This chapter examines the opportunities available to a range of professions that directly or indirectly influence urban settings, to achieve Vision Zero safety outcomes. Starting with how we want our urban areas to be, the chapter examines options to eliminate the systemic risk of deaths and serious injuries on urban roads from three separate but related viewpoints; managing the threats to life and health posed by the energy embedded within the road transport system, the potential for crashes to occur and the exposure of those who use the system to severe injury risk from crashes. In urban settings, it is sometimes possible to eliminate or minimize vehicular traffic on selected roads and streets but, in general, it is either impractical or undesirable to do so. By physically separating vehicles from other vehicles, and from highly vulnerable road users, we risk creating the types of cities and towns that do not support our high level aspirations of highly liveable and healthy societies, with sustainable and equitable urban transport systems. Where physical separation is not viable, it becomes necessary to manage transport system energy to ensure risk remains below the levels we set for Vision Zero outcomes – no one being killed or seriously injured. The main focus of this chapter therefore is on the means by which we can manage kinetic energy, primarily through compatible combinations of infrastructure design and speed limit setting, to protect all who use urban roads. Vehicle technology and structural design are important considerations for system performance as a whole.