**Background:** Large-scale agricultural land acquisitions (LSLAs) are prevalent in Mozambique, but their specific effects on health equity in affected communities since 2020 remain inadequately understood. Documenting these impacts is essential for integrated land and health governance.

**Purpose and objectives:** This study aimed to compare health equity outcomes resulting from LSLAs in three agro-ecological regions of Mozambique from 2021 to 2025. It specifically assessed differential impacts on healthcare access, nutritional status, and environmental health conditions.

**Methodology:** A mixed-methods comparative case study design was used. Data collection included household surveys (n=450), key informant interviews, and focus group discussions in communities affected by LSLAs and matched control communities. Secondary data from district health information systems for the period 2021–2025 were analysed.

**Findings:** The analysis revealed a clear negative equity gradient. Communities near LSLAs reported a 30% higher incidence of household food insecurity compared to control communities. Consistent themes included reduced access to primary healthcare services and an increased prevalence of water-borne diseases. These impacts disproportionately affected women and subsistence farmers.

**Conclusion:** LSLAs in Mozambique have exacerbated health inequities, primarily through livelihood disruption and environmental degradation. The health consequences are not uniform, intensifying vulnerabilities within already marginalised groups.

**Recommendations:** We recommend integrating mandatory health equity impact assessments into land lease approvals. Public health systems in affected districts require strengthening, with targeted programmes to address nutritional deficits and water contamination.

**Key words:** land grabbing, health disparities, social determinants of health, food security, Mozambique, natural resources.

**Contribution statement:** This study provides comparative evidence on the health equity consequences of contemporary LSLAs in Mozambique, offering insights for national land-use policy and regional public health strategy.