While progress in oncology has been remarkable in recent decades, not every cancer patient is benefitting from the advances made in treating their disease. The contrast in diagnosis, treatment and its outcome between high-resource and low-resource countries is dramatic. Africa presents an enormous challenge with population growth and life expectancy increasing in many countries as the toll of AIDS and other communicable diseases declines. However, there has been little investment in capacity of any sort to deal with the current cancer problem, never mind the rapid increase in incidence which is underway. This is a critical area for investment and not only of a purely financial nature. It is bad to have cancer and worse to have cancer if you are poor. The gap between rich and poor, highly educated and less educated and the North–South divide is substantial and continuing to grow. Radical solutions are urgently needed: the status quo is not an appropriate response to the current situation. Recognising that no single government or source of philanthropy has the means to solve this problem, new models are needed to cope with and improve this situation.