Mathematics is central in school curricula around the world, yet outcomes are mixed at best. This is true both in relation to attitudes expressed towards mathematics, and in relation to observed assessment outcomes, showing how poorly individuals are prepared to use mathematics in a world in which the ability to do so is of increasing importance. Why? This essay uses some mathematics outcomes from the Programme for International Student Assessment (PISA) 2012 to seek explanations and possible ways forward. The main message is that negative outcomes of school mathematics arise for a variety of reasons, and they can be reversed through deliberate and concerted action.