I invited Professor Kuh for an interview so that I could learn more about how she achieved her various academic successes, the route she took to becoming a Professor, and the training and support she received during her career.
This article follows Prof Kuh’s journey. Her academic career began with an economics degree at Cambridge University. Her experiences living in the United States, where she delivered meals on wheels to older people in rural Vermont, and her early research experience studying the needs of adolescents with disabilities greatly contributed to her passion for epidemiology and understanding disparities in lifelong health and health care.
Professor Kuh’s academic journey
What does Professor Kuh do now?
Prof Kuh became director of the NSHD in 2007 and LHA which was established in 2008. As director of the NSHD and LHA, much of Prof Kuh’s time has focused on developing a scientific vision and conceptual framework to maintain core MRC funding and secure additional research funding. This has enabled her to build a strong team of LHA scientists and collaborators focused on new data in NSHD enabling testing of life course hypotheses about musculoskeletal, cardiovascular and mental ageing and wellbeing.
Prof Kuh is serving her tenth and last year as director, and in 2017 will celebrate 30 years working on the NSHD. She is now able to spend less time securing grants and more time writing first-author papers, an opportunity that she is very much enjoying. With the 24th data collection at 68-69 years completed, she has many unanswered questions still to address and a large amount of data to analyse.
An example is an NSHD study she initiated in the 1990s looking at women going through the menopause transition. At that time, she and her colleagues published a number of papers on the lifetime factors associated with onset of natural menopause, hysterectomy and oophorectomy risk, and HRT use. Now, they are investigating how the menopause transition relates to later life ageing phenotypes, such as bone, muscle, cognition, and cardiovascular function.
When asked what she enjoys about research at the moment, Prof Kuh said: “I enjoy the research, I enjoy the strategic overview of the science and I enjoy collaborative team working and bringing on the next generation of scientists”.
Which of your research publications do you think opened doors for you?
“Co-editing the book on life course epidemiology in 1997 with Yoav Ben-Shlomo which helped to advance the field of life course epidemiology and created an international network of collaborators. Our latest review of life course epidemiology is in the International Journal of Epidemiology’s special issue on life course and ageing in August 2016.”
Where did Professor Kuh’s research journey start?
Prof Kuh’s journey started with an economics degree at Cambridge University. After graduating in 1974, she spent a year in the United States and delivered “meals on wheels” to older people.
On her return from the US, she became an operational research scientist at the Institute of Biometry and Community Medicine at Exeter University, where she contributed to what were then ‘big data’ models for allocating health and social care expenditure to different patient groups.
It was during Prof Kuh’s next position, working at the Paediatric Research Unit at Exeter University for Professor Frederick Brimblecombe, that she began to develop her research interests. Prof Kuh gained many skills in this position because of Prof Brimblecombe’s trust in her abilities. He tasked her with running a study that investigated the health and social needs of 400 adolescents with multiple disabilities who had left his care. He was one of the first paediatric consultants in the NHS and developed new integrated models of care for families with children with disabilities. Investigating the life chances of these children, and how best to care for them as they faced the challenges of becoming young adults, prompted Prof Kuh to start thinking within a life course framework.
Through Prof Brimblecombe, Prof Kuh learnt about the British birth cohort studies, and soon after his retirement, was recruited onto the small NSHD team as a research scientist, making the decision to become an epidemiologist.
Her move to London, however, did not come without its challenges. Juggling two children, a husband, an initially unfriendly London environment and commuting between Devon and London made for tough times. It also brought doubts about whether she had made the right decision.
This changed on meeting Professor David Barker, an epidemiologist at the University of Southampton who had exciting theories about chronic diseases and their fetal origins. Prof Kuh contributed to one of Barker’s early papers (Barker et al 1990), which still remains one of her most cited papers. The meeting inspired her to develop her life course ideas and test new hypotheses in her PhD thesis and early publications.
In addition, during this time, Prof Kuh was learning from NSHD director Professor Michael Wadsworth about how to manage a cohort study, maintain the engagement of participants, and work with a growing number of scientists. Among them were George Davey Smith and Yoav Ben-Shlomo, epidemiologists now at the University of Bristol, whom she described as great collaborators and very intellectually stimulating.
Which roles has Professor Kuh enjoyed the most?
Being the director of NSHD and LHA is the role that Prof Kuh has enjoyed most, because it has allowed her to build up a great study team and to put into effect the life course ideas that had been developing in the field.
Interestingly, what I found surprising in interviewing Prof Kuh was that she was not only excited but somewhat shocked after learning she had been offered the role as director of LHA. This was because, at the time, there were not many female directors.
At the end of our interview she added, “Though it’s been my best role, it has also been the most stressful.” Nevertheless, the results have far outweighed any stress caused.
If you were to give me advice on my next steps, what would be your top three tips?
- Seize opportunities when they present themselves. Also, remember that not all opportunities will land on your lap. At times you will need to go and find them.
