied between $0.35 per cubic meter in Chicago and $3.01 in Atlanta in 2007. The combined water and sewer tariff was $0.64 in Chicago and $3.01 in Atlanta, with Atlanta not charging separately for sewer services. Annual combined water and sewer bills vary between $228 in Chicago and $1,476 in Atlanta in 2008. For purposes of comparison, the average water and sewer bill in England and Wales in 2008 was equivalent to $466. The average annual increase in typical residential water bills was approximately 5.3 percent from 2001 through 2009, while the increase in typical residential sewer bills was approximately 5.5 percent according to data from the 50 Largest Cities Water and Wastewater Rate Survey by Black & Veatch. Retiring workforce The water community in the US is faced with a swiftly retiring workforce and a tightening market place for new workers. In 2008, approximately one third of executives and managers were expected to retire in the following five years. Water and sanitation utilities in the United States had 41,922 employees in 2002. Fluoridation Water fluoridation, the controlled addition of moderate concentrations of fluoride to a public water supply to reduce tooth decay, is used for about two-thirds of the U.S. population on public water systems. Almost all major public health and dental organizations support water fluoridation, or consider it safe. Nevertheless, it is contentious for ethical, safety, and efficacy reasons. Responses to address issues Supply-side management Historically the predominant response to increasing water demand in the U.S. has been to tap into ever more distant sources of conventional water supply, in particular rivers. Because of environmental concerns and limitations in the availability of water resources, including droughts that may be due to climate change, this approach now is in many cases not feasible any more. Still, supply-side management is often being