- Gain experience working with different people on a range of topics, to develop your interests and strengths and build up your collaborative network.
- Your research should be smart. Your conceptual framework and assessment of data quality, rigorous interpretation of your results and their implications for improving health are as important, if not more so, than any sophisticated modelling technique.
Thoughts about the opportunities and career barriers currently faced by Early Career Researchers
Prof Kuh highlighted that the next steps for early career researchers (ECRs) have definitely changed. ECRs are now expected to be part of big collaborations, which can be challenging when dealing with different personalities, and in obtaining recognition for individual scientific contribution – especially when a middle author on multi-authored papers.
In terms of barriers, Prof Kuh said it was important to know how to organise and extract what’s important from the sheer amount of scientific knowledge being created, which can be daunting. Similarly, finding your scientific niche within a greatly expanded field of population sciences can be challenging. Then there will always be a time where you will have to deal with difficult people, often senior scientists. Learning how to overcome such challenges and to “negotiate fairness and roles in team efforts” is a maturing experience.
What did Prof Kuh think could be done to increase opportunities for ECRs?
Working in a team where training and capacity building is valued and encouraged helps, as does the growing number of mentoring schemes. But ultimately we need to increase the number of fellowships, particularly those embedded within team science. The MRC unit for Lifelong Health and Ageing has promoted short research fellowships to give ECRs the time to put together a strong fellowship application – so far the success rate has been 100%! And perhaps “senior scientists need to retire on time to make way for younger people with fresher minds!”
What value do UK cohorts bring to the UK and international research environment?
“They are basically the envy of the world, particularly the cohorts that have the life course data.”
How do you think ECRs could be making better use of cohort data for their research?
“ECRs could make better use of cohort data by taking the time to think conceptually, operationalise the scientific question they wish to address, and gain a deep understanding of the data they use.”
Prof Kuh added, “The ability to model data to death does not make for a great researcher. You also need to consider the bigger picture”.
Do you see any barriers to ECRs accessing cohort data?
“There are few barriers, except where cost recovery has been introduced, as long as the metadata or guidance from primary investigators is of good quality.”
My thoughts as an Early Career Researcher
I have to say that from the hour I spent sitting with Professor Kuh, I was certainly left inspired.
I am someone much like others; I have the undergraduate and master’s degree and I’ve also gained many skills while working in a research environment. In the last year, I have found myself at a crossroads trying to decide what I want to do next to further my career. How best could I use the skills I’ve learnt theoretically and practically, and use them to further my educational background? Or, if there was even a chance to do anything at all. Prior to meeting Prof Kuh, I was somewhat hesitant about the idea of doing a PhD, mainly because I know it is a challenging task, but also wondering if I would be able to juggle work and a PhD programme at the same time. After hearing about Prof Kuh’s 5am wake up time, so that she could do some PhD work before having to wake the children to get them ready for school, then commuting to work, doing a PhD while working seemed much less daunting.
Perhaps the fact that Prof Kuh is a woman played a part in this, but I left feeling very encouraged. She kindly offered me some words of wisdom and got me thinking about how best I could combine my research interests with the research studies I currently work on.
Who knows what will happen, but I will certainly be exploring a career path in which I can continue to conduct clinical trials while maybe doing a PhD alongside.
Professor Diana Kuh is director of the MRC Unit for Lifelong Health and Ageing (LHA) at University College London and of the MRC National Survey of Health and Development (NSHD). The NSHD, which is the oldest British birth cohort study, has followed more than 5,000 individuals since their birth in March 1946. Under Prof Kuh’s leadership, the study has developed into an integrated and interdisciplinary life course study of ageing.
Norah Epie is a study co-ordinator based at the Institute of Neurology, University College London (UCL) and is a member of Professor Rossor’s familial disease cohort discovery team (work package five). She has a bachelor’s degree in Biomedical Science from Keele University and a master’s degree in Public Health and Health Services Research from Newcastle University. Norah began her clinical trials career in 2014 where she worked at the Biomedical Research Unit at Southampton General Hospital working on Phase I & II interventional clinical trials. She later worked in stroke and haematology research before joining UCL to work in the world of dementia.
Norah Epie first came across Professor Kuh while helping coordinate Insight 46, a clinical sub study of the MRC NSHD. Insight 46, aspects of which form DPUK’s amyloid discovery cohort (work package four, which involves the recruitment of 500 members of the NSHD cohort, who attend for serial amyloid PET and MRI brain scanning, neuropsychological testing, genetics and biomarker collection). The overarching aims are to discover the genetic and life course influences on the development of Alzheimer’s pathology, neurodegeneration and cognitive decline; explore the earliest biomarker and imaging changes in Alzheimer’s disease; validate sensitive measures of disease progression; and use these data to optimise trial design for clinical trials aiming to prevent Alzheimer’s disease. For DPUK’s work package four, this cohort will provide a means of trying to use MRI and blood tests to determine which individuals may have evidence of preclinical Alzheimer’s disease, i.e. brain amyloid accumulation